Health Plan Cost Management 34. Describe your experience assessing and implementing self-insured options.
• For any clients that have at least 100 eligible employees, Yates will conduct a feasibility study to determine if self-insured options are appropriate. The results of this study and collection of data. This will apply to any employees currently in or seeking a self-insured option or captive arrangement. This includes the collection and assessment of the prior 36 months: o Claims data (medical and Rx) o Prior renewals o Enrollment and plan participation • Additional items to explore in regards to implementation or assessment of a self-insured program include: o Actuarial risk assessment o Premiums vs. claims o Incurred but not reported o PBM management o Etc.
35. Please provide examples of how you have helped your customers manage and/or reduce healthcare costs.
• Cost management strategies will vary depending on their size and resources. Yates works with each client directly to ensure appropriate measures are taken to manage and reduce spend. Traditionally, we
will analyze and explore changes/updates to: o Deductibles/reimbursement arrangements o OOP o Copays o Co-insurance
• For larger employers (over 100 eligible), options to reduce spend can include strategies to address: o Disease management o Wellness programs o Network accessibility o Direct primary care o Rx spend and assistance programs
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