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Making Healthcare Costs Transparent
Feb 15, 2017   08:26 AM
by GM&A Corporate Healthcare Consultants

Making Healthcare Costs Transparent

From business to government to essential services like banking and healthcare, transparency is the name of the game in our current cultural climate. People crave honesty and uprightness from anyone or anything they are invested in, and understandably so. In healthcare, transparency is truly the future – but unfortunately, it’s only a rare few who understand and act upon that principle. When a healthcare consumer has no idea what services cost at his hospital or physicians group, it’s a dismal reality. All he knows is that he gets sick, he gets treated, and he hopes for the best.  

But in the health plan solution we offer, direct contracting, consumers get the exact opposite experience; in other words, they get the transparency they rightfully hope for as a healthcare consumer. That’s because their employer agrees with us upon a set of rates, and both sides are contractually bound to those rates. The employer, normally through its human resources department, makes it clear to the members of the plan what the costs are and we are openly communicating with all parties along the way.

From the healthcare consulting group (that’s us), to the human resources department, to company management and of course to the employees, we are all on the same page when it comes to healthcare costs; that’s the beauty of the direct contracting model. It’s an ecosystem that works really well for an organization that is trying to reduce healthcare costs while keeping the lines of communication open with its employees.

Now, we know what you might ask: “What if someone has an atypical situation with their healthcare?” Well, good news: If there are issues with an employee’s plan – say, there’s something strange, tricky or otherwise unusual about the care he requires for a condition – we are not afraid to get involved. We encourage employers to alert us in these situations, so we can intervene on their behalf to reduce costs for the employee. That’s a whole new layer of transparency, isn’t it?

For questions on reducing your organization’s health plan costs through the direct contracting healthcare model, contact GM&A today. We will be happy to provide you with more information. 

A Solution for the Obamacare Repeal
Feb 15, 2017   08:24 AM
by GM&A Corporate Healthcare Consultants

A Solution for the Obamacare Repeal

As we all know, Republicans on Capitol Hill are currently moving forward with long-anticipated plans for repealing and replacing the Affordable Care Act, more commonly known as Obamacare. Depending on who you listen to, this could mean 1) the end of the end for Americans who have health insurance through the individual Obamacare exchanges in their states, or a 2) new beginning for the Americans who were already covered by employer-sponsored health plans, but were angered over the rising premiums that private insurers have imposed over the past several years.

Which one is it?

So, which one is it? Maybe it’s a little bit of both – and maybe, just maybe, neither side has the answer. “The ACA made changes in every part of the health care system,” said Larry Levitt, senior vice president at the Kaiser Family Foundation, of the Affordable Care Act. “Virtually everyone has been touched by the ACA.” That’s true – and that’s why changes to it could bring about changes that are both positive and negative.

What’s the Solution?

For employers who are struggling to make a decision about what health plan option should be implemented as our lawmakers overhaul the current government solution, we suggest direct contracting. Direct contracting is a private employer health plan solution that is tailor made for mid-sized to large organizations. It can be entirely customizable for an employers’ needs.

Here is just one example: If an employer wishes to continue covering part-time employees (employees who work 30 hours a week who were covered because of the Obamacare employer mandate), they can – and, they can do it more affordably by working with experts who know the healthcare market enough to help them hand-pick the providers in their network.

The Shopping Cart Method

Direct contracting allows employers to choose which aspects of the Affordable Care Act they want to keep. In addition to the employer mandate aspect of Obamacare, employers can choose other parts of the law they wish to retain – such as keeping children on their parents' health plans through age 26. Time has shown this to be one of the most popular provisions of Obamacare, and employers who recognize that are free to make it part of their customized corporate health plan if employee demand requires it. This is the “shopping cart” method of corporate health plans – keeping what you like, passing on what you don’t like – and it works.

Direct contracting can be a welcome solution for the repeal of Obamacare, and employers need to investigate it before a full repeal takes place. To learn more about direct contracting from a firm that provides it as a solution, contact GM&A to request a complimentary health plan consultation.   

