Presentation of Capabilities for
Protecting what you’ve built since 1949.
2800 Century Parkway Suite 300 Atlanta, GA 30345
company name
Our Expertise Each valuable, together powerful
Thank you for the opportunity to respond to your RFP. We are excited about the prospect of partnering with your company and are confident that our approach will provide exceptional value to your employee benefits program. Since 1949, Yates has been an independent, family-owned agency specializing in employee benefits consulting. For over 75 years, we have built strong, lasting relationships with our clients, understanding that these connections are key to mutual success and growth. We have thrived by remaining flexible and adapting to market changes, while staying true to our commitment to our team, community, and our reputation for delivering high-quality service. We focus on trust, pride, and long-term vision, which allows us to provide personalized, hands-on attention that fosters strong partnerships. We believe that this close-knit, collaborative approach enables us to offer solutions tailored to your specific needs, ensuring we all succeed together in ways that other firms simply cannot match. We would be honored to work with your team and look forward to the opportunity to demonstrate how our expertise, dedication, and values can help drive the success of your employee benefits program.
Table of Contents
Employee & Employer Service Model
Company Information 4
Compliance
21
11
Strategy & Marketing
Financial Analysis
Enrollment & Communication 24
38
28
Mergers & Acquisitions
Programs & Technology
Wellness
49
9 15-17 44
47
Fees & Contracting
51
Company Information
Yates Story
Dan Yates Jr. and Alan Yates Sr. formed Yates Insurance Agency in 1949. Yates LLC remains independently owned and has grown to become one of the largest independently owned agencies in the Southeast. All of the current stockholders of Yates are employees of the company, and there are no shares held by any outside investors. Today, we are one of the largest privately held agencies in the Southeast. Yates represents the past, present, and future. It's all about relationships to us, because we believe those relationships are what build future opportunities. Our commitment is unmatched. As our agency continues to grow and mature, we remain committed to the same principles shared by Dan & Alan Yates over 50 years ago: "We are going to look after our clients and prospects needs like they are our own, and our goal each day is to do our best."
Please visit our website to read client feedback, which we proudly showcase as a testament to our long-standing commitment to excellence since 1949.
www.yatesins.com
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Meet the Team
Brandie Andermann Sr. Account Executive
Billy Eissler Client Executive
Billy’s primary objective is to maintain strong relationships with our clients, working closely with the team to accomplish this goal and ensure clients’ needs are exceeded. He has been in the insurance industry for the past 10 years, including 8 years at a national brokerage firm, where he gained extensive experience in evaluating current benefit offerings to control costs and risk while maintaining an industry-leading benefits program. His focus is to present innovative strategies that meet the evolving needs of our clients in the ever- changing employee benefits landscape.
Brandie brings 19 years of experience to the team. She spent 17 years at a national brokerage firm, where she specialized in working with large, multi-site self-funded clients throughout the Southeast. She then transitioned to a major health insurance carrier selling group medical. Brandie is known for her strategic thinking and ability to build lasting relationships based on exceptional service and execution. She’s passionate about working directly with clients, helping them create and implement tailored strategies. Her strengths include self-funded arrangements, data analytics, benchmarking, and employee engagement.
Brooks Fischer Managing Partner
Charlie McDaniel Client Executive
Brooks holds a BA degree from Washington and Lee University and an MBA from Emory University. After working in the banking and real estate industries, Brooks joined the agency in 2011. Brooks earned his CRIS designation in 2012 and completed the Insurance Executive Program at UNC Chapel Hill in 2013. In addition to handling the property & casualty insurance programs for his own clients, as a Managing Partner at Yates, Brooks oversees special projects within the agency and maintains responsibility for carrier and broker relations.
Charlie has been in the employee benefits industry for 15 years. Prior to joining Yates, he spent 12 years at the largest privately held ancillary carrier in the U.S. as an independent life & health insurance agent. Charlie focuses on developing long-term relationships with his clients with an emphasis on exceptional service and consistent communication. His experience in the industry allows him to best advise his clients on how to properly administer their benefits program and manage employer costs, while also delivering value and competitive product offerings to their employees.
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Meet the Team
Resa Carter Senior Account Manager
Paige Duckworth Account Manager
Paige started her career in the healthcare sector, focusing on medical coverage, before transitioning to the brokerage side to broaden her expertise and gain a deeper understanding of employee benefits. Over the past 6 years, she has developed a strong passion for advocating on behalf of clients. Paige finds great fulfillment in helping both employers and employees navigate the complexities of benefits, ensuring they receive the support and guidance necessary for success.
Resa has worked in the employee benefits industry for 20+ years bringing a wealth of knowledge and experience to her clients and their employees. Resa has established strong and long-standing relationships with her client’s human resources department – supplementing daily tasks of benefits administration, claims resolution and overall employee benefits-related support. Resa also manages each of her client’s annual renewal, marketing efforts, implementation of benefits and further employee education.
