Reduce healthcare costs and comply with Sarbanes Oxley

Transcription

1 The most comprehensive health benefits measurement system available on the market today for self-insured employers. Reduce healthcare costs and comply with Sarbanes Oxley Along with many financial advantages businesses face today, the self-insured health plans adopted by thousands of companies, government jurisdictions and labor organizations present several significant risks and challenges. Double-digit medical inflation, skyrocketing drug costs, the inherent risk of self-insuring and expanded reporting requirements under Sarbanes-Oxley are making it almost mandatory for employers to measure the performance of third-party administrators and pharmacy benefit managers. Healthcare expenditures alone in the United States total almost $2 trillion. In 2005, employers spent an average of $4,024 for single coverage and $10,880 for family coverage and this year employers will spend over $7,000 per employee per year on health benefits. Potential risks inherent in self-insured health plans: Payment of claims may not be made according to Summary Plan Document Relying on internal controls of third-party administrators and pharmacy benefit managers Relying on policies and procedures of third-party administrators and pharmacy benefit managers may have cost implications Discrepancies in funding Lack of stop-loss management may result in overpayments Recovered overpayments may not reach your account Weak other party liability monitoring may increase your exposure Contracted care management services may not result in adequate ROI About HDM Healthcare Data Management, Inc. (HDM) is driven by our customers need for accountability of healthcare costs and plan administration as we help self-insured employers reduce the cost and risk of paying medical and pharmacy claims through auditing and data management services. Since 1992, HDM has become the leading independent source of cost reduction, risk management and Sarbanes- Oxley compliance services for sponsors of self-insured health, dental and pharmaceutical plans. HDM successfully offers the most comprehensive health benefits measurement system available on the market today for employers to maximize their value and accountability of health benefit programs..

2 Maximizing the value & the accountability of your employee health benefits HDM offers services and technology to evaluate both historical and current health plan operations that provides the assurances and cost savings that our customers need. HealthAudit: Solution for Self-Insured Health Plans HDM s HealthAudit a retrospective audit that provides an extensive review of employer health plans administered by third-party administrator and pharmacy benefit managers, and others. It offers clients a detailed analysis of past performance, monitors contract compliance, evaluates discounts/rebates, audits claims, recovers overpayments and assures compliance with Sarbanes-Oxley and other auditing standards while identifying performance issues that result in recovery of past overcharges, errors and future savings. The audit sets a performance baseline, identifies the need for ongoing monitoring and creates an action plan to reduce costs and manage risks. BenefitsWatch: Solution for Healthcare Cost Management HDM s BeneiftsWatch is a proprietary web-based analysis tool that provides ongoing financial surveillance, cost management and performance analysis of medical, pharmacy and HSA accounts and other employee programs through a web-based decision support software application drawing on an enterprise healthcare data warehouse. With BenefitsWatch, employers require tools to manage medical loss ratio, measure the performance of vendors and verify cost containment. BenefitsWatch is delivered as an ASP. Our Commitment At Healthcare Data Management, we believe in providing the best service and support to our customers. We have a professional approach when working with plan administrators. Our service will help plan administrators improve performance and create an opportunity to implement a plan for continual improvement. We also understand the business relationship between the employer group and the healthcare benefits administrator is very important to both parties. Our goal is not to disrupt the business relationship but to remain independent. Additionally, we are committed to keeping customer information confidential and will not give, sell or trade data to any third-party for any purpose. Contact Us Maximize the value and accountability of your employee health benefits. To learn more about our leading-edge software solutions for self-insured employers, contact a Healthcare Data Management representative today at or visit us online at Healthcare Data Management, Inc West Dekalb Pike, Suite 202, Wayne, PA

3 Finally a solution that measures performance, evaluates contract and SPD compliance plus recovers overpayments. Best-of-breed solutions for self-insured health plans HDM can help health plans with at-risk payors reduce the cost of paying medical and pharmacy claims through data mining and auditing services. HDM s HealthAudit is a retrospective audit of third-party administrators and pharmacy benefit managers that determines whether or not an employer has been getting paid correctly for in healthcare coverage over the past three years. HealthAudit provides an extensive review of employer health plans and offers clients a detailed analysis of past performance, monitors contract compliance, evaluates discounts/rebates, audits claims, recovers overpayments and assures compliance with Sarbanes-Oxley and other auditing standards while identifying performance issues that result in recovery of past overcharges, errors and future savings. The audit sets a performance baseline, identifies the need for ongoing monitoring and creates an action plan to reduce costs and manage risks. Main Features: 100% Claims Analysis and Focused Claims Review Construction of a data warehouse; analysis on benefit design, contract provisions and industry standards; potential questionable payments and claims identified Operational Review Onsite operational review conducted at the TPA s facility with the goal of evaluating the control environment and assessing the risk of fraud/error Discount Audit or Rebate Rx Audit Audit of the provider discount arrangements for medical claims and manufacturers rebates for prescription drug claims Dependent Eligibility Audits Utilize dependent eligibility data files to categorize dependents, make requests, monitor responses and evaluation Contract Compliance Audit Recommended contract changes based on industry s best practices derived from review of contract terms, summary plan description, and accounting, reporting and contracted services Financial Reconciliation Performed utilizing administrators and PBM reports and client banking records to assure the adequacy of the funding requests, and reconcile funding and payment banking records Post Audit Identified problem areas and causes, contract compliance issues and internal control improvements suggestions, corrective actions and future cost savings recommendations