Making the Fate of the ACA Irrelevant to You
Feb 15, 2017   08:21 AM
by GM&A Corporate Healthcare Consultants

Making the Fate of the ACA Irrelevant to You

With a new President, and now a new Secretary of Health and Human Services, we’re continuing to hear that the Affordable Care Act will be repealed and replaced – but, if you listen to the people with mouthpieces, “portions” of the act will be retained. Often, they’re speaking of the popular, consumer-friendly aspects of the law such as children staying on their parents’ plans until age 26, etc. But what about the less talked-about parts of the ACA? Here are some aspects of the ACA that lawmakers are considering the fate of:

  • Cost-sharing      subsidies, AKA the money that goes to insurers to help protect low-income      healthcare consumers from paying too much out of pocket
  • The      individual mandate, otherwise known as the ACA’s requirement that every      American obtain health insurance or face a tax penalty
  • Consumer      protections in the ACA, which are the portions of the legislation that      make it a bit too easy for Americans to game the system – in other words,      wait until they get sick or injured to sign up for a healthcare plan (and      on the flip side, make it too easy for them to cancel that plan once they      feel better)

Congress and the new administration has a lot to consider when it comes to repealing and replacing the ACA – but as a consumer, employer or human resources person tasked with deciding how you and those in your organization obtain healthcare, you can avoid having to worry about the fate of the act altogether. How? By finding a privately funded alternative to provide the healthcare coverage you need.

Direct contracting is a completely private solution to the healthcare coverage needs of individuals, public employers, private employers and even non-profit organizations. It can cover the people you’re responsible for affordably and easily, with less red tape and lower overhead costs for those in charge. This is the healthcare solution you’ve been waiting for. To learn more about direct contracting, contact GM&A Healthcare Consultants at (325) 224-3245. We will be glad to answer your questions!

New Year, New Health Plan
Feb 15, 2017   08:19 AM
by GM&A Corporate Healthcare Consultants

New Year, New Health Plan

Now that it’s 2016, we are getting inquires on getting started with direct contracting during the open enrollment period – and that’s a good thing, because the beginning of the year is the best time to inquire. Every healthcare program requires some time to implement, and direct contracting is no exception. The truth is, if a company is serious about getting started with direct contracting for its employer health plan, then everyone should be prepared for the timeline to be up to six months in duration, from start to finish. Keep in mind, the steps include:

Consultation: The first consult is an important appointment that provides the potential client with all the necessary information on the direct contracting healthcare model. If you are interested in being a client, you want to schedule your consultation as early in the new year as possible.

Analysis: Once the client is on board, we perform an analysis of the company’s healthcare data – namely, examining the number of employees and dependents requiring coverage and analyzing their past claims data. This is important because it helps us identify the most appropriate providers to approach with contract proposals.

RFP: Next, we enter the request for proposal (RFP) stage. This is when the right providers are identified and approached with proposals on contracting with your company; it is the stage where the actual healthcare services are secured.

Processing: We then obtain signatures and process the contracts with each provider, ensuring that they are legally binding contracts for the enrollment year.

Preparation: Finally, we prepare for open enrollment. This is a process that requires us to obtain the most up-to-date data on your employees and their dependents so we can get them enrolled during the eligibility period.

As you can see, it takes months to put a complete employer health plan program together. That’s why it is in every client’s best interests to begin the process at the beginning of the year. It’s not too late to inquire now, so we can begin creating and establishing your new company health plan. Contact GM&A to learn more today!

What Will a New HHS Secretary Mean for Your Company Health Plan?
Feb 15, 2017   08:16 AM
by GM&A Corporate Healthcare Consultants

What Will a New HHS Secretary Mean for Your Company Health Plan?

As those who are plugged in to current events may be aware, President-Elect Donald Trump has chosen an outspoken critic of the Affordable Care Act to be the next Secretary of Health and Human Services. Congressman Tom Price (R-GA) is an orthopedic surgeon who has his own decided positions on health care reform – positions that some say may “heal” the weakest parts of the Affordable Care Act.

