4C Digital Health

Isn't it time to take control of your data? 👉👉 We're thrilled to be hosting our annual conference (next month!) where we'll share real insights that drive impact! 🎶 With over 20 thought leaders and special guest speakers, this event promises to be another blockbuster for public and private employers. See you in February! (Feb 19-20 | Wilmington, DE). ✅ Register Now!! https://lnkd.in/eB4MwxP7

Thank you Eric Bricker, MD as always for shining radical light on our inefficient and outdated healthcare system, this time focusing on claims processing … and what a mess indeed!  Employers write the healthcare checks for more than 180 million working Americans and you clearly illustrate how they have no idea what anything really costs, what they are paying for, or what it should cost. Let’s be real: no one has been watching these billions of claims being processed and adjudicated. Period. Except for the payers/TPAs--and that’s the proverbial fox watching the hen house! Sure, employers legally are fiduciaries for healthcare benefits. However, they traditionally relied on consultants and brokers (many of whom were conflicted and making commissions and bonuses from an employers’ TPAs, PBM, etc.) to manage their benefits.  Employers never had meaningful access to their own data anyway, so it was just too hard. This huge blind spot caused staggering consequences. Today, the costs for healthcare benefits employers pay for their employees is usually the second largest expenditure they make outside of wages! If this was a supply chain, would they keep looking the other way? Nevertheless, over the years it seems everyone just became immune to this mess and played along. However, I do see hope on the horizon. Employers are beginning to stand up. Urgency is being driven by employers who simply cannot take it anymore. There is also a clear and present business danger and enhanced litigation risk brought on by the Consolidated Appropriation Act of 2021. This new law (supported by the last two Administrations) has made clear that ALL public and private employers regardless of size and how insured must focus on their health plans and prudently oversee all their vendors and consultants … or else. There have been 3 lawsuits filed against employers this year so far, and the Department of Labor (DOL) is much more active. Employers must get tough and show actions that prove they are taking responsibility and becoming more accountable (and yes, I’m using “prove” in the way you may think). They need to be better contract negotiators, and they probably cannot rely on their payers and other conflicted vendors for analytics around their own data and reasonably believe it is trustworthy. I have heard my friends Jeffrey Hogan, Jamie Greenleaf AIF, CBFA, C(k)P and Julie Selesnick say they need help and analytics that are from arms-length companies that can provide unbiased findings and advice to help them understand very complex data. I agree completely. Companies like 4C Digital Health (shameless plug I recently joined the company) and Fiduciary In A Box can be those independent voices and arms-length arbiters that employers can trust to help them make better decisions. To employers out there: If DOL come knocking on your door, they will assume you have access to all your data and know what you are doing ... are you ready?   And seriously ... COBAL!!??

Some Advice to Employee Benefits Teams on Fiduciary Responsibility The Consolidated Appropriations Act (CAA) of 2021 introduced significant changes to your responsibilities. You are now responsible for ensuring there are no fiduciary breaches at your company. The C-Suite, Board of Directors, and other HR professionals are looking to you to prevent your company from becoming the next to face employee lawsuits, as seen with companies like Johnson & Johnson and Mayo Clinic. Key fiduciary responsibilities are: - Acting solely in the interest of plan participants - Acting with care, skill, prudence, and diligence - Paying only reasonable fees for necessary services I am going to make a assumptions that you are already completed the following tasks: 1. Removed "gag clauses" from all service provider contracts 2. Requested detailed vendor compensation information 3. Requested plan-level prescription drug data collection (RxDC) data from your pharmacy benefit manager (PBM) But, you still have the hardest one: 4. Developing processes and criteria for evaluating vendor performance Stay tuned for more posts from me on how to work with your claims evaluation vendors (Merative, Springbuk, Artemis by Nomi Health, 4C Digital Health, AMS (Advanced Medical Strategies), Health Data & Management Solutions, Inc. (HDMS), Certilytics, Accorded) or those used by your brokers/advisors. The key is to evaluate plan performance from your employees' perspective, focusing on overpayments for prescription drugs, adherence to plan documents (SPDs), and prudent benefit design decisions. Pointe Consulting LLC, Blake Zenger, MBA, Fiduciary In A Box

🚨 Attention Plan Sponsors! 🚨 Are you navigating the ever-changing legal maze of self-funded health plans? Join us for an essential webinar that will equip you with the knowledge and tools to protect your organization and your plan participants. Sign up today!

Mark your calendars! 4C Conference | Insights to Impact 2025 is coming. Stay tuned for more details and get ready to transform the healthcare world. #SaveTheDate #InsightsToImpact2025

Finding the right tools is key to unlocking the full potential of your self-funded plan. Need help navigating the complexities and finding the right solutions? Our team has the expertise and resources to guide you through every twist and turn. https://lnkd.in/ei_6CPD5

Open enrollment is almost upon us! Don't let rising healthcare costs and confusing regulations stress you out. Get the data you need to make informed decisions for your employees and your business.

"America is another name for opportunity." – Ralph Waldo Emerson Wishing everyone a Fourth of July full of opportunities and celebration! #FourthOfJuly #July4th #IndependenceDay

Self-funded health plans are gaining data independence to control costs and improve care. With expert support from partners like 4C Digital Health they're able to leverage their data to make informed decisions and deliver better outcomes for their members. #dataindependence #selffunded #healthcareinnovation https://lnkd.in/e2g4fdsv

Tired of overpaying for your self-funded health plan? Our comprehensive monitoring system uncovers savings you didn't even know existed. Learn more today: 4cdigitalhealth.com.