In order to contain health insurance cost, we have to contain the cost of care.

We are benefit consultants strictly focused on decreasing health insurance cost — without having to change your current plan design or shift cost to employees.

  • Does your health insurance renewal increase every year?
  • Are you the only fiduciary (liable party) listed on your plan?
  • Are you passing health insurance increases to your employees?
  • Do your deductibles and copays go up each year?

Let us show you a better way…

*Yes this is possible, and yes we can prove it!

Why is the current model broken?

There many more reasons that what we have outlined here, but this list is a good start.

Government Defined Medical Loss Ratio

The Affordable Care Act requires insurance companies to spend at least 80% or 85% of premium dollars on medical care. This mandated spend actually give the carriers no real reason to control your insurance claims.

Broker trips and persistency bonus.

Would it shock you to believe that insurance carriers have incentivized your “consultant” with huge bonuses and give away personal trips for what the industry calls “persistency”. This means your “consultant” is perversely incentivized to make sure you renew (with that carrier).

Commission Based Compensation

Brokers, especially the publicly traded ones, have a massive incentive and shareholder responsibility to raise revenue. If their compensation is directly tied to your health insurance premium, how can their goals be aligned with yours?

Preferred Provider Organization (PPOs)

PPO networks charge access fees, a fixed cost of a group health plan, of $12 – $20 per employee per month for what is arguably the obligation to overpay providers for healthcare services. This leads to a failure in your companies fiduciary responsibility under ERISA.

Little or No Transparency

Medical insurance carriers make it tough to access real claims data. Far too many medical claims are auto-adjudicated based on a UB form, which allows for billing errors a manual review would have caught.

Outrageous pharmaceutical spending

Do you know if there is a spread between the pharmacy and your PBM contract? What is your current PBMs declination rate? (Do you know why this matters?) Answers to these questions and many more is why your pharmacy spend is so high.

Still not convinced? See our latest video post on why PPOs are not a good choice for employers?

How can we decrease the actual cost of care?

Some brokers promote having huge carrier premium volumes, many in-house resources and global expertise. We deliver a different
message focused on long-term cost containment, transparency and breaking free of the 12 month “quote and hope for results” cycle.

Measure what you wish to control

According to studies performed by the U.S. Government and Equifax, over 90% of all hospital bills contain errors, to the detriment of the payer. Our audits reveal mistakes that average 7.15% in savings with a 5 year track record.

Out-of-network management

Out-of-network charges can get out of control quick. We implement policies that drastically reduce the out-of-network claims process that will substantially reduce your claims spend.

Prescription Benefit Risk Management

If you spend more on prescription medications this year than last, we can reverse that trend. We have see plan participants save 20% – 50% on average in the first 12-18 months with no changes to benefit design. Learn more >>

Performance based compensation

Chances are you are currently paying your broker for activity instead of outcome. We base our compensation on how well the health plan performs, instead of how much you pay in premium.

Alternative Claim Pricing

Employers are driving a trend toward alternative medical cost management seeking reprieve from inflated medical pricing and PPO overpayment — this can result in approximately 37% less than BUCA PPO reimbursement levels.

Better choices at renewal

Forget shopping just a few carriers at renewal. Does your broker show you level-funded, self-funded or captive solutions at renewal? Have they even talked about those options?

Find out more about our pre-client retro fiduciary bill review & recovery process.

A two year audit of past claims will allow us to identify potential recovery opportunities for any unwarranted charges on a contingency basis. More importantly, it will allow for additional savings by using the same process for future claims.

“Break free from the 12-month quote and hope cycle” with Workforce.

These things are always included!

Support, benefit eligibility communication and consulting are
always included and there is never an extra change.

Consulting

We manage the entire process of your employee life cycle and can support you through decision making process of your health & welfare plan, ERISA disclosures & eligibility. We are also certified to advise you through the fully insured or self funded landscape.

Eligibility Maintenance

We combined health and welfare consulting, a “never outsourced” benefit enrollment service, an employee benefit call center and an in-house benefit eligibility communication team, all together to better serve your employees and their needs.

Support Service

The people behind our company and services we offer is what really make us stand out from the competition. Not only do we service you, the employer, but we are also a resource for your employees should they have a question or need to file a claim.

Contact us today to find out more.