“We are going to look after our clients and prospects needs like they are our own, and our goal each day is to do our best”
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The Yates Employee Benefits Experience
At Yates, we believe that exceptional service and dedicated account management are at the heart of a successful employee benefits strategy. Our consultants don’t just create a benefits plan and walk away—they work alongside you, offering ongoing support to ensure your program evolves as your company grows and changes. We provide proactive, hands-on account management to address any issues, offer guidance on plan adjustments, and help optimize your benefits offerings for maximum value. The team identified in this RFP will be the same group dedicated to working with you moving forward. From the producer to the account executive to the account manager, we collaborate closely as a team to address your needs and solve any challenges that arise. Our dedication to providing exceptional service and working together ensures that we deliver the best solutions for your employee benefits program. Your Team Whether it’s ensuring seamless implementation, managing employee communications, or navigating industry trends, our team is always available to answer questions, solve problems, and provide the strategic advice you need. This continuous support ensures that your benefits program runs smoothly and remains aligned with both your business objectives and your employees’ needs.
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Business Details
How many organizations does your company currently adminsiter benefit plans for? Within our Employee Benefits practice we provide broker services for over 200 employers. These employers reside in many parts of the country. Average Size of Clients The Yates team that would be working directly with the Digeronimo companies works with employers’ average size of 415 employees. The clients this team works with ranges from 100 - 1,300 employees currently. It’s important to note that in the past, the team has successfully worked with clients that have 5,000 employees. How many construction and manufacturing clients? The designated account team actively works with over 25 construction and manufacturing customers. Yates, LLC as a whole works with over 600 manufacturing and construction customers. Since our inception in 1949 we always had an extremely strong presence in the manufacturing & Construction industry. With that experience it has also allowed Yates to become one of the largest placer of Bonds in the Southeast. How many are Multi State? Over 50% of our manufacturing and construction customers operate Multi-State. That is either defined by job site location or the customer having physical locations in other state
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Who We Are. What sets us apart.
75 Years of Business
Average tenure of Employees 14 years
97% Client Retention
At Yates, we offer the best of both worlds: the deep knowledge and expertise of large consulting firms, combined with the personalized, hands-on service you can expect from a family-owned business. Our team is made up of seasoned professionals with decades of experience in the employee benefits field, and we leverage the latest tools and insights to create effective solutions. We prioritize building close, enduring relationships with each of our clients. We take the time to understand your unique needs and provide tailored support that aligns with your goals—ensuring that you receive the attention and care you deserve.
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Employee & Employer Service Model
Independence Excavating Service Model
Account Management
The Account Management team plays a critical role in fostering long-term relationships with clients, acting as the primary point of contact for all benefits-related needs. They provide consultative support by collaborating with their clients to better understand each client’s unique needs. The Yates team is dedicated to helping both the clients and their employees navigate claims and resolve any concerns that may arise. They will provide hands on support to resolve all claim or billing discrepancies.
Vendor Management
Vendor Management focuses on maintaining strong relationships with partner carriers to oversee the quality of services provided, ensuring that they deliver as promised to our clients. We work to negotiate the best possible terms and secure competitive rates, ensuring that clients get the highest value for their benefits investment.
Data Analytics and Reporting
Yates will gather and analyze data to provide valuable insights into employee usage patterns, claims, and overall plan effectiveness. By identifying trends, we will provide actionable recommendations to optimize benefits offerings while managing costs. Will also provide customized reports (more in reporting section).
Compliance and Regulatory
Yates will ensure that all benefit plans remain up-to-date with current laws and regulations such as the ACA, HIPAA, and ERISA. Your team will provide guidance on how to stay compliant, helping avoid costly penalties by proactively identifying changes in legislation that could impact their benefits offerings.
Enrollment and Communications Yates will assist in clear and concise communication during Open Enrollment and ongoing. We will focus on benefit program education and will leverage benefits technology to streamline the process.
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Client Management Approach
Strategic Planning
Assessment Cost management Benchmarking
Financial Management
Financial analysis Health Program review Funding Alternatives Modeling
Competitive Bidding Implementation Management Vendor performance Vendor Management
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Renewal Management
Vendor negotiations Plan design Modeling Contribution Strategies Budget Development
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Client Management Approach
Phase 1
Phase 2
Strategic Planning
Current Program Analysis
Collect and review SPDs, contracts, employee communication materials, historical claims experience, utilization and other important information. Benchmark plan designs, employee contributions and total cost. Discuss cost analysis and financial forecasting for the current program Review wellness offerings, disease management and employee engagement
Understand current and desired employee benefit program intentions Determine how the benefit program objectives align with your corporate strategy Assist in designing a responsible benefit program to protect your employees Evaluate current market trends and incorporate all strategies into a three-year action plan Create performance metrics to ensure success
Phase 3
Phase 4
Program Management
Action Plan
Renewal pricing, analysis and negotiation Financial and plan design analysis Monthly/quarterly claims experience Plan benchmarking Quarterly program reviews Compliance and ACA guidance HR Assistance Service calendar Monthly newsletter
Vendor Management Employee/Employer communications
Claim assistance and resolution Eligibility management support Compliance Updates Employer/Employee Education Programs designed to provide resources for making wise healthcare choices Updates on benefit trends and product innovation
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Service Timeline
Please see the proposed calendar of service interactions below, designed to support you throughout the year.
