Focused on Your Success
Wilson Partners’ consulting practice takes a fully comprehensive approach to the management of improved employee health and wellbeing that is fully focused on the health and health care of the whole person. It requires an integrated vision of health and health care management to include: culture, environment, comprehension, responsibility, relationship, engagement and reward. At WP, our solution is inclusive of health improvement, clinical and behavioral health care management as a single continuous management process, invested in the whole person. At WP, our team is successful because we are dedicated to advancing your objectives. Meeting your objectives is how we measure our success. We look forward to the opportunity to be of service to you as a client partner.
At Wilson Partners we understand the health and wellbeing of an individual to be central to the effectiveness of any health care management program. As the medical benefits market continues to undergo significant change, a sound medical benefit strategy is more important than ever. It is a central and integrated component of your compensation, health care, and wellness management efforts, focused on the improved health and wellbeing of the whole person. At Wilson Partners we are dedicated to our client’s success through achieving improved employee health, long-term decreases to health care costs, and increased employee satisfaction with your health management program.
- 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 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 benefit offerings 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.
At Wilson Partners we understand behavioral health to be central to the effectiveness of health care management and an essential component of any wellbeing program. During these unprecedented times, we believe that your behavioral health strategy has never been more important to maintaining and improving the mental health, wellbeing and productivity of your employees.
- Analysis of medical, behavioral, pharmacy, and disability claims, and health assessment responses, to identify design improvements, increased coordination of care opportunities, and reduced claims cost.
- Evaluation, implementation, and on-going support of domestic and global EAP services in accordance with negotiated Service Level Agreements.
- Development of strategies centered around the identification and co-management of medical and behavioral health conditions.
- Enhancing the user experience to increase member engagement in care.
- Development of preferred provider networks that produce positive outcomes for members. These networks are created by analyzing locations that are geographically relevant to your employee population.
- Implementation of methods to decrease out-of-network costs and utilization.
- Identification of the advantages and disadvantages of a carve-in vs. a carve-out behavioral health plan.
- Integration of behavioral health and EAP services in the larger employee health, wellness and wellbeing plan design, reward and management infrastructure.
At Wilson Partners we understand the appropriate design and utilization of a prescription drug program to be central to the greater health and wellbeing of the employee. Effective prescription drug programming and plan management is an essential component of any health and wellbeing program. During this period of unprecedented growth in cost, your prescription drug strategy has never been more important.
- Analysis of plan design and pharmacy claims (including specialty drugs), co-occurring medical claims, and health assessment responses, to identify potential design improvements, increased medication adherence opportunities, and reduced claims cost.
- Evaluate and integrate cash price prescription drug service providers with current Rx benefits (e.g., GoodRx)
- Identify opportunities to further manage specialty drugs costs and alternative delivery methods.
- Evaluate the efficacy of the formulary (including identification of areas of waste) and recommend and implement changes as necessary.
- Identification of the advantages and disadvantages of a carve-in vs. a carve-out prescription drug plan.
- Identify the appropriate pricing and rebate structure to ensure optimal transparency, cash flow, and cost savings.
- Structure discount arrangements to ensure clients are receiving the maximum amount of savings possible.
- Evaluation, implementation, and on-going support of PBM services in accordance with negotiated Service Level Agreements.
- Implementation of a value-based prescription drug copay structure so those with commonly diagnosed chronic conditions are able to obtain prescriptions at a lower (or zero dollar) cost.
At Wilson Partners we understand the health and wellbeing of your employees to be essential to your health care management program and to the sustainable success of your business. Without a healthy, present and engaged workforce no business can operate at its optimal level. By developing an effective and engaging wellness program strategy, you can improve the health and wellbeing of your workforce and empower them to take greater responsibility for their health and wellbeing.
- Design of a 4-5-year employee health care and wellness management roadmap with clearly defined decision points, financial impact, recommendations and considerations for next steps. This roadmap is created utilizing Wilson Partner’s proven process:
- Analysis of wellness program results in relation to medical, prescription drug, behavioral health and disability claims, and provide benchmarks to compare against like employers.
- Evaluation, implementation, and on-going support of domestic and global wellness services with the objective of enhancing and personalizing the user experience, thereby increasing member engagement in the wellness program.
- Evaluation, Implementation, and on-going support of a performance-based pricing model that incentivizes the wellness program vendor to design and deliver a program that leads to a long-term reduction in claims spend.
- Evaluation and implementation of reward strategies that maximize employee participation in the wellness program and aligns with the your employee benefit offerings.
- Evaluation, implementation, and on-going support for a comprehensive communications strategy which effectively incorporates the overall company mission statement and messaging from key leaders within the company.
- Identification of the advantages and disadvantages of a standalone wellness program and a carrier-offered program.
Primary Care Services
- Design, implementation and management of direct contracting solutions, inclusive of on-site or near-site direct primary care clinics to empower the patient (employee) – physician relationship and allow for the doctor to provide the time, passion and care needed to maintain and improve employee health and wellbeing .
