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Devoted to Broker Success- Differentiate

  • ACA Marketplace Problems
  • Cost Modeling
  • Healthcare Consumption Audit

ACA Marketplace Problems

imagePresentation identifies the cost drivers, by design, that drive fully insured group health insurance premiums. Our business is conducted to a Fiduciary Standard and all service is classified as “concierge.”

Our focus is on the ERISA Self-Insured market, beginning at 25 covered employee lives in some markets. We are experts in crafting benefits to match employer’s culture; all alternative funding concepts, Direct Primary Care Networks, Networks, and Reference Based Pricing integration. We have all the “Next Generation” administration, services and products. 80% of group health solutions are now self-insured! The number is increasing.

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Cost Modeling

imageCost Modeling - Self-insured employers with 50+ employees on their plan: Claim repricing and vendor vetting for replacing vendors with 100% transparency and business to a Fiduciary Standard. Implementing “Best in Class” vendors reduces spending up to 25% and improves Benefit Satisfaction. Data mine 24 months of Healthcare and Rx Claims. Reprice all consumed healthcare. This will illustrate any overcharging in your current claim adjudication process. Checking your PBM’s charges per script written will expose excess profiteering. Check your benefit vendors for accuracy and integrity. Recommend new vendors when needed for claim adjudication, network, administration, and Pharmacy Benefit Management. Recommended vendors are 100% Transparent & do business to a Fiduciary Standard which will increase benefit satisfaction and reduce benefit cost.

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Healthcare Consumption Audit

imageIs there a new simpler approach to Health Plan Financial Analysis or Healthcare Consumption Audit?

I believe so.

Scott Hettesheimer has 43 years of experience as a consultant and strategist helping employers evaluate and select health benefit plan service providers. This discussion is intended to illustrate the complexity wrapped in "Healthcare Business As Usual."

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1RatedLevel
Group Agent Resources
Sell Level Funded Health Plans that return 100% of unspent claims funding to employers.

Sell No-Network every provider is in and Transparent Pharmacy delivered from a fiduciary standard.

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1time and money
Brokers

Support with a Full Array of Self Insured & Cost Containment Solutions

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greyarrowsandgreen
Winning Employer Presentation

Best Practices in Designing Your Benefits Portfolio

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1cellblocks
Unique
Differentiate & Be the Superior Healthcare Consulting Firm.

"The End of Healthcare Business as Usual."

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Pass-Through Rx

Most PBM partnerships are fraught with conflicts of interest, the plan is misdirected and the goals of the employer and PBM are out of alignment.

PBMs often keep hidden revenue streams that should be returned to the plan sponsor and intentionally make it difficult to see how they are really making their money.

Traditional PBMs try to sell value through low administrative fees, high pharmacy discounts, low dispensing fees and artificially inflated rebate payments. But additional pharmacy discounts, hidden markup or "spread" pricing, rebate earnings, and other pharmaceutical incentives may not be completely disclosed; leaving you guessing as to the real cost of your plan.

Our transparent pass-through model focuses on helping clients understand the industry and manage drug spending. The complexity of the traditional model vanishes and a productive partnership is the new result.

 

Bottom line - "Next Generation" Pass-Through PBM can create up to 20% reductions in your pharmacy spend.