New Plan Year Kick-off Meeting Debrief on Open Enrollment and the renewal process What worked and what could improve. Finalize goals for the upcoming year and work on the multi-year strategy. Benefit program financial and claim deep dive. Launch any well-being initiatives
Quarter 01
Quarterly Check-in
Quarter 02
Discuss trends from the first quarter. Review any program updates and a communication/engagement check-in.
Mid-year Check-in Review claims and findings from the first half of the plan year. Renewal prep and finalize recommendations for marketing. Finalize recommendations for carrier, plan, rate and benefit changes. Plan and finalize communications strategy for Open Enrollment.
Quarter 03
Open Enrollment Kick-off
Quarter 04
Begin Open Enrollment Period Host education webinars and in-person meetings as needed Pre and mid open enrollment check-ins Finalize and close open enrollment Finalize year end projections. Make notes for next years strategies and recap the years successes and challenges.
New Plan Year
Monthly
Monthly Claim Reporting A cadence of calls (weekly, bi-weekly or monthly) based on the time of year to address any open items and check-ins
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Client Satisfaction
At Yates, Independence Excavating’s satisfaction is our top priority. We are committed to going above and beyond to exceed your expectations. To ensure we’re delivering the best service, we regularly survey our clients to assess their satisfaction. We focus our effectiveness in the following areas: How do we measure client satisfaction?
At Yates, our team makes it a priority to check in with clients regularly, even when there aren’t any issues. This helps show our clients that we truly value them and are always here to support them, no matter what. We schedule regular meetings with clients on a set cadence to track, review and discuss any open items, helping us monitor how quickly we are addressing and resolving client concerns. This also helps identify areas for improvement and ensure we remain on track. We monitor client retention rates over time. High retention rates are often a good indicator of satisfaction. We also consistently ask client for feedback during the renewal process to understand their experience and whether they feel their needs are being met.
Step 01
Communication & Relationship Building
Step 02
Client Meetings
Step 03
Client Retention
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Our Performance
What quality control processes or auditing do you perform to ensure the quality of your brokerage and consulting work?
Data-Driven Decision Making
Internal Audits
After implementing a benefits program, we continue to monitor and audit the effectiveness of the plan. This includes tracking enrollment data, analyzing claims data, and assessing how well the plan is meeting the objectives set out at the beginning. We conduct regular compliance checks with respect to federal and state regulations governing employee benefits. This includes ensuring that all plans adhere to requirements such as the Affordable Care Act (ACA), COBRA, HIPAA, and other applicable laws.
Client Feedback We are in constant communication with our clients to make sure all issues and concerns are addressed quickly and efficiently. This involves regular check-ins and satisfaction surveys. Our recommendations are based on market data, industry benchmarks and regulatory updates. We consistently track and analyze data to identify trends and areas for adjustments to ensure your benefits program remains competitive and compliant. Training & Professional Development The Yates team goes through continuous training on market trends, legal updates and best practices.
This ensures our recommendations align with your objectives and the industry standards.
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Supporting our Clients Yates will support employees by offering guidance and advocacy, and involve the carrier when the situation requires their direct intervention or when there are complexities that need carrier-specific resolution. Our goal is to ensure a smooth and positive experience for employees while minimizing the burden on your internal team. All of the support for HR and your employees are handled by your local support team. Claims Support
Initial Support If an employee has a claim issue, our team will assist them in understanding the benefits process, review their claim details, and help identify where the issue may have occurred (e.g., billing errors, eligibility concerns, missing information). We would correct the issue or provide guidance on how to file an appeal or resolve any issues internally.
Escalation & Education
Tracking & Follow-up
If the issue cannot be resolved or if further intervention is needed (e.g., a claim denial, incorrect payment, or delays), we would escalate the matter to the carrier on behalf of the employee. We will see this situation through until claim is resolved. We will provide the member with additional updates throughout the process and final education if needed based on the situation.
We track and report back all open and closed claim issues with the HR team. We monitor claim issues to see if there are trends with a specific vendor or if additional member education is needed for the entire membership.
