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Employee Benefits Consulting
Market Trends...
  • Tasked with forecasting healthcare reimbursement changes / budgetary impact across the employer spectrum
  • Several leading EBCs are operating their own web-based health insurance exchanges
  • Healthcare reform initiatives require constant clinical, financial, political analysis to align present and future  healthcare benefit plans and administration; EBCs usually overlooked in pharma / medical device marketing strategy

Several firms listed above specialize in pharmacy benefit consulting. These include ArmsRx, KMR Pharmacy Advisors, PBIRx, Pharmacy Benefit Consultants, Pharmacy Outcomes Specialists and Pharmaceutical Strategies Group / PSG.  They focus on formulary management, prescription benefit plan design, pharmacy claims auditing, rebate management, medical versus pharmacy benefit coverage, retail/mail order/specialty pharmacy administration and other clinical/financial matters.  Through auditing and other means, they assess if the correct copays, dispensing/administrative fees, pricing and other financial or clinical claims adjudication edits are functioning as intended. They can also detect fraud, over-prescribing and other issues.

The larger employee benefit consulting firms like AON, Mercer, Segal, Willis Towers Watson, Xerox Human Resources also deploy staff members specializing in pharmacy benefits as part of their overall healthcare benefits consulting practices covering active employees, dependents, retirees, medical, dental, vision and other programs plus compensation, profit-sharing and other administrative / human resource functions.  

While the concept of "Big Data" and its associated analytics and management has been a comparatively recent trend in many industries, it has been a routine part of the employee benefit consulting and managed care / health insurance realms for decades.  Actuarial and risk management professionals have routinely engaged Big Data to assess past, present and future trends.  The cloud, accelerated analytic capabilities and advanced programming packages have made it easier / faster for them to execute queries and subsequently base decisions and direction on.

Transitioning into 2018, 2017 was a year of fluctuation as Obamacare crossed over into the Trump era.  There was significant change underway for employee benefit programs.  The Employer Mandate Compliance requirements of the ACA was in full swing.  Employers with 100 or more full-time/full-time equivalent employees are required to offer minimum essential coverage to at least 70% of full-time employees and dependents.

Prior to 2017, in 2016 compliance was required at 50 or more full-time/full-time equivalent employees and at a 95% threshold. A compliant offer of affordable minimum value coverage will resolved penalty exposure. Behavioral healthcare is also part of the requirements based on the Mental Health and Parity and Addiction Equity Act. There must be parity between medical/surgical and mental health/substance abuse coverage.

The IRS will be implementing auditing initiatives to verify employer compliance.  As 2016 was the first year of composite reporting, some leniency was expected as some errors in the implementation and administration of the ACA measures was expected to carry over from 2015.  However, the IRS more closely audited employers to assess "good faith" compliance with the ACA standards.  There may be significant penalties for those who do not demonstrate they have taken assertive steps to implement and manage the required benefit changes.  2018 will require thorough alignment with the ACA standards moving forward.

To gain maximum value, reduce costs and understand the changes and complexities of healthcare benefits, employers and other organizations are relying on brokers and employee benefit consultants for wider, deeper analytics and increasingly competitive rates. Clients are seeking ongoing guidance in managing changes required through healthcare reform measures which impact care, costs and coverage. They are looking to employee benefit consultants to help them manage rising healthcare costs which impact their employees and dependents as well as the profitability and financial well-being of their organization.

As companies acquire or merge with other companies, benefit consultants and brokers play integral roles during the process. It is crucial employee benefit costs are accounted for in the finances of merger and acquisition transactions. Once deals have been completed, benefit coverage continues and differences between the legacy and new organization benefit designs must be accounted for.  Healthcare benefits, which can include medical, pharmacy, dental, vision, rehabilitation, disability and other care facets, continue to be more closely managed.  Health insurance companies and managed care organizations seek to offer more services as a marketing / revenue driver but continually are seeking ways to cut costs and risks for themselves and their customers.
... This is a list of leading Employee Benefits Consulting Firms and Health Insurance Brokers; scroll down for managed care presentations, employee benefit trends ....
... Digital marketing, the ACA and other factors are changing the way healthcare insurance is marketed; visit the resources below to get more insights ...
... Employee Benefit Consultants (EBCs) have significant roles in how new and existing medications are managed in prescription benefit plans which impact market access; learn more from the resource below ...

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