Our 5-Year Plan to Reduce Your Company’s Healthcare Costs by 75%
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Year 1 - Analysis
Understanding company culture and data. Every company is its own unique living organism. Our first year is dedicated to analyzing your company culture, existing benefits with what strategies, current claims, and positioning you for the next phase.
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Year 2 - Change
By year 2 we have implemented key strategies from our analysis, and begin paving our road towards success. Whether that is a PBM contract adjustment, MSK claims reduction, direct primary care and telemedicine construction, wholesale drug arrangements, etc.
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Year 3 - "All Cylinders"
Our plan is starting to come alive. We see the most changes in year 3 as our health plan begins taking us to new heights with noticeable change.
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Year 4 - Fine Tune
By year 4 we are maximizing revenue to make the the best health plan possible by fine tuning things on a granular level.
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Year 5 - Revenue Generating Profit Center
By year 5 your benefits plan is now a revenue generating profit center for you. now you see the results in reduced turnover, reduced training costs, and reduced healthcare costs - generating scalability and more retention. By year 5 you have likely saved 75% of your healthcare costs from all of the adjustments we made along the way.
Turn Your Health Plan Into A Profit Generator
Our mission is to revolutionize the outdated and misaligned systems of your healthcare plan, and transform it into a system that not only eliminates employee out-of-pocket expenses, excessive pharmaceutical costs, and yearly premium overages but also enhances staff productivity and reduces turnover.
Strategies We Leverage
Medical Cost Containment Strategies
Reference-Based Pricing (RBP) – Reimburse providers based on a multiple of Medicare rates instead of PPO-negotiated rates.
Utilization Management Programs – Implement rigorous prior authorization and case management protocols.
Claim Audits & Bill Review – Conduct detailed audits to eliminate billing errors and overcharges.
Centers of Excellence (COEs) – Direct members to high-quality, cost-effective providers for complex procedures.
Pharmacy Benefit Management (PBM) Optimization
Top-Performing Transparent PBMs – Partner with PBMs that offer pass-through pricing and rebate transparency.
Specialty Drug Carve-Outs – Separate high-cost specialty drugs from standard PBM contracts to manage them independently and more aggressively.
Direct Contracts with Manufacturers – Negotiate directly with drug manufacturers for better pricing on high-cost therapies.
Alternative Funding Programs – Leverage assistance programs or foundations to cover specialty medication costs outside the plan.
Network Design & Care Delivery Innovation
Robust National PPO Networks – Offer broad access while leveraging negotiated discounts.
Direct Primary Care (DPC) Contracting – Partner directly with primary care providers for flat-fee, unlimited access care.
Narrow or Tiered Networks – Steer members toward high-value providers using plan design incentives.
Onsite or Nearsite Clinics – Establish dedicated clinics to control cost and improve access for high-utilization employee populations.