Employee Education & Engagement through the Plan Year
Effective communication and engagement around medical benefits are critical not just during open enrollment to ensure employees fully understand and appreciate their healthcare benefits. The complexity of medical benefits can often overwhelm employees, leading to confusion or disengagement, which can impact their overall satisfaction and healthcare outcomes. We promote employee engagement and education by providing clear, client specific communication strategies that help employees navigate their benefits with confidence. By sending ongoing education throughout the year, the goal is to drive better health outcomes, optimize plan utilization, and ultimately enhance both employee well-being and plan success.
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Connecting Clients
To connect our customers with one another, we create opportunities for collaboration and knowledge sharing through various channels. This can include organizing networking events, webinars, or roundtable discussions where clients can share best practices, challenges, and insights on employee benefits. Additionally, we ensure our clients have access to a community of resources, including case studies, success stories, and shared experiences that can provide valuable learning opportunities. Our goal is to foster a supportive environment where clients can connect, learn, and grow together.
Benefit Enrollment Audits
Yates will provide benefit enrollment audits. As part of our comprehensive services, we regularly conduct thorough audits to ensure that your employee benefit enrollments are accurate.
These audits help identify any discrepancies or errors in enrollment data, ensuring that employees are correctly enrolled in the right plans and that the company avoids potential compliance risks. We review plan design, eligibility, contribution data, and enrollment processes to ensure everything is running smoothly. Our goal is to provide peace of mind that your benefits enrollment is accurate.
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Employee Retention & Enagagement
In today’s competitive job market, providing the right mix of benefits can impact employee satisfaction and engagement. We are working with our clients to find the right mix of benefit offerings to personalize their benefit package based on employee needs and demographics. There are a variety of solutions that we have packaged for our clients. What new offerings do you provide or are in motion to increase employee retention?
Flexible Benefit Packages
Offering flexible benefits packages can cater to the diverse needs of employees. For example, allowing employees to choose from a variety of benefits (e.g., wellness programs, pet insurance, child care assistance, or educational stipends) gives them more control over what matters most to them, which can improve loyalty. Mental health is a growing concern, and offering comprehensive mental health support—such as counseling services, stress management programs, and access to meditation apps—can significantly improve employee retention. A holistic wellness program that includes physical, mental, and financial wellness resources can show employees that you care about their overall well-being. Wellness and Mental Health Support Providing personalized recommendations based on employee demographics or life stages (e.g., new parents, retirees) can make employees feel like their benefits are directly aligned with their needs, enhancing their connection to the company. Personalized Benefits
Below are some creative strategies that can tie into your overall benefits package, wellness program or an incentive program.
Lifestyle Reimbursement Account
Work Clothes Account
Student Loan Reimbursement
Giving Savings Account
Pet Care
Allows employers to give money to employers for wellness and wellbeing expenses determined by the employer.
A Pet Care Reimbursement Accounts allows employees to be reimbursed for a variety of expenses related to caring for pets.
Allows employers to reimburse for work clothes expenses incurred by employees. Limited
Reimburses employees for student loan debt payments.
A Giving Savings Account allows employees to set aside funds for their favorite charities.
to clothes for employment.
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Compliance
Compliance & Legislation We understand the challenges today’s employers face, and we know you’re asked to take on more than ever before. Yates will provide a full spectrum of solutions for Independence Excavating, from employee facing to HR compliance education. We offer attorney-reviewed resources to help you stay in compliance. We also partner with trusted outside counsel to address legal issues, which allows us to bring in specialized expertise and diverse perspectives on complex matters. This approach ensures we have access to a broader range of legal insights and up-to-date industry knowledge, providing you with the most comprehensive and effective solutions for your employee benefits needs.
COMPLIANCE BULLETINS
The Compliance Bulletins provide timely, essential information on the latest legal updates. These newsletters cover a variety of legislative topics, including health care law and federal agency health and safety standards.
NEWSLETTERS
Remaining informed on a variety of legislation and trending industry topics is easy with our regular newsletters. These newsletters feature concise summaries of rule changes and other topics to help you catch up with the latest information.
EMPLOYER EDUCATION
We offer thousands of employer-facing materials to help you navigate a wide range of topics. Our resources include deadlines, training and comprehensive HR compliance overviews. These tools are designed to help you stay informed and ensure your benefits program remains compliant with the latest requirements. We provide a variety of trackers and checklists to help you stay on top of compliance requirements. The goal is to simplify the process, ensuring that you meet all necessary deadlines and regulatory standards, from plan design to reporting and documentation. COMPLIANCE TOOLS
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Compliance & Legislation
Yates offers annual compliance audits to ensure that your employee benefits program meets all requirements. Our team will assist with preparing and managing all necessary compliance documents, including Section 125 plan documents and signature-ready 5500 filings. Our goal is to make the compliance process as easy as possible and ensure everything is up to date and in line with the latest rules.
