What is a Fiduciary and what do they do for a Health Plan?
The primary responsibility of fiduciaries is to run the plan solely in the interest of participants and beneficiaries and for the exclusive purpose of providing benefits and paying plan expenses. Fiduciaries must act prudently in order to minimize the risk of large losses. They also must avoid conflicts of interest. In other words, they may not engage in transactions on behalf of the plan that benefit parties related to the plan, such as other fiduciaries, services providers, or the plan sponsor.
If you are a plan sponsor, you are a Fiduciary to the plan. Your broker, Carrier, Re-insurance provider and other service providers are not. How can you possibly oversee a plan as a Fiduciary, without access to detailed claims information for both Medical and Pharmacy expenditures? You rented a network of providers, but do you know the quality of providers that are included in the network?
True Cost & Benefits has partnered with one of the most successful population health companies in the US, Community Care of NC. Community Care of NC has been managing more than 1 million Medicaid lives for nearly 15 years and has saved the State of NC more than 1 Billion dollars over the past 3 years. This technology infrastructure is now available for the first time to self-insured plans.
What does the analytics platform do?
Empowers Plan Sponsors with Actionable Data
- Aggregates data from multiple sources and vendors to provide a simple, clearview of what is happening across your plan
- Analyzes medical and pharmaceutical expenses to identify opportunities to impact utilization and conduct targeted outreach
Identifies Savings Opportunities
- Determines opportunities for potential drug switch savings and creates strategies to maximise the value of your pharmaceutical spend
- Shows plan sponsors how to help avoid hospital admissions and readmissions through early, cost-effective care and the appropriate venue for that care
Evaluates Vendor and Program Performance
- Provides impartial analyses of programs run by insurers, pharmacy benefit managers and wellness companies
- Delivers an independent and automated audit process of vendor performance and population management
Provides Insights into Clinical Quality and Cost
- Compares provider performance and costs directly with CMS quality benchmarks and Medicare pricing
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