Your Partner In Fiduciary Compliance
.png/:/rs=w:1353,h:338)
Exclusive
Special Offer!
Use code FIDUCIARY10 for a 10% DISCOUNT on any Validation Institute service when checking out on their website at www.validationinstitute.com
Our Point of View
What Can You Do About It?
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.
Fiduciary Duty
It’s about acting with diligence and prudence to ensure employees and their families get the best benefits at the lowest cost. 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.
Participant Interest Mindset
Good things happen when employers have a clear focus on participant and beneficiary interests. Having an experienced Advocate Adviser educate the benefits committee and monitor performance may be the best investment an employer can make in compliance.
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. High performing health plans achieve Compliance + Cost Savings 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's not rocket science. At least when you strip away opaque pricing and unfavorable contract terms to embrace your fiduciary duties:
- Acting solely in the interest of plan participants
- 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?
We've developed pragmatic Compliance Education & Consulting Services designed to help health plan fiduciaries, including Board Directors, General Counsel, CFO, HR Leaders, and Benefits Committee, to improve Compliance + Cost Savings.
Education & Consulting Services
Education
Presentations and training:
- Executive Presentation - Webinar
- Fiduciary Training Program - Online
- Fiduciary Handbook - Digital Book
- Fiduciary Committee Training - Quarterly
- Newsletter Subscription - Monthly
Governance
Committee design:
- Model review
- Authorization and delegation
- Charter
- Processes
Assessment
Current state & gap analysis:
- “Hot Spot” compliance reviews
- Benchmarking cost and quality
- Contract language review
- Medical & Rx claims analysis
Planning
Future state:
- Strategy, priorities
- Savings opportunities
- Quick wins, fixes
- Multi-year roadmap
- Transparent and innovative services
Implementation
Implementation
Management and controls:
- Benefits committee participation (ex officio)
- Monitoring denials, delays, complex cases
- Ongoing reviews
Sample Experience
Employers
Health Tech
Health Tech
- Benefits Committee - Conducted compliance education and advised on fiduciary issues
- Rx - Evaluated benefits and found transparent pharmacy solutions to reduce generic drug costs by 90%+
- Mental Health - Assessed benefits and digital mental health solutions to address access and cost issues
- Claims Analytics - Deployed AI-based claims tools to identify inaccurate claims and overpayments
Health Tech
Health Tech
Health Tech
- High Value Care - Developed claims analytics tools to identify low and high value specialist practice patterns
- Physician Quality - Deployed analytics to measure physician performance against quality standards
- Specialist Referral - Developed analytics to help employees navigate to the best specialist care
- Navigation - Implemented AI-assisted triage of patient healthcare issues to reduce ER visits by 50%+
Providers
Health Tech
Providers
- Digital Health - Worked with hospital executives to develop strategic plans for analytic and digital health solutions
- Risk Predictions - Developed AI-based risk stratification for complex surgical patients
- Brain Check - Developed analytics to assess brain function for athletes and the elderly
The Health Plan Compliance Advantage
Fiduciary Handbook
Free Weekly Newsletter
Free Weekly Newsletter
- Employers are facing runaway healthcare costs and increasing litigation risks due to lax compliance.
- It's time to embrace your fiduciary duties and discover compliance and cost savings go hand-in-hand.
- Learn how to be a responsible fiduciary and operate a high-performing fiduciary committee.
Free Weekly Newsletter
Free Weekly Newsletter
Free Weekly Newsletter
- Compliance best practices, cost-saving strategies, time-saving tools, and real world case studies for employer-sponsored health plan fiduciaries.
- Ideal for employer-sponsored health plan Board Directors, CFOs, General Counsels, exec management, benefit committees, advisors, lawyers, and service providers.
Testimonials
Al Lewis, CEO Validation Institute
Al Lewis, CEO Validation Institute
Al Lewis, CEO Validation Institute
The Validation Institute is delighted to be a sponsor of The Health Plan Compliance Advantage newsletter. Their mission aligns perfectly with ours: "Empowering purchasers to control health care spend and transform health benefits." Together we can help employers find the vendor alternatives they need to fulfill their fiduciary duties.
Dean Jargo, CEO Fair Market Health
Al Lewis, CEO Validation Institute
Al Lewis, CEO Validation Institute
"As a former CFO, I was happy to find the Fiduciary Handbook and newsletter. They focus on the idea of good health plan compliance leading to cost savings and better benefits. Every Board Director, CFO, General Counsel, and health plan benefits committee member should add this to their reading list."
About Us
Our Mission
Our Approach
Our Mission
Provide exceptional healthcare education, compliance guidance, 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 + Compliance + 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. My personal journey, combined with decades of professional experience, has led me to the realization employers have the power to make a real difference.
That's why I'm helping employers pursue The Health Plan Compliance Advantage.
Our Partners
