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The employer bill of rights


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The employer bill of rights

  1. 1.  The Right to a Transparent ASO/TPA We all know that the current construct of ASO/TPA contracts allows for proprietary contracts to be written between the ASO and provider. Contracts that shield the QWBP from conflicts of interest. According to ERISA, Plan Assets should never inure to the benefit of the employer.…nor should they inure to the benefit of the TPA/ASO. A transparent model, if the proper risk management platform is utilized, can deliver additional savings of 20% to 30% for the self-insured client.  The Right to a Transparent PBM As with the TPA/ASO model, PBMs provide a myriad of hidden contracts, rebating and true pricing information. This opaque system raises costs 5-15%. Employers have a right to lift the veil on any transaction. They should have a right to see all the components of PBM pricing.  The right to have policies and procedures in place to mitigate certain risks that could result in overpayments on member medical claims. This can only occur with a transparent model! Employers should be able to monitor and measure to drive continuous improvements where needed.
  2. 2.  The right to own your own data and have access to your own data in real time. You should never have to arm wrestle your “clerk” for data that you own, after all, you are self-insured! Delays, truncated and missing data are unacceptable.  The right to hold service vendors accountable and to independently audit SLA’s. The technology is available to enact this objective, the decision to act is yours.  The right to measure for ROI and to drive continuous improvements and efficiencies where needed. If you can’t measure it how can you control it? You have the right to robust data and the right to monitor and measure it. This is the engine that drives accountability and continuous improvements.
  3. 3.  The right to expect integration across vendor relationships to achieve economies of scale and compliance requirements. Information is power. It should be intelligent and streamlined to avoid duplication of processes. The goal is to integrate and promulgate like data feeds. HR functions should be “point and click.” Additionally, end users should be able to access and navigate a user friendly technology platform to ease enrollment and find pertinent information in regards to their health plan information.  The right to equip your employees with the tools to make informed choices and drive efficiencies so they can focus on delivering your value proposition. Contact us today to learn more about the newest technology platforms …from Wellness Programs and Medical Concierge to Telemedicine. Ask us about our newest service offering “Plan Asset Review” –