Employee Benefits Consulting

• Starting the Request for Proposal (RFP) process gives you a lot of leverage when negotiating fees and terms from vendors, carriers or TPAs, PBMs, brokers and with setting up direct contracts with providers.
• Having the right strategy in place when going through the RFP process will get you your desired results. 
• It will also save time and money and start engaging with the front runners early.
• Having a consultant involved to represent your best interests during the RFP process helps you to identify strategic flaws in presented proposals.
• Independent recommended vendor vetting. Each vendor in the RFP needs to be vetted properly and without bias. This is a tactical and critical step to achieve optimal results while executing a successful RFP.

• Independent consulting on the process of hiring a new broker.
• We engage with applicants during the process asking critical questions and making unbiased recommendations to you.
• We can do a search for a new broker and agency that will help you achieve your goals and make recommendations of who to invite to the process.

When the relationship between a doctor and a patient is streamlined and bureaucracy is removed one of the greatest benefits is better health outcomes.

• Many doctors and providers are very willing to do direct contracts with patients, employers, Third Party Administrators and other organizations.
• It lowers the administrative burden and cost of billing traditional health insurance plans.
• Doctors and providers are paid fast and also receive fair compensation for their work.
• It creates a pipeline of good business and referrals to their practice.
• It helps independent providers remain independent. 

• Having high quality providers for employees to get care at creates safe harbors where employees can go without getting surprise medical bills or balance bills.
• In many cases employers will waive the cost sharing to employees if they get their care with providers where there is a direct contract.
• Employers can pay for bundled services instead of fee-for-service billing.
• Employers and employees enjoy price transparency for services and procedures.
• Employers can help steer employees towards high quality providers, doctors and services.
• Employees are more likely to get the care they need when they know how much services and procedures are going to cost them than when they don't know the prices and costs or those procedures and services.
• Employers and employees can save a lot of money on their healthcare spend with good direct contracts in place.

• When health plans can carve out certain services and move away from carrier network contracts a lot of money can be saved.
• This also leads to better health outcomes to plan members in many cases when high quality providers are favored.
• This allows health plans to reduce or waive cost sharing to plan members.
• Health plans pay for bundles instead of fee-for-service billing.
• It also avoids balance bills and surprise medical bills to plan members.

• A strong foundation for good healthcare is giving people easy access to good primary care.
• Relationship based primary care that doesn't involve an insurance company between the doctor and the patient has better health outcomes.
• Removing fee-for-service primary care avoids unnecessary treatment and overtreatment associated with the fee-for-service hamster wheel.
• DPC doctors have smaller patient panels so that they can spend more time with their patients when they see them.
• Can Direct Primary Care be a good benefit for your company and employees?
• Benefits for the Employer:
• With the Direct Primary Care (DPC) model, the employer pays a monthly membership for his employees to have access to DPC doctors.
• What makes this so great?
• Employers can put together more robust health insurance options that work well with DPC. This can lower the amount of money spent on health insurance and provides the employees and the business with better value for the money spent on benefits with lower out of pocket exposure.
• Employees have easy access to health care with the DPC model. Same day office visits if needed, text, email, video consultations. All at no cost to the employee and very efficient.
• They don't have to take a long time off from work to see their doctor. In the DPC model, employees can schedule appointments around their work schedule so that they don't lose revenue from wages etc. This also makes it more likely that an employee will see the doctor and not let something that could have been taken care of easily to escalate. So, less time off work and lower out of pocket costs for employees when they need convenient access to healthcare.
• Because employees have easy access to primary care, it lowers ER visits and urgent care visits. Better access to primary care for employees lowers health care costs for employer groups. This could result in lower health insurance renewals and save money in the claims pool for self-funded employers.
• Happier, healthier and more productive employees.
• Possibly lower workers compensation insurance premiums at renewals because many minor work injuries could be handled by the DPC doctor and there are no medical claims filed for DPC treatments.
• Benefits for the Employee:
• With the Direct Primary Care (DPC) model, employees have easy access to their doctor at no cost to them.
• What makes this so great?
• Employees have a relationship with their doctors, who knows exactly who they are and what their health history and challenges are.
• Employees have easy access to their doctors when they need to see or talk to them.
• Employees can be proactive about their health instead of reactive.
• Because this is not a fee for service model, Employees can call, text, email or do a video consultation with their doctor when they have questions or concerns. This saves everyone a lot of time. Most of the time, someone does not have to go in to see the doctor to get help. In the fee for service model, the doctor does not get paid if the patient does not go in to see them, so the doctor can't and won't help the patient unless they go in for an appointment.
• Better access to primary care prevents unnecessary hospitalizations and urgent care visits.
• Employees can have a high deductible health plan, saving them a lot of money on their health insurance premiums.
• Since Employees have full access to primary care with their DPC membership, they keep their insurance for expensive medical emergencies or illnesses. This way they only pay for insurance that covers what they can't afford to pay and does not use it for inexpensive medical services like primary care.
• Employees’ doctors can get them better pricing on labs, drugs and radiology as needed.
• Employees’ doctors have time to be their advocate should someone develop a serious medical condition and needs to be hospitalized or undergo treatment.
• Employees can get same day appointments if necessary.
• When an employee goes to see their doctor, they are met by friendly staff in what is in most cases an empty waiting room with almost no waiting time. The employee isn’t questioned about their insurance, they don't have a copay and will not get billed for the consultation.
• What are the benefits of the DPC model to the Doctor?
• With the Direct Primary Care (DPC) model, the primary care doctors charge a monthly membership fee per patient for patients who are enrolled at their practice.
• What makes this so great?
• The doctor has a smaller panel of patients, so they can spend more time with their patients.
• Many chronic conditions can be treated by the DPC doctors instead of referring them out to specialists.
• The doctor has time to develop a real relationship with their patients and be very accessible to their patients.
• Because there are no third parties involved, like insurance carriers, the doctors spend most of their time treating patients. No need for coding or billing and other administrative work.
• The DPC model has much lower overheads so the doctors get to keep a much higher amount collected from memberships. Compare this to the fee for service primary care model which comes in at 26% of money billed that the doctor gets to keep. This way the doctor can keep monthly membership fees low and very reasonable while providing excellent care and attention to patients.
• DPC doctors are happier with their careers and lives because they spend most of their time doing what they love to do.
• More time with patients means better health outcomes.
• It also avoids balance bills and surprise medical bills to plan members.

• We advise brokers and agencies on complicated benefits designs on some of their cases.
• We make recommendations on improving benefit packages.
• We make recommendations on vendors that will work well to help the client accomplish their goals.
• We help retain business by developing better strategies and tactics in the fast changing market place and healthcare system so agencies can break from the status quo offerings and plans.

• We are always looking for agencies to bring new business to when we help clients with RFPs and new broker searches.
• We have many cases where we collaborate with other agents and agencies to win new business and improve the benefits packages of clients and prospects.