Medical Benefit Strategic Services
At Wilson Partners we understand the health and wellbeing of an individual to be central to the effectiveness of any health management program. The medical benefit strategy is a critical and integrated component of your health care and wellness management efforts, focused on the improved health of the whole person. As the medical benefits market continues to undergo significant changes, a sound medical insurance consulting is more important than ever. At Wilson Partners we are dedicated to our client’s success through achieving improved employee health, long-term decreases to health care costs, and employee satisfaction with the health management program.
Our medical insurance consulting services include:
- Analysis of the medical plan and health care strategy, inclusive of medical claims and wellness program results to identify potential plan design improvements, plan integration opportunities, care advocacy, coordination of care opportunities, and reduced claims cost impact. The development of strategies centered on the identification and co-management of medical claims, pharmacy, behavioral health, dental, vision and disability claims are all important elements of this analysis.
- Analyze network utilization and discount levels and compare to relevant benchmarks to identify opportunities for alternative or narrower, high-performing networks.
- Development of referenced-based pricing and direct contracting benefit structures to manage and decrease long-term claims cost and improve the quality of care.
- Evaluation of funding alternatives as appropriate, inclusive of insured, self-funded or level-funded programs.
- Implementation and integration of direct primary care plans that enhance the patient-physician relationship and lead to long-term cost savings across multiple service areas of the medical plan.
- Evaluation, implementation, and on-going support of medical benefit administrative services, including TPAs, stop loss carriers, and telehealth vendors in accordance with negotiated Service Level Agreements.
- For self-funded plans, determination of the appropriate stop loss levels through detailed claims analyses.
- Evaluation of voluntary benefits offering to assist employees with out-of-pocket medical exposure and financial security needs.
- Annual review and regular assessments conducted to ensure compliance with the required benefit rules and regulations – ACA, HIPAA, ERISA, Mental Health Parity, etc.