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Advanced Benefit Design Institute

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The New Standard in Benefit Consulting

Employers need advanced analytics to identify their root causes in increasing healthcare costs. Our software platforms accurately identify all of the cost drivers throughout your covered membership. We truly reduce the frequency and size of claims.

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Fully Insured vs. Self Insured Analytics

(a) Better negotiate your fully insured renewals

(b) Make available alternative funding options with highly effective risk management tactics to reclaim control of your company’s healthcare spend.

(C) Where are you now?

(d) Where do you want to be?

(e) How soon do you want to get there?

(f) How much disruption are you willing to endure?

Self Insured Plans Inherently Do Not Reduce Claim Costs

There’s the fact, for example, that self-insured health plans, in the main, control costs no better than fully insured health plans. Most of us, industry insiders included, have simply assumed that the opposite is true. On the face of it, self-insured plans have every advantage, an argument health benefit consultant enthusiastically embrace when urging their employer clients to move to self-funding. Plan sponsors can avoid the costs of state-mandated benefits. They can define their benefit designs and, to a large extent, designate which providers their enrollees will use, and which vendors will manage complex processes.

Healthcare Claims Data Drives Decisions

Problem solving at the root cause. Custom Crafted Benefits promoting your culture. Effective incentive development to change behavior and drive steerage.

The answers to where your money is going will anger you. If we are going to have a serious debate about healthcare cost, you need to understand current healthcare delivery and partner with us to implement effective processes that reduce the frequency and size of your healthcare utilization.

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Fiduciary & Specialty PBMs

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Direct Primary Care

Pharmacy Benefit Managers

100% Transparent, 100% Pass-Through, Fiduciary PBM's. What is significant about this terminology? Our PBM and specialty programs are designed to provide affordable meds for your employees, which means not only will they have access to the drugs, but they will also be more likely to follow their prescribed doses. We provide employee outreach, a proactive approach, ongoing monitoring and identification of savings opportunities, and prescription advocacy.

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#1 Next Generation DPC

Focus on Superior Individual Healthcare, Preventative and Proactive Medical Management, Better Access Through Technology, Labs & Prescriptions at Significant Savings, Effectively Manage Employee Healthcare, A HealthPlan to Recruit and Retain, and Eliminate Fee for Service Model. Advanced Telemedice Patient Access Terminal Available. Access Terminals can be placed on Site to improve access to care. The terminal is used to provide a virtual visit that includes an actual Physical Exam!

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Healthcare Supply Chain Management

Our consulting suite is the most comprehensive software/technology available in the country.

Legacy Carriers and Brokers fall short of our expectations, not because they cannot work, but because they are conflicted, poorly operationalized, or flawed in some other way.

 

Only the Best of the Best in Healthcare Analytical Packages

Model out changes to:

  • Deductible on the plan design
  • Size of group and geographical area - Mergers & Acquisitions
  • Network discounts- Negotiated higher discounts for the upcoming year
  • Reference based pricing – Network change or offering
  • Compare self-funded structures – Cost analysis
  • Risk/Reward - Move from fully insured to self funded
  • Optimize member deductible and premium contribution to  members Healthcare consumption
  • Optimize specific and aggregate limits to premium costs
  • Calculate projected Healthcare claim cost savings generated by DPC, by percent of engagement 
  • Project savings in name-brand drug and specialty drug categories

Additional benefits to your clients:

  • Projected enrollment for the new year with the proposed plan
  • Experience analysis based on the clients claims history; Self-Insured plans and Fully-Insured plans without carrier provided Healthcare data
  • Informed discussions & negotiations with insurance companies
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