Services.

One of the services we offer to all of our clients is drafting a professional employee benefits guide outlining their benefits package, eligibility rules, benefit summaries, contribution levels, helpful information and much more. Our clients love these guides especially for use in the recruiting process. For the client shown here, we were able to incorporate into their guide actual photographs of their schools, students and activities.

Another standard service we deliver is a clinical review of our clients' medical and prescription drug claims data. Through this review, we identify on-going claimants, estimate their future claims expenses and note those who should be contacted by the plan's medical manager for Case or Disease Management services.

Once we complete our claims analysis, we develop a written narrative of our findings and make specific recommendations for our client's consideration such as wellness activities, targeted member education, disease-specific payroll stuffers or implementation of additional Health Risk Management programs.

Because all groups have different drivers of their healthcare costs, no one strategy is appropriate for all; therefore, after analyzing the prevalent diseases and preventive medicine effort, we construct a calendar of events to ensure that our strategy is effectively implemented.

Having managed literally hundreds of self-funded plans over the last 20 years, our clients have told us what key information they like to have at their fingertips. This report is one example of how we bring together in one report the financial information our clients focus on the most: Monthly / YTD / Average enrollment, fixed costs, claims, stop-loss reimbursements, aggregate attachment point calculation, Per Employee Per Month (PEPM) costs, plan performance and a year-to-year comparison of key metrics.

As part of a physical promotion program, we might offer on-site blood screening and health risk assessments to maximize the ability for employees to participate who might not do so outside of work. Once the lab results and assessments are complete, each participant will receive a report like the one shown here.

An example of the cutting-edge technology that we deliver to our clients is MedIntelligence. This advanced software program applies over 700 clinical algorithms to monthly prescription drug claims data to uncover situations such as duplicate therapy, inappropriate prescribing and patient compliance. When an algorithm is triggered, this program notifies all of the patient's prescribers via letter that a problem has been identified and suggests a corrective course of action supported by referenced scientific studies. The letter also provides each physician with their patient's four-month drug history - not surprisingly, this is often the first time the physician learns of all the medications and dosages their patient is on.

"Predictive Modeling" software is receiving a lot of attention these days from plan sponsors who are interested in the active management of their health plan. We believe that this kind of reporting is only as good as the clinicians interpreting and acting on it - so we rely on our Registered Nurse / Certified Case Manager, Physician, Pharmacy expert and Pharmacists to take full advantage of this information. As you can see from this report, we are able to identify and stratify at-risk members; target them for intervention and monitor their health status over time.

This report also shows gives us valuable HEDIS information so we can assess various levels of patient compliance such as how many women over age 40 in the population received a mammogram within the last two years (see page 35). We use information like this to help us better develop specific wellness and disease management initiatives that will best benefit each of our clients' unique populations.