- Analysis of the impact of a direct contract arrangement and/or an on-site or near-site clinic compared to a traditional care setting. This impact analysis includes differentials in cost and utilization of:
- Inpatient Services
- Emergency Room
- Urgent Care
- Outpatient Surgery
- Home Health Care
- Ambulance Services
- Specialist Visits
- Prescription drugs
- Average time spent with the physician
- Average time spent in the waiting room
- Creation of a communication strategy for launching and continued promotion of the direct primary arrangement/clinic(s).
- Evaluate the plan design changes necessary to allow for cost-effective and appropriate utilization of the direct primary arrangement/clinic(s).
- Integration with online platforms which allow employees to select their direct primary care physician and the site of their care.
- Implement telehealth services with DPC providers to improve access and increase employee convenience.
Life & DIsability
At Wilson Partners we understand the importance of life and disability insurance to the greater health and wellbeing of the whole person. Effective life and disability insurance design and plan management is an essential component of any health and wellbeing program. With a sound life and disability insurance strategy, you can ensure your employees and their family members are able to receive the necessary financial protection and support they need during life’s most difficult times.
- Review life and disability plan contracts to ensure your plan design, and the various contract provisions, meet and/or exceed industry standards, and follow the applicable rules and regulations.
- Analysis of life and disability claims, inclusive of co-occurring medical, prescription and behavioral health claims. Claims data, in combination with health and financial assessment responses, are used to identify potential design improvements, increased management and rehabilitation opportunities, and reduced claims cost.
- Analysis of life insurance claims to identify any condition specific or employee demographic similarities that may impact or require changes to other benefits (e.g., medical or disability).
- Identification of the advantages and disadvantages of a self-funded short-term disability plan.
- Structure executive life and disability benefits to ensure compliance and understanding of the applicable rules and regulations.
- Evaluation, implementation, and on-going support with the life and disability insurance carriers in accordance with negotiated Service Level Agreements.
- Review the viability of, and implement, alternative life and disability insurance plan offerings. This includes benefits such as Universal Life Insurance, Variable Universal Life Insurance, Whole Life Insurance, and Key Person Disability coverage.
Dental & Vision
At Wilson Partners we understand the appropriate utilization of dental and vision benefits to be central to the greater health and wellbeing of the whole person. Effective dental and vision benefit programming and plan management is an essential component of any health and wellbeing program. As the number of dental and vision products offered in the marketplace continues to expand, it is critical that employers continuously evaluate their benefits offering. By doing so, you can ensure your plans remain up to date with the continued advancements in dental and vision treatments.
- Analysis of dental and vision plan contracts to ensure your plan design meets and/or exceeds industry standards.
- Review plans to ensure the latest approved technologies and plan design opportunities are incorporated into your plan offerings in an intelligent, staged progression.
- Evaluation of dental and vision networks to ensure your employee population is receiving the highest level of discounts and access to dentists and eye doctors.
- Identification of the advantages and disadvantages of self-funded dental and vision plans.
- For self-funded plans, conduct claims analyses to identify high-cost and high-utilization services, and identify potential co-occurring medical, prescription drug or vision conditions.
- Evaluation, implementation, and on-going support for dental and vision benefit vendor services in accordance with negotiated service level agreements.
- Implementation of virtual visit services in accordance with market demand.
Federal & State Policy
At Wilson Partners we understand the critical requirements and importance of success in developing and implementing strategies to expand access and improve the health and wellbeing of all residents. We possess the deep market, economic, analytical, policy, creative innovation and integrative market skill sets required to define the success of your strategy.
- Conduct a series of objective-setting meetings with the identified stakeholders.
- Analyze the current state of the existing market in order to define the baseline for innovation impact.
- Define comprehensive set of market-based and market-wide innovations. These adoption opportunities are inclusive of, but not limited to:
- Risk-mitigation strategies
- HRA expansion
- Association Health Plan expansion
- Short-term limited duration insurance plan expansion
- Promotion of direct primary care programs
- Health care demand management strategies
- Patient-physician engagement management initiatives
- Advancement of interoperability technologies, inclusive of the identification of the social determinants of health
- Patient wellness engagement management
- Identify required changes in the state’s certificate of need
- Market-wide competition requirements
- Economic and actuarial impact analysis for all pursued innovations. Inclusive of the measurement of increased market-wide access to “high-value and affordable health coverage regardless of income, geography, age, gender or health status”. Within this process, the cost impact of expanded employer and individual market-based insurance coverage on government funding and budgets will be detailed.
- Assist the state in completion of any applicable waiver application (e.g., Section 1332 waivers) for submission and approval
- Provide technical assistance and testimony to and for the state leadership to assist in appropriate consultation required for legislative action(s).
- Participate with key-identified state think tanks and state thought leaders throughout the process.
- Identify the market implementation requirements for state leadership and provide future assistance as desired to ensure market implementation success.
Address 2250 Butterfield Drive, Troy MI 48084