“You can’t manage what you don’t measure.”
—Author unknown

It may be cliché, but these often-used quotes perfectly describe the focus of our Health Care and Benefit Analytics (HCBA) operating unit. Whether it is medical and prescription claims data or clinical service utilization metrics, our HCBA unit continually monitors your plan performance.

That said – let’s remember data is just data. The data must be translated into understandable and actionable information. We believe to do this properly it requires different thinking. The HCBA operating unit is therefore the backbone of all our consulting activities.

We have all seen reams and reams of reporting from health insurance carriers. How many times have you felt that the information was put together in a way that assisted your decision making and action plans?

We fix all that. We first translate the health carrier data into our proprietary analytical models. Then we extract all useful information and consulting observations that provide the root connections to the real problems you are facing. The process of better thinking applied to detailed data creates better outcomes for both the company and its employees. Here is a sampling of better outcomes we produce:

  • Accurately forecasted carrier renewals and self-funded budgets well in advance of typical renewal planning schedules
  • Successful negotiated fully-insured and reinsurance renewals based on carrier- recognized underwriting observations contained in our proprietary reports
  • Accurately forecasted self-funded claims impact from plan design changes
  • Well-founded decisions to move from fully-insured to self-funded and vice versa.
  • Appropriate cost-sharing strategies between employer and employee
  • Cost-reducing pharmaceutical carve-out arrangements.
  • PPACA-driven strategies for cost reduction

The “pay-or-play” provisions under the Affordable Care Act (ACA) became effective as of January 1, 2015. Officially referred to as the “employer shared responsibility” provisions, they represent a cornerstone of the ACA and are among the provisions that have most concerned employers throughout the multi-year rollout of the health care reform law.

As we look at your specific needs and analyze your claims trends, we can also perform a pay-or-play financial analysis to help determine the best approach for compliance and cost control, while remaining consistent with your human capital management strategies.

With the Pay-or-Play financial analysis, we can:

  • Perform affordability and minimum value tests
  • Project potential penalties and out of pocket costs for employers and employees
  • Implement strategies that will allow employers to continue business as usual
  • Recommend cost control strategies