4 Maximizing the value & the accountability of your employee health benefits With skyrocketing costs of healthcare, prescription drugs and reporting requirements, you need to know how your self-insured employee health plan is performing. Key Benefits: Reduced Claims Exposure Reduces claims exposure and improve claims processing performance, proactively manages health expenses, prevents overpayments before they happen and identifies overpayments and other party liability issues Improved Performance Uses performance evaluations to create a plan for improvement and evaluates internal controls of your organization Furnished Intelligent Reports Mine health care data for valuable information and decision-making This level of detail provided by HealthAudit will give you actionable information to allow your company to meet Sarbanes-Oxley and other reporting requirements with confidence and to recover overpayments that often equal two to five percent of total payments. You will also gain a basis of understanding that can support improvement of current controls and/or negotiation of more favorable agreements in the future. Completion of the HealthAudit process sets a foundation with reliable metrics for ongoing measurement of prescription drug expenditures using HDM s web-based BenefitsWatch. The same data collected for audit can be instantly engaged and derive ongoing recurring revenue. About HDM Healthcare Data Management, Inc. (HDM) is driven by our customers need for accountability of healthcare costs and plan administration as we help self-insured employers reduce the cost and risk of paying medical and pharmacy claims through auditing and data management services. Since 1992, HDM has become the leading independent source of cost reduction, risk management and Sarbanes- Oxley compliance services for sponsors of self-insured health, dental and pharmaceutical plans. HDM successfully offers the most comprehensive health benefits measurement system available on the market today for employers to maximize their value and accountability of health benefit programs. Contact Us Maximize the value and accountability of your employee health benefits. To learn more about our leading-edge software solutions for self-insured employers, contact a Healthcare Data Management representative today at or visit us online at Healthcare Data Management, Inc West Dekalb Pike, Suite 202, Wayne, PA

5 Now there is a decisionsupport tool to track performance and verify costs and risks of your self-insured health plan. Single source solution for managing healthcare costs Now there is a comprehensive decision-support tool to track the performance of your self-insured health plan to measure and verify costs and risks, manage complex vendor relationships and meet reporting requirements with confidence. HDM s BenefitsWatch gives finance executives, benefits managers, internal auditors and medical directors the accurate and timely information they need to keep health care costs and quality in line with expectations. A proprietary web-based analysis tool, BenefitsWatch provides on-going financial surveillance, cost management and performance analysis of medical, pharmacy and Health Savings Accounts (HAS) and other employee programs through a web-based decision support software application drawing on an enterprise healthcare data warehouse. It simplifies what had been a labor-intensive process of tracking health vendors. It allows you to compare the performance of vendors and use that information to implement a best-practices strategy of continuous improvementwith BenefitsWatch, employers require tools to manage medical loss ratio, measure the performance of vendors and verify cost containment. BenefitsWatch is delivered as an Application Service Provider (ASP). Main Features: Web-Enabled Support Tool Driven by an enterprise healthcare data warehouse and delivered as an ASP Vendor Management Tracking vendors, performance monitoring, single source for vendor reports, contract management and summary plan documents Data Warehouse Single source for claims, eligibility and benefits data COST AND UTILIZATION REPORTING Benefits analysis, financial/actuarial, benchmarking, quality of care, medical and disease management, auditing and performance HDM designed this innovative software tool to make it easy to get the information you need. Just with one look and you will realize that it delivers all the performance capabilities and ease-of-use that you would expect from the leader in solutions for self-insured health plans. BenefitsWatch has a friendly menu-driven interface which gives you quick access to any information in the system.

6 Maximizing the value & the accountability of your employee health benefits The robust reporting of BenefitsWatch will allow you to pinpoint health expenditures, benefit design compliance, medical loss ratio, financial analysis and to identify recovery opportunities. Key Benefits: Ongoing cost management system Monitor vendor performance Improve administrator processes and performance Reduces overpayments Limit claim exposure Intelligence from claims analysis leads to better employee benefit decisions Monitor stop-loss Model benefit design BenefitsWatch allows better health benefit decisions and vendor management assessments and represents a natural evolution of existing business intelligence technologies. It allows managers and decision-makers to visualize, manipulate, and project essential health benefits metrics in an easy-to-use web-delivered environment. By combining the best aspects of reporting, OLAP, BenefitsWatch provides the perfect blend of collaboration, connectivity, and interactivity for a true breakthrough in decision support. typically achieve a significantly greater return on investment than simple data warehousing services alone.. About HDM Healthcare Data Management, Inc. (HDM) is driven by our customers need for accountability of healthcare costs and plan administration as we help self-insured employers reduce the cost and risk of paying medical and pharmacy claims through auditing and data management services. Since 1992, HDM has become the leading independent source of cost reduction, risk management and Sarbanes- Oxley compliance services for sponsors of self-insured health, dental and pharmaceutical plans. HDM successfully offers the most comprehensive health benefits measurement system available on the market today for employers to maximize their value and accountability of health benefit programs. Contact Us Maximize the value and accountability of your employee health benefits. To learn more about our leading-edge software solutions for self-insured employers, contact a Healthcare Data Management representative today at or visit us online at By combining both the findings from HDM s HealthAudit with the concurrent data from BenefitsWatch, clients will Healthcare Data Management, Inc West Dekalb Pike, Suite 202, Wayne, PA