Medical Plan Consulting
Self-Funded Benefits Plans Managed
Pharmacy Negotiation Saves County
Wellness Strategy Saves City
Managing & Consulting
Becoming a Trusted Partner in Benefits
Mark III develops an understanding of the goals and priorities of all of our customers by meeting with the customer. The purpose of the meeting is to discuss benefit priorities and financial/budgetary constraints. Our vast experience allows us to discuss all of the various products available in the marketplace. We also share our experiences with typical plan designs and cost structures of other clients with similar demographics as a perspective for the client to consider. Once the coverage items have been discussed, Mark III then helps the client create a strategic plan.
Mark III, with the client’s input, will create an employee benefits strategic plan. The strategic plan will follow the SWOT analysis method.
A SWOT analysis identifies the following:
- Strengths of the current benefit plan.
- Weaknesses of the current benefit plan.
- Opportunities to improve the current benefit plan.
- Threats to the current benefit plan.
Once the SWOT analysis has been completed, a strategic plan will be developed based on the results.
Typically plans include 2 to 3 year strategy incorporating budget, plan design, contribution strategy, and wellness goals. Mark III has consistently guided the client working in conjunction with the county based on its budget.
Strategies can be developed with long-term goals, discussing the various ways to achieve the goals noted. Often these are ever-changing, dependent upon plan performance in comparison to budget, whether recommendations are taken on plan renewal action, elected official decision making, pay raises, and the marketplace in general.
Get Estimates at least 7 months prior to new Plan Year
We deliver accurate renewal estimates 7 months prior to the start of the new plan year, which is months in advance of the renewal delivered by the payor.
This allows your organization to accurately budget for the upcoming Fiscal Year and not be surprised if there is a cost issue with the medical plan.
So rather than being caught off guard if there is a challenge, planning and bidding can be done to give your organization multiple renewal options.
Prior to receiving the renewal from the carrier/vendor, Mark III evaluates the initial renewal package and gauge the competitiveness of their offer.
Once we have completed the initial evaluation, we will meet with your organization to deliver our initial assessment. Based on the initial results of our meeting and how satisfied we are with the renewal, the next step will be determined. If the renewal is competitive and there is not a significant financial or benefit change that is required, no action would be taken. If the response from the carrier/vendor were uncompetitive, then further negotiation would take place. If a satisfactory response from the carrier/vendor does not occur, the Mark III would market the plan in question to see if a more competitive offer can be attained from another source.
Stop Loss Insurance Evaluation
Mark III regularly reviews stop loss impact and the value for your organization. We also review the competitiveness of the rates offered for specific and aggregate protection as well as the value of the aggregate coverage versus the premium paid, whether with the TPA or a third party stop loss carrier, reviewing both plan experience, stop loss reimbursements, medical plan trend year over year, and leverage trend factors used by stop loss carriers.
Medical Plan Claim Audits & Dependent Eligibility
Mark III can arrange for an audit of your claims payor to review for:
- Eligibility Confirmations
- Claims Pricing Accuracy
- Timeliness of Payment
- Compliance Contract Terms
- Duplicate Payments
- Coordination of Benefits Review
- Non-covered Procedure Review
Our experience is in the Public Sector and is important because your employees have different needs and expectations than other industries.
Mark III partners with a firm to evaluate payor discounts to determine if current and potential networks provide competitive solutions.
Pharmacy Plan Management
Mark III has extensive consulting experience with pharmacy plan management, whether wrapped into the medical or through a third-party vendor. We have worked with third party administrators that provide pharmacy administration through various pharmacy benefit managers, using their leverage to get the best value for our clients.
Whether under one carrier or carved out, we exam utilization patterns to determine population disease states, generic versus brand utilization, and specialty drugs costs. Data is shared with all parties to ensure care management needs are addressed where needed if there are gaps in care issues due to non-compliance.
We review the need for design levers such as DAW, Step Therapy, quantity level limits, controlled drug programs, required maintenance mail order, specialty drug care management programs, deductible plan designs, and overall education regarding pharmacy. Annually, data is used to determine plan design needs based on employee feedback, the employer experience, and budget needs.
You’re in Good Company
This is not an exhaustive client list. We serve over170 public sector clients across the Southeast. Please contact [email protected] for a complete list of references.