Benefits administration technology is the set of systems that runs a health plan day to day: enrollment and eligibility, claims processing, reporting, vendor integrations and the tools members use to find care and check their coverage. For a self-funded client, most...
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Benefits administration technology is the set of systems that runs a health plan day to day: enrollment and eligibility, claims processing, reporting, vendor integrations and the tools members use to find care and check their coverage. For a self-funded client, most...
Self-funded employers spend months vetting stop-loss carriers, provider networks, and third-party administrators (TPAs) before a plan document is ever signed. The pharmacy benefit manager, or PBM, rarely gets the same scrutiny, even though it typically represents 20...
Health plans rarely lose money to one dramatic failure. They lose it a few dollars at a time, spread across thousands of claims, in ways that are easy to miss until the numbers are added together. Payment integrity is the discipline built to catch that leakage, both...
Most self-funded employers can tell you what they pay in premium equivalents and administrative fees. Far fewer can tell you what their pharmacy benefit manager (PBM) actually earns on their plan, because that number is rarely in the contract in plain language. Two...
Every self-funded employer is feeling the same pressure right now. GLP-1 claims are landing on renewals in numbers nobody budgeted for, specialty drug costs keep climbing faster than wages, and a single high-cost claimant can undo a year of otherwise disciplined plan...
A few years ago, GLP-1s were a diabetes drug most benefits leaders barely thought about. Today they are reshaping pharmacy budgets across the country, and they will not be the last drug class to do it. Gene and cell therapy costs, already running into the millions of...
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