Health Benefits Administration and Consulting

We bring all of our skills and technology to bear to help employers optimize their self-funded health plans. Our capabilities span design, consultation, and administration, optimized by predictive analytics, compliance support, advanced care coordination, and specific expertise in self-funding.  

Thoroughness Counts

We explore every angle. For example, because of the significant impact of prescription drugs on costs and outcomes, we have managed care pharmacists on staff to review the Rx plan, consult with prescribing providers, and support members with adherence to their medications. We establish opportunities and address them, whether direct cost, member satisfaction, or short/long term health and wellness.

What Makes Us Different?

  • Plan design and administrative protocols that consider clinical trends and patient needs as well as claims
  • A web-based self-service portal that's especially easy to navigate and can be customized to reflect specific client needs
  • Preparedness in supporting responsibilities of the plan sponsor for compliance to changing regulations
  • Connection, shared knowledge, and strategies between trainers, claims leaders, and quality assurance specialists that eliminate gaps regarding process and plan changes
  • Constituent support structure including call center representatives and web-based self-service tools along with a dedicated client service coordinator
  • Advanced care coordination that features seamless integration with claims, analytics, and the patient care team
  • Claims analysts, technicians, and compliance specialists with in-depth experience with self-funded plans
  • Reporting (enrollment, financial, and monthly, quarterly, and annual utilization) that includes analysis, interpretation, and acting on findings

Our Services Include:

  • Claims adjudication and network integration

  • Eligibility intake, maintenance, and coordination of benefits

  • Pharmacy benefit management integration and Rx plan/PBM activity oversight by a pharmacist

  • Disbursements and member and provider benefit reporting

  • Plan utilization management, member care management, and condition support clinical coaching

  • Management of banking and funds transfer

  • Stop loss filings and related services

  • COBRA and CDHP administration

  • Consolidated billing, member communication, and ID card design and deployment

  • Utilization management, care management, and condition support clinical coaching

Using our proprietary analytics, we uncover opportunities for health plan modification and integrated care management. Insights and solutions might include:

  • Chronic condition incidence and identifying high-risk members
  • Analyzing utilization patterns for efficiency (for example, rerouting frequent emergency department utilizers)
  • Cost drivers (avoiding minor inpatient admissions)
  • Identifying and closing gaps in care
  • Streamlining care by connecting employees with primary care physicians
  • Creating a match to the optimal specialist for a specified health condition
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“We use empirical evidence and real experience along with predictive analytics to support decisions that balance cost with the health and satisfaction of employees.”

Stacey Asbell, FAHM, FSIL, CIOP, CHC, MCMC, Vice President, Operations & Health Plan Management

Interested in learning more?