Solutions

TPA & PBM Management

Many employers don’t stop to think about the administrative infrastructure servicing their benefits delivery model. There are many vendors behind the scenes that integrate at various points in order to deliver the benefits your employees are accustomed to. What employers don’t realize is that most of these vendors unintentionally operate as silos. Each silo cares about their client but focuses only on the products and services they provide and their own bottom line. Just as our picture illustrates below there are gaps between the silos. Where those gaps occur – the employer loses out on potential savings and possibly incurs additional costs. Our industry experts have lived in each of these silos and understand where the gaps exist. With our experience we not only manage the silo but also bridge the gap driving increased accountability in and between all the vendors.

At this point your unsatisfied judgment is nothing more than an IOU. Secured Resolutions has the resources and expertise to pursue the debtor and enforce the judgment. Our dedicated Judgment Team has mastered the art of judgment recovery. We specialize in the enforcement of court awarded, monetary judgments.

What is Direct Primary Care?

Direct Primary Care (DPC) is an innovative alternative payment model improving access to high functioning healthcare with a simple, flat, affordable membership fee. No fee-for-service payments. No third-party billing. The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider.

We provide assistance as employers, consultants, brokers and DPC physicians migrate to a model which places the primary care physician in the center of all health care. This is better for all involved, especially the patient.

Patients have extraordinary access to a physician of their choice, for an affordable amount per month, and physicians are accountable first and foremost to their patients. DPC is embraced by health policymakers on the left and right and creates happy patients and happy doctors all over the country!

Benefits

Better Health Outcomes - Patients achieve superior health outcomes with Direct Primary Care's innovative service delivery. DPCs provide better access to physicians, empower an authentic therapeutic relationship, and comprehensive patient care 24 hours a day, 7 days a week, 365 days a year.

Lower Costs - Affordable, transparent costs based on a periodic overall flat rate (i.e. membership or subscription). Patients (or employers) pay for their care directly to the physician. No third parties or Fee for Service billing ("FFS") to inflate costs. Most DPC memberships/subscriptions cost less than the average cell phone bill.

We are experiencing a 37% of max cost run rate for our clients that have transitioned to a DPC model. Not only are the cost savings amazing but it also provides increased employee, patient and provider satisfaction.

Enhanced Patient Experience - Patients receive unrestrictive access to their healthcare provider, report little to no wait time, and longer appointments (in person, virtually, or via phone). In turn, creating a real therapeutic relationship between patient and provider.

Cost Management Services

Employers unnecessarily overpay more than $250 billion in medical claims annually. Managing health cost trend demands a strong cost containment methodology to control costs beyond just network discounts. Today’s healthcare landscape requires creativity to cut costs. Our proven cost-savings strategies are custom built based on each clients specific cost drivers. Some of our example strategies are:

• Eligibility audits
• Out of network claim negotiation
• Physician and hospital bill auditing
• Specialty drug programs
• Telemedicine services
• Subrogation
• Reduction in gaps in care
• Plan audits
• Case management
• Disease management
• Utilization review
• High dollar claim review
• Dialysis management
• Transplant networks
• Radiology networks
• Coordination of benefits

Stoploss Marketing & Management

Stoploss insurance helps protect employers with self-funded health plans when employees or their dependents experience a catastrophic claim, or incur unexpected high medical costs. It also protects self-funded employers when their total group medical costs are higher than anticipated.

We provide our clients an unmatched stoploss expertise, access to the industry's top-rated Stoploss Carriers, highly competitive premium rates, and superior service. Resulting in the appropriate coverage protection to reduce risk.

Wellness & Disease Management

The decisions your employees make about their health have a direct impact on your organization's bottom line. Healthcare costs typically represent the second or third largest line item of the employer's budget and it's critical employees understand the relationship between the choices they make (e.g., skipping preventive care screenings or neglecting to take medications, etc.) and your organization's ability to continue to provide quality, affordable employee health benefits.

We believe it’s important to understand your long-term objectives with regard to employee benefits. We will work with you to create a comprehensive 3-year strategic plan/roadmap that includes wellness & disease management initiatives.

TCS’ unique approach to trend management focuses on your population’s specific cost drivers. Utilizing our robust data analytics tool we identify and stratify your cost drivers by risk and provide innovative strategies to eliminate and/or mitigate them. The recommended wellness & disease management strategies are customized for each client and are intended to help avoid and reduce future costs thereby controlling your trend.

Our Wellness programs are designed to create a cultural change over time and help you achieve the return on investment you should expect from your benefits spend. Our goal is to make healthy living attainable and health improvements achievable. Our clinically based, fully integrated wellness program focuses on an employee’s total well-being, connecting participants to clinical care and bringing together all elements of your benefit program. With our personalized biometric screenings, immediate outreach, industry leading engagement rates, powerful data analytics and detailed reporting, we support you every step of the way.

For those already living with a chronic condition, disease management has emerged as a promising strategy for improving care for those individuals. People with chronic conditions usually use more health care services, which often are not coordinated among providers, creating opportunities for overuse or underuse of medical care. The goal of disease management is to limit preventable events (inpatient & emergency room usage) by encourage patients to use medications properly, to understand and monitor their symptoms more effectively, and possibly, to change behavior. These programs produce significant clinical improvements, as well as financial savings.

Eligibility Audits & Ongoing Verification

We believe plan trend management begins during the enrollment process. Once viewed as sometimes too intrusive or a low priority, dependent eligibility audits are a necessary process due to increasing forms of self-service online enrollment, lack of eligibility vendor controls, and some plans even excluding spouses from coverage. The number of ineligible dependents for any given organization can range between 2 - 10%.

Claims from these “ineligible” dependents increase your costs and go unnoticed until one of the ineligibles may reach a stoploss threshold. One of the first things a stoploss carrier will verify before they reimburse our client is – was the participant eligible to be on the plan. Once they find out the participant was ineligible for coverage – the reimbursement is ZERO! This can be a significant risk.

We start with a comprehensive document-based dependent verification process to ensure all dependents currently on the plan are eligible for coverage. Once the initial audit is complete our ongoing process verifies newly enrolled dependents guaranteeing our client’s costs are for true eligible participants.

Other eligibility factors we continuously monitor are:

• Participants becoming eligible for Medicare primary coverage
• Dependents turning age 26
• End stage renal disease progression to Medicare primary coverage

Alliance Partners

Our partnerships allow you to use our solutions together with confidence!

We understand that your finance, benefit management and HR needs are incredibly complex and you use products from several different vendors. You need them all to work well together. Our partnerships allow you to use our combined solutions with confidence. To find out more about our key partner relationships and integrated technology, explore the links below.

Sheridan Benefits

• Commercial Insurance Options
• HR Services (HR 360)
• Payroll Services
• COBRA

ROI Financial Group

• Family Protection
• Estate and Legacy Planning
• Business Succession and Exit Planning
• Executive Benefits
• Wealth Management and Retirement Planning
• Philanthropy