An open, honest discussion is the place to start.

ALL conversations are confidential, NO pressure.

Come with questions, or we will start the dialogue!

Do you get any reporting on your health plan? Annually? Quarterly?

We don’t mean pages of spreadsheets and graphs/charts. THAT IS NOT REPORTING – that is just spreadsheets and graphs/charts.

REAL reporting answers questions, defines outcomes, and suggest next steps.

If you are not getting REAL reporting, you are not managing your plan.

Do you know what the ROI is on your healthcare spend?

That starts with knowing what you are paying for.. EXACTLY what you are paying for and HOW MUCH you are paying!

Are you getting your money’s worth?

ARE YOUR EMPLOYEES BENEFITING FROM WHAT YOU ARE PAYING FOR?

Over 2,000,000 companies and their health plans are NOT in compliance!

Are you in compliance?

We believe you are not in compliance!

Allowing your broker or vendors to act on your behalf DOES NOT RELIEVE YOU OF YOUR FIDUCIARY RESPONSIBILITIES.

You are not in compliance!

We are 100% confident that 99% of employers are NOT in full compliance.

Compliance means that ALL aspects of the Consolidated Appropriations Act of 2021 are satisfied. Other applicable federal and state laws must be satisfied as well.

Compliance does not mean that your vendors are signing off on your behalf!

If you are self-funded we are 99.9% sure that you are at HIGH RISK of a lawsuit.

Your employees can sue you for breach of fiduciary duty - because you are not managing your health plan and healthcare spend

Don’t believe it? Check out these lawsuits URL - Douglas

Concerned? We can shield you from a lawsuit!

Every decision has to be driven by data — not spreadsheets or summary reports!

If you (by way of your broker / vendors) are not making EACH decision based on data, your health plan is adrift.

There is considerable discussion regarding healthcare data transparency recently.

Are your service providers using transparency data to lower your costs or improve quality of care?

What’s all the hype about? We can help you sort it out.

What is happening every day in your plan?

Is utilization management happening with each claim?

Is appropriate care navigation helping employees get the best care?

If you are paying for it, results should be tangible!

Mental Health Parity and Addiction Equity Act (MHPAEA)

Is your health plan compliant with the MHPAEA? We hazard a guess that you are not compliant.

MHPAEA's fundamental purpose – to ensure that individuals in group health plans or group or individual health insurance coverage who seek treatment for covered MH conditions or SUDs do not face greater burdens on access to benefits for those conditions or disorders than they would face when seeking coverage for the treatment of a medical condition or a surgical procedure.

Health plans must perform and document a comparative analysis of the design and application of 6 applicable nonquantitative treatment limitations (NQTL).

Have you attested that your contracts do not have Gag Clauses? Or did you let someone else attest on your behalf?

BEWARE IF SOMEONE IS ATTESTING FOR YOU……. THEY ARE HIDING SOMETHING

A gag clause is a contractual provision that restricts a plan from sharing price or quality of care information or data with other parties.

The Consolidated Appropriations Act of 2021 (the “CAA”) prohibits group health plans from entering into agreements with entities offering access to a network of providers if those agreements (or any underlying agreements) contain gag clauses.

The CAA also requires group health plan sponsors to submit compliance attestations annually.

“RxDC report” refers to the data submission required under Section 204 of Division BB, Title II (Section 204) of the Consolidated Appropriations Act, 2021 (CAA).

Section 204 requires group health plans (plans) and health insurance issuers (issuers) offering group or individual health insurance coverage to submit information about prescription drugs and health care spending to the Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Department of the Treasury (the Departments).

WHO IS DOING YOUR RxDC REPORTING?

Do you know about the pharmacy rebates you are owed?

Did your PBM or TPA or Broker tell you (lie to you) that you cannot get plan-specific data?

The cost of medications, access to medications, and rebates are only the beginning of the PBM problems in your health plan.

Does you PBM share its revenue sources? Are they 100% pass-through?

Have you heard Mark Cuban’s conversations about PBMs?

Who is helping you with your health plan?

Have they been transparent with what they are charging you?

When was the last time you challenged them to prove their ROI?
Can they prove their ROI?

You know when other parts of your business are causing you problems.

Who monitors your high cost claimants (HCC)?

What dollar value is the cutoff for a HCC? $100,000? $50,000? $25,000?

What is ACTUALLY being done about the HCCs?

Who is sitting on your side of the table at meetings with your vendors?

WE WILL SIT ON YOUR SIDE!

You are an expert in your business!

Are you an expert in medicine, healthcare, health insurance?

You need a on-demand resource - EHPAA is your answer!

The devil is in the details!