The main focus is the provision of advisory, analytics and placement services for employer provided group health (i.e., medical, prescription drug, dental, vision) and income replacement (i.e., life, disability, paid time off) plans utilizing expertise in analytics (i.e., proprietary business intelligence), business acumen (e.g., M&A, finance), risk management (i.e., stop loss), compliance & tax (i.e., nondiscrimination requirements, tax advantaged strategies) as a privately-held, analytics-as-a-service, boutique consultancy.


Healthcare Metrics — Analysis of Medical and
Prescription Drug Metrics in Assessment of Plan Performance

Utilization Management — Evaluation of Programs
Used in Providing Most Effective Care

Care Management — Evaluation of Activities to Manage
Conditions to Improve Care and Reduce Demand for Services

Network Analysis — Assessment of Network Contracts for Inpatient, Outpatient and Professional Services

Annual Trend — Development of Trend Statistics as
Part of Design, Utilization and Financial Assessment


Plan Design — Number of Tiers, Copayment Amounts,
Coinsurance %'s, Formulary Adoption, Access to Network

Drug Categories — Generics, Single Source Generics,
Brand (Single and Multi-Source), Lifestyle, Specialty

Structure —Type (Carve-In/Carve-Out),
Channels (Retail, Mail), Terms (Discounts, Rebates, Fees)

Formulary Management — Preferred Drug List
(Open/Closed Formulary), ACA Drug Lists (Preventive/Enhanced)

Utilization Management — Prior Authorization,
Step Therapy, Quantity Limits, Medication Possession Ratio


Connectivity — Databases (i.e., SQL, Oracle, ODBC),
File Types (i.e., CSV, Text), Folder Connectors (i.e., SharePoint)

Data Elements — Organization (e.g., Divisions), Demographics (e.g., Age, Gender), Claims Data (e.g., Inc & Pd)

Process —ETL (Extract, Transfer & Load),
Transform (e.g., Cleanse, Format), Model (e.g., Queries, Formulas)

Access — Cloud (i.e., Licensed Azure Tenant Space),
24/7 (e.g., Laptop, Mobile), HIPAA (i.e., Microsoft BAA)

Visualization — Reports (e.g., Customized, Interactive),
Dashboards (e.g., KPI's, Executive Summary, Interactive)


Identification — Identify Cost and Utilization
Drivers Analyzing Claims and Eligibility Data

Development — Develop Strategic Options and
Financial Models into Decision Making Framework

Evaluation — Evaluate Options from Design,
Funding, Benchmarks, Risk and Operations

Selection — Select Strategic Option, Set KPI's,
Measure Performance and Report Outcomes

Implementation — Plan Design Changes,
Operational Considerations, Vendor Updates


Specific Stop Loss — Excess Losses Over Predetermined
Dollar Threshhold Transferred to Carrier on Per Member Basis

Aggregate Stop Loss — Excess Losses Over Calculated
Dollar Threshold Transferred to Carrier on an Aggregate Basis

Retain — Assessing Strategies to Finance Rather Than
Transfer Losses Using Risk Management Logic

Neutralize — Analyzing and Implementing Processes that Reduces the Likelihood or Size of Unexpected Losses

Transfer — Evaluation of Risk Transfer and Attachment
Point Levels to Eliminate Catastrophic Risk Above Appetite


IRS — Internal Revenue Service Administers Code Provisions
Governing Various Types of Welfare Benefit Plans

DOL — Department of Labor Administers ERISA,
FMLA and Other Federal Labor Laws

EEOC —Equal Employment Opportunity Commission
Administers the Age Discrimination in Employment Act (ADEA)
and the Americans with Disabilities Act (ADA)

HHS — Department of Health and Human Services Office
for Civil Rights Enforces HIPAA Privacy and Security Rules

ACA — IRS, DOL & HHS Jointly Administer Affordable Care Act

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