An option is a right, not an obligation. A real option is a financial option adaptation. It supports real world decision making through the integration of new information into a framework useful for executive management and corporate finance.
Network Access, Cost Sharing, Involvement
Design and long term strategy. Alignment with an approach that manages direction to network providers and encourages employee engagement using financial incentives in both plan design and cost sharing arrangements.
Integration, Carve-Out
Managing the Rx spend using quantity limits, step therapy, prior authroization, formularies and negotiating the most favorable financial terms within a carrier's integrated (carved-in) PBM or with a stand alone, carved-out PBM.
Participation, Activity, Outcomes
Review of participatory, activity based and outcomes based wellness programs to determine whether any approach has a measurable opportunity to exceed an ROI hurdle rate when assessing the financial results from healthcare outcomes.
Contributions, Account Funding, Surcharges
Targets an employer contribution percentage to the total cost, redistributes employer cost across the tiers of coverage by setting constraints within tiers, allows for optimal configuration of tier structures, etc.
Capabilities, Insource, Outsource
Reviewing the internal capabilities with respect to subject matter expertise, technological resources and administrative services to assess whether to insource or outsource services necessary for compliance, managing appeal processes, answering questions, financing, funding, compliance, communication, reporting, and overall plan management.
Funding, Taxation, Reinsurance
ART includes, but not limited to, ASO with/out stop loss (e.g., specific, aggregate, aggregate specific deductible, advance dividend, etc.) and extends to using wholly owned or protected cell captive insurance company arrangements.
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