HEALTH CARE REFORM
Health care reform is a primary concern for employers. We have a vast array of materials on health care reform to make it easy to stay on top of the ever-changing laws associated with health care reform.
FMLA COMPLIANCE
Complying with the Family Medical Leave Act (FMLA) is an important responsibility for HR and benefit managers. We have easy-to-understand informational materials and forms you need to administer FMLA within the law.
COBRA COMPLIANCE
Administering the Consolidated Omnibus Budget Reconciliation Act (COBRA) is another vital HR responsibility. Access to numerous employer- and employee-facing educational pieces, as well as, model forms and notices to help you remain compliant.
HIPAA COMPLIANCE
Plan sponsors know the importance of complying with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and HIPAA Privacy and Security regulations, but sometimes the implications of those laws on a business can be unclear. We can help our clients understand HIPAA laws and stay current with updates, as well as make administration easier with notices and forms.
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Enrollment & Communication
Open Enrollment
Customized Pre-Enrollment Communications:
Effective pre-enrollment communication sets the foundation for a successful open enrollment period. The flyers, videos and brochures help ensure employees are aware of upcoming deadlines and help them make informed decisions. Face-to-face meetings create a unified platform where employees can engage in discussions, receive clear explanations, direct access to answer any benefits question and address any concerns in real-time. Employees feel more confident in making informed decisions and understanding of the benefits available to them. Face-to-Face Meetings Personalized email campaigns, brochures, and digital content designed to inform employees about upcoming changes, benefits options, and key deadlines. Education & Communications Ensuring each client receives dedicated, responsive support throughout the entire enrollment period, with your team readily available to address questions or concerns in real time. Focused Attention
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Open Enrollment
We prioritize client support during Open Enrollment. We will help you make sure employees have all the details they need to make the best benefits choices.
Before enrollment starts, we create customized communication materials that take into account the unique needs of your employees. We are flexible and add a personal touch because we know how important open enrollment is for everyone involved. We have translation services for all of our guides, flyers and videos, All of our communication services are provided at no additional costs. Effective communication and engagement around medical benefits are critical to ensuring employees fully understand and appreciate their healthcare options. The complexity of medical benefits can often overwhelm employees, leading to confusion or disengagement, which can impact their overall satisfaction and healthcare outcomes.
We promote employee engagement and education by providing clear, tailored communication strategies that help employees navigate their benefits with confidence. By fostering a strong connection between employees and their benefits offerings, we drive better health outcomes, optimize plan utilization, and ultimately enhance both employee well-being and organizational success.
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Employee Communication
QR CODE FLYERS
BENEFIT GUIDES
CUSTOMIZED VIDEOS for consistent messaging
POSTCARDS
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Strategy & Marketing
Marketing
We are confident in our process and will guarantee a seamless experience from strategy development through to open enrollment. Our approach will secure the best coverage for your needs, keep costs under control, and significantly enhance employee satisfaction.
Discovery & Strategy We will discuss and work with you to understand your specific needs, goals, and budget for coverage options. Then we will analyze the current benefits package and identify areas for improvement or enhancement to align with client goals (e.g., cost savings, employee satisfaction, comprehensive care). Develop RFP & Vendor Negotiation Yates will develop a detailed Request for Proposal (RFP) outlining coverage requirements, goals, and key performance metrics. We will negotiate terms with carriers to secure competitive pricing, better benefits, and additional perks (e.g., wellness programs, telemedicine). Vendor & Plan Design Selections Yates will evaluate vendor proposals based on coverage options, pricing, service levels, and reputation and negotiate to secure competitive pricing, better benefits, and additional perks. We will then partner with our client to discuss and finalize vendor selection. Contract, Implementation & Communications Yates will review and analyze contracts to ensure all terms and conditions are favorable and clear. We will coordinate with vendors to ensure smooth implementation of the chosen benefits. We will provide employees with easy-to-understand information about their coverage options and changes for the upcoming year.
Discovery & Strategy
Develop RFPs & Vendor Negotiation
Vendor & Plan Design Selections
Contracts, Implementation & Communication
Open Enrollment
New Plan Year
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Benefit and Cost Saving Strategies
Modify benefits offerings by re- evaluating plan designs, such as increasing deductibles, out-of-pocket maximums, or changing co-pays for certain services. This can help reduce premium costs while maintaining essential coverage. Implementing disease management programs for employees with chronic conditions (e.g., diabetes, heart disease) can help control future healthcare costs by encouraging better management of those conditions and reducing costly medical interventions. Providing resources such as coaching, support groups, and tools to manage chronic health conditions can reduce the need for expensive treatments and hospitalizations. Exploring self-funding or level funding options for health plans can provide more control over healthcare costs and cash flow, potentially leading to savings. In some cases, companies may form a captive insurance group with other organizations to pool risks and potentially lower the cost of employee health benefits. These strategies, when tailored to the specific needs of an organization and its workforce, can lead to substantial savings on employee benefits programs.
