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Our Point of View
What We Believe
4 Pillars Of An Exceptional Health Plan
- Sound Compliance
- Superior Benefits
- Sustainable Savings
- Satisfied Employees
Fiduciary Duty
Sounds dry. But it’s actually about “Acting solely in the interest of plan participants and their beneficiaries” as ERISA requires. This means acting with diligence and prudence to ensure employees and their families get the best benefits at the lowest cost.
Doing The Right Thing
Ultimately, breaching your fiduciary duties, particularly when people are sick and need their benefits the most, leads to the source of lawsuits: unsatisfied employees facing an untenable financial burden and deferred care.
Advocacy
Good things happen when employers have a clear focus on participant and beneficiary interests. Having an experienced "patient advocate" advise the benefits committee and monitor performance may be the best investment an employer can make.
Transparency
Many TPAs, PBMs, and other service providers collect undisclosed fees. These payment schemes are a compliance risk and drive up costs. Find partners who want to create value, not extract it at the expense of your plan and employees.
Compliance + Cost Savings
Yes you can have both. That's what we call The Health Plan Compliance Advantage. Sound compliance leads to strong relationships with transparent and innovative service providers aligned with your goal to deliver high quality benefits and care at an affordable cost.
How Can We Help?
Strategic Approach To Compliance
Compliance used to be a "check the box" exercise.
Not any more. Today, health plan compliance requires a multidisciplinary approach. The highest performing health plans achieve their results by combining:
- Strong fiduciary focus on participant interests
- Data-driven insights into new delivery, pricing, and contract models
- Strategic understanding of industry trends
It doesn't have to be complicated.
It truly is not rocket science. At least when you strip away opaque pricing and unfavorable contract terms. We've developed pragmatic education, consulting services, and tools designed to help health plan fiduciaries, including General Counsel, CFO, HR Leaders, and Benefits Committee, improve compliance and uphold their fiduciary duty as stipulated by ERISA:
- Acting solely in the interest of plan participants and their beneficiaries
- Paying only reasonable plan expenses
- Carrying out their duties prudently
- Following plan documents consistent with ERISA
- Avoiding "contractual capture" by conflicted delivery partners
What makes us different?
Expertise and Advocacy. We use our professional expertise and (importantly!) personal experience as patients. We're committed to an uncompromised focus on participant and beneficiary interests as our North Star.
Education & Consulting Services
Education
Presentations and workshops:
- Fiduciary duties, personal liability
- Participant and beneficiary interests
- ERISA and CAA pitfalls
- Litigation lessons
- Risk mitigation
- Conflicts and disclosure
Assessments
Current state & gap analysis:
- “Hot Spot” compliance reviews, detailed audits
- Governance models, committee design, controls
- Contract language review
- Medical & Rx claims analysis
- Benchmarking
Operations
Management and controls:
- Benefits committee participation (ex officio)
- Monitoring denials, delays, complex cases
- HIPAA compliant employee surveys, hotline support
- Ongoing reviews
Planning
Future state:
- Strategy, priorities
- Savings opportunities
- Quick wins, fixes
- Multi-year roadmap
- Transparent and innovative services
The Health Plan Compliance Advantage
Subscribe To Our Weekly Newsletter
You'll receive actionable insights you can put to use right away:
- Compliance best practices
- Cost-saving strategies
- Time-saving tools
- Case studies with real world results
Ideal for employer-sponsored health plan fiduciaries:
- CFO
- General counsel
- Benefit committees
- Advisors
- Lawyers
- Service providers
Click here to subscribe via email
Testimonials
Dean Jargo, CEO of Fair Market Health
"As a former CFO, I was happy to find a newsletter focused on the idea of good compliance leading to cost savings and better benefits. Every CFO and health plan benefits committee member should add this newsletter to their reading list."
About Us
Our Mission
Our Approach
Our Mission
Provide exceptional healthcare education and consulting services to employers, health plans, advisers, legal, and health tech clients.
Our Team
Our Approach
Our Mission
Experienced, independent consultants and subject matter experts with diverse healthcare backgrounds covering compliance, strategy, analytics, and technology-enabled services.
Our Approach
Our Approach
Our Approach
We have a first hand, patient-centric perspective focused on delivering high quality, cost effective benefits and care for employees and their beneficiaries.
Contact Us
My Story: Consulting + Advocacy
I’ve worked in healthcare for 30+ years. My focus has been using analytics and digital health to deliver higher quality more cost effective care.
When I became a patient, I saw a whole different side of healthcare. I kept asking myself, “How does anyone, without a healthcare background, manage through this mess without pulling their hair out or depleting their bank account?”
That's why I'm using my professional expertise and newfound personal experiences to help others get the care they need.
Our Partners
Like-minded experts supporting high-performing health plans