What are those weak spots? Remember, the ACA will most likely account for $1.8 trillion in new spending over the next decade, while only covering approximately 31 million of the 48 million uninsured Americans. That was not necessarily by design, of course; it is mostly due to employers being forced to restructure due to the law, followed by the reality that around 9 million fewer Americans have enrolled in their state exchanges than the government anticipated. Meanwhile, median health insurance premiums have shot up 116% since 2012. Clearly, there is a lot about the ACA (Obamacare, for those who prefer the colloquial term) that needs to be reformed – so this new cabinet choice is intriguing. But will it be effective?

No one can say for sure, of course. And that’s why, no matter who is appointed to the new presidential cabinet and what their positions are when it comes to regulation and subsidies, companies still need to take the appropriate measures to protect their bottom lines and serve the employees who keep their operations working. For healthcare, one of the best ways to do this is with direct contracting, a model that involves implementing contracts with healthcare providers rather than insurance carriers. If a new HHS secretary ushers in big changes that make a positive impact for employers, that’s great – but for employers that have made smart choices for the health plans they offer, the benefits will be even greater. Learn more about it by calling GM&A at (325) 224-3245.

Obamacare Open Enrollment: Should You Sign Up?
Nov 20, 2016   08:00 AM
by GM&A Corporate Healthcare Consultants

Obamacare Open Enrollment: Should You Sign Up?

According to the Centers for Medicare and Medicaid Services, over 1 million Americans signed up for health insurance plans on the federal government’s HealthCare.gov platform during the first two weeks of this year’s open enrollment period. That includes 250,000 new Obamacare consumers and over 750,000 renewing their current Obamacare plans. With that in mind, should you enroll in your state’s Obamacare exchange this open enrollment period? That’s a decision only you can make for yourself, but what we can tell you is this: If you don’t have access to a health plan through your employer, Obamacare isn’t necessarily the only option you have for coverage. 

What if you could contract directly with healthcare providers, rather than worrying about the foibles of the mixing government subsidies with the health insurance industry altogether? It is possible, not just for employers but also for individuals in some cases – and direct contracting is what makes it possible. Direct contracting is a service that people can take advantage of if they are interested in exploring their options for healthcare coverage, not just to save costs, but also in order to gain more control over their own care. It can be especially useful for people who need to see specialists, or people who require ancillary healthcare supplies to support certain conditions: wheelchairs, shower chairs, walkers, etc. If you speak with a healthcare consultant who facilitates direct contracting services, you are under no obligation to proceed with contract negotiations – but you just might find yourself  excited about the money you can save.

To find out if you can cut your personal healthcare costs with direct contracting, contact GM&A Healthcare Consultants to request a complimentary consultation. You’re under no obligation to purchase; this can be an informative meeting to discuss your personal healthcare expenses and ways to address them. If Obamacare is something you’d rather avoid, then there’s no better time to make this appointment.  

Alternatives to Traditional Company Health Plans: Now’s the Time
Nov 15, 2016   07:30 AM
by GM&A Corporate Healthcare Consultants

Alternatives to Traditional Company Health Plans: Now’s the Time

 

As you know, a lot of changes have come about in our nation over recent days – leading to some volatility in the American stock market, global financial markets and of course, the public discourse. Meanwhile, employers and their human resources professionals still have organizations to run. They can’t afford to stop and reflect for too long; even in the eye of the storm, they have to keep moving forward. Of course, one of the most urgent matters on their agendas this time of year is wrapping up their duties for the annual open enrollment.

 

No matter what happens to be going on in government, there’s no time to waste when it comes to improving your organization’s employee benefits – chief among them, the company health plan. As you know, there’s a lot of talk that the incoming presidential administration wants to “repeal and replace” the Affordable Care Act; maybe it will happen, maybe it won’t. Maybe it will only partially happen. If you’re an employer, you can’t afford to stand by and wait to find out.  

 

Right now, before any sweeping changes are enacted, employers need to start looking into alternatives to save costs on their company health plans. For many of those employers, one of the most promising alternatives to traditional health plans will be direct contracting. Direct contracting is a service that is an alternative to traditional company health plans. It can bring about the money-saving changes your company plan needs without compromising on the care your employees receive. It sounds simple, because it is; all the best things are.

 

A winning campaign usually has a simple message, and ours is no exception: Corporate health plans are too expensive. With direct contracting, GM&A can help lower your company health plan costs while ensuring your employees receive uninterrupted care. If