Plan Design Optimization & Contract Management
1
Health Risk & Disease Management
2
Alternative Funding
Arrangements 3
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Benefit and Cost Saving Strategies
Data Analytics and Reporting
Yates uses data analytics to identify patterns in healthcare utilization. By analyzing claims data, we can pinpoint high-cost areas or specific conditions that need to be addressed, enabling targeted interventions to reduce costs, Analytics can also help us determine the effectiveness of different benefits options, adjusting plan designs to focus on the most cost-effective treatments or services. Telemedicine is a key strategy in reducing costs within a group medical program, especially when considering the importance of site of care coverage. When employees use telemedicine for appropriate care, it eliminates the need for more costly visits to urgent care centers or emergency rooms for non-emergency issues. By promoting and educating employees on the benefits of telemedicine for routine consultations, employers can ensure that employees are accessing the right care at the right time, improving
4
Site of Care Cost Savings
5
health outcomes while reducing unnecessary healthcare spending.
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Strategic Outcomes
We’re excited to share some examples of successful outcomes we've achieved for our clients.
Pharmacy Contract Management
Situation
Solution
Outcome
Situation out pharmacy. Client was placed in a 3 year contract with early termination fees and a 90% rebate share. Yates won the BOR on a large self-funded client with carved
Client was approaching the 2nd year of the contract. We reviewed and analyzed the pharmacy AWPs, rebate share and contract terms.
Yates moved the client to a one year contract and eliminated early termination fees, improved AWPs in all categories and improved rebate shares.
Stop Loss Analysis
Situation
Solution
Outcome
Yates conducted a Stop Loss analysis by reviewing historical claims for frequency and severity. We compared the savings of lowered stop loss premiums to the increased out of pocket expenses for a higher Specific Deductible.
Client is considering increasing their specific deductible liability. The client’s concern is balancing risk versus potential cost savings from lowering their stop loss premiums.
Based on the results of the Stop Loss analysis, the client was able to make an informed decision to reduce their stop loss premiums by increasing their specific deductible.
Wellness & Point Solution Support
Situation
Solution
Outcome
Our team implemented a program to improve adherence to medication and care standards, as well as, provide
Employees with diabetes experience better disease management, fewer complications, and improved quality of life due to regular monitoring, education, and personalized care. The employer also achieved cost savings.
After review of our Client’s claim utilization, there is a prevalence of diabetes among the group's membership. The rise in cost is affecting the health plan cost and the goal is to improve health outcomes.
lifestyle and behavioral support for their diabetic population.
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Pharmacy Management
The pharmacy industry is facing rising challenges that are significantly impacting healthcare costs, particularly for self-funded clients. The lack of transparency from Pharmacy Benefit Managers (PBMs), combined with complex pharmacy contracts and rebate structures, is creating confusion and driving up expenses. As these issues continue to escalate, self-funded employers are seeking ways to better manage their pharmacy benefits. As a broker, we play a crucial role in pharmacy management.
Manage PBM Contracts
Cost Management Strategies
Utilization Management
Optimizing Pharmacy Benefits
Formulary Design & Management
Employee Education
Plan Design
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Pharmacy Management
Our goal is to analyze prescription trends, leverage client data, benchmark against industry standards, and effectively manage costs. We achieve this by ensuring that the pharmacy network offers broad access and convenience for employees while maintaining cost-effectiveness. We negotiate with pharmacy benefit managers (PBMs) to secure competitive pricing, discounts, and rebates. Additionally, we collaborate with PBMs to ensure the formulary includes appropriate medications and promote the use of lower-cost alternatives. We also focus on managing specialty drugs to address the high costs of biologics and complex medications.
Negotiate & Oversight on Pharmacy Contracts
PBM contracts usually range from one - three years. It’s important to stay on top of your contract and utilization trends. We will hold PBM’s accountable by reviewing pharmacy claims to ensure contract terms are being met and managing the PBM rebates.
Consider utilization management for GLP-1s. Cost Management Strategies
Specialty drugs account for a large percentage of overall health care spending. Engage with specialty pharmacies and consider specialty cost containment solutions such as manufacturer copay assistance solutions. Specialty Drug Management Regularly monitor claims data and conduct utilization reviews to identify patterns of high specialty drug usage. This can help identify opportunities to switch to lower-cost alternatives, optimize therapy regimens, and prevent overutilization. Utilization Management Biosimilars typically cost less, with an average savings as high as 45%. Encourage the use of biosimilars when available, as they offer a cost-effective alternative without compromising clinical outcomes. Consider utilization management for GLP-1s. Rx Management Programs Plan design plays a vital role in optimizing pharmacy benefits. Yates will work with your pharmacy benefit manager (PBM) to ensure that your formulary is optimized, with a focus on cost-effective specialty medications. Plan Design & Formulary Management
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How do you analyze the service model for your customers on a centralized versus a decentralized model? We are flexible and can work with either centralized or decentralized HR teams. Over the years, we've had experience with both models and understand that the ideal approach depends on various factors, such as organizational size, structure, geographical spread, and employee demographics. We will work with you to discuss your specific needs to determine whether plan harmonization across the organization is the best solution or if each region or location would benefit from more flexibility based on local needs. Our goal is to recommend the approach that best supports efficient benefits administration, ensures regulatory compliance, and maximizes employee satisfaction.
Centralized
Standardizing the benefits program would create a unified approach for the entire population, ensuring consistency across all locations. Yates would support the review of all plan and financial elements to harmonize the benefits offering. Communication efforts would focus on delivering consistent messaging while also assisting with local-level communications. Compliance could be effectively managed through regular audits to ensure that all locations remain aligned. Additionally, a centralized program would streamline administration and minimize redundancy, making the process more efficient overall.
Decentralized
Supporting a decentralized HR team requires offering flexibility and customization to meet the needs of each location based on its demographics and geography. Yates would collaborate with each team to ensure personalized communications for each location. Compliance would still be managed through regular audits. We would also have regular meetings with all locations to make sure all locations feel supported and connected. This approach allows for strong support of local networks and will require collaboration with each location's HR teams to better address their specific challenges and needs.
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In medical benchmarking, the ongoing metrics shared with clients to keep them informed can vary based on the specific focus of the benchmarking initiative (e.g., clinical outcomes, operational efficiency, patient satisfaction). However, the following are some common categories of metrics that are typically tracked and reported to clients: Benchmarking
Client Meetings Yes, we absolutely encourage in-person meetings when necessary. Within the employee benefits space, there are so many moving pieces that sometimes sitting down for a strategic discussion provides significant value. That being said, we don't believe every meeting needs to be conducted in person. We have the tools and capabilities to connect with all of our clients, whether virtually or in person. Benchmark Data Our benchmarking approach combines data from our in-house clients, who voluntarily provide information about their health plans, with a variety of national benchmarking data. The health analytics platform we utilize also provides robust benchmarking in real time. We place a strong emphasis on national benchmarking studies, as this enables us to offer more comprehensive and detailed metrics to our clients across the country. Benchmark Timing Benchmarking can be provided on either a quarterly or annual basis. However, depending on the metrics being evaluated, it is often more meaningful to review certain items annually, as those metrics are typically updated on an annual basis. While
Benchmarking Metrix
Cost Trends
Analyze the cost of premiums and out of pocket expenses. Compare costs to similar sized employer groups Quarterly or Annually
Cost per Employee
Track total cost per employee Contribution arrangements HSA funding Quarterly or Annually
Enrollment/Participation Trends Enrollments by plan and benefit Monthly or Quarterly
Claims Data
Compare Medical and Rx claims month to month Overall spend and the split between Medical/Pharmacy Monthly, Quarterly and Annually
quarterly data can be useful, the full value of some benchmarks is realized with an annual review.
Health & Wellness Programs
Review Gaps in Care, Preventive Care, Chronic Disease Management Quarterly
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Based on the information received, what recommendations do you have for other lines of service? We would like to learn more about your current strategy and objectives to ensure that any recommendations we make align with your broader goals. We would like to make sure you have robust health analytics platform in place. An in-depth claim review would determine if point solutions around diabetes or musculoskeletal would provide value to your employees. Based on the information we've received so far, our initial recommendation is to gain a deeper understanding of the demographics of your groups, the enrollment breakdown across each plan, and the pricing structure. Currently, there is a broad spread between the medical plan offerings and contributions. The Di Geronimo medical plans are a dual option traditional and HDHP. There’s a wellness program offered alongside the medical plan with a premium incentive. Winter Construction offers a dual option HDHP with a third narrow network HNOnly (HMO).
One of our first steps would be to conduct a harmonization and a full benchmarking analysis for all of your entities.
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Financial Analytics
Underwriting Support
At Yates, we are here to help you manage all aspects of your employee benefit program and while we do not have underwriters directly on staff, we do have a team of professionals who have completed advanced underwriting training and possess extensive knowledge in the underwriting field. Our team brings valuable carrier experience, having worked with both fully insured and self-insured medical plans, allowing us to provide in-depth insights and support. With our support, you will be able to optimize your plan design, manage costs, and reduce risk in today’s ever-changing benefits landscape.
Claims Analysis and Forecasting
We will review and analyze past claims to help predict future spend and utilization. This will allow us to identify areas of opportunity for cost containment. Yates will review plan options and help model plan design that outlines coverage changes as it relates to cost savings. Pricing and Plan Design Assessing financial risk is a critical piece of benefits program management. We will conduct a thorough risk analysis through our reporting capabilities to determine the financial impacts of high-cost claimants and how it relates to Stop Loss for clients that are or are considering self-funding. Risk Assessment and Management For self-funded clients, we will create cost projections for the upcoming plan year and work with our client to set a realistic budget for the upcoming plan year. Cost Projections and Budgeting
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Reporting
Effective employee benefits programs require regular reporting to ensure they remain aligned with organizational goals and employee needs.
Monthly
Monthly reporting typically focuses on key metrics Enrollment figures
Claims activity Plan utilization
providing a snapshot of how the benefits are being used.
Quarterly
Quarterly reports offer deeper insights, including trends in claims costs, employee feedback, and any adjustments that may be needed to improve plan performance. These reports often include benchmarking data to compare the organization's benefits offering against industry standards.
These reports serve as the foundation for any necessary adjustments to the program for the following year, such as plan design changes, cost-saving initiatives, or wellness program enhancements. Regular reporting at these intervals ensures continuous optimization and helps keep the benefits program efficient, cost- effective, and aligned with both employee needs and organizational goals. We use Springbuk for health analytics and reporting.
Annual
Annual reporting is a comprehensive review of the entire benefits program, analyzing: Cost trends Utilization Chronic disease management Plan performance Compliance with regulations Employee satisfaction
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Reporting
Below are a few examples of the reporting we offer, showcasing just a small part of the range of insights we can provide to our clients. The analytics we deliver help clients better understand their employees' healthcare needs, allowing us to recommend more effective benefits programs backed by solid data. We focus on identifying trends, leveraging predictive analytics, managing costs, and benchmarking against industry standards. While reviewing the data is key, it’s the actionable outcomes that truly make a difference. We can provide customized reports as needed.
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Negotiating and Managing Contracts
When negotiating medical contracts, we take a strategic, data-driven approach that leverages both our financial modeling capabilities and underwriting experience. Our goal is to secure the best possible outcomes for our clients, balancing cost and plan integrity.
Yates will begin the renewal process with a financial analysis that will help us develop a financial projection and determine our targets. This is based on cost drivers and utilization.
Financial Analysis
Leverage Underwriting Experience
The Yates team’s carrier and underwriting experience plays a critical role in negotiating contracts that are financially sound and tailored to your unique needs. We draw on our experience working with insurance carriers to evaluate risk.
Using the insights gained from our financial models and underwriting expertise, we work with the with insurance carriers to negotiate your contracts based on our analysis helping us secure favorable renewals and the best possible deal for you. Our ability to understand the carrier’s underwriting practices allows us to negotiate in a way that gets us the best possible contract terms. As part of the negotiation process, we also focus on the overall plan design and how it impacts the cost. We will have up front discussions to determine whether plan design adjustments need to be made as a strategy to manage plan utilization or to reduce premiums. Additionally, we explore cost-containment strategies like wellness initiatives, care management programs, and disease management services. Rate caps or guarantees for Medical can be valuable in budgeting in planning for future years and create stability for employees. However, for pharmacy contracts we recommend a one-year contract. Pharmacy and drug trends are changing rapidly and a multi-year agreement may lock you into pricing or terms that no longer align with the current industry changes.
Negotiate
Evaluate Plan Design & Cost Containment Strategies
Durational Approach
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Self-Funded Experience
Our team has extensive experience working with self-funded clients and brings a wealth of expertise in this area. Our team has a decade of experience working with self-funded clients understanding the unique needs and challenges associated with this funding model. Our team has developed fully insured equivalent (FIE) calculations and managing and analyzing Incurred but Not Reported (IBNR) reserves, ensuring that our clients have accurate projections of future claim liabilities. By monitoring and evaluating claims data in real-time, we help ensure that our clients are financially prepared for any fluctuations in claims activity, which is a critical part of maintaining the financial stability of a self-funded plan. Your Yates team will monitor stop loss activity, which is essential for mitigating risk and protecting self-funded plans from catastrophic claims. Our strategic approach to managing self-funded plans is driven by a comprehensive understanding of the financial, operational, and regulatory aspects involved, which allows us to identify cost- saving opportunities, enhance plan performance, and ensure compliance with the latest healthcare regulations.
Self-Funded Feasability
The Yates team can model the financial impact of switching from a fully insured plan to a self- funded plan, comparing total costs, potential savings, and risks. We take into consideration factors like claim volatility, administrative burden, and the flexibility of the benefits package. A self-funded feasibility study involves thorough data gathering, risk assessment, financial projections, and legal considerations. It also requires evaluating administrative costs and vendor partnerships, as well as comparing the financial benefits and risks of self-funding versus fully insured plans. With proper planning and evaluation, a self-funded benefits plan can offer greater control, flexibility, and potential cost savings, but it requires careful management and ongoing monitoring to ensure its long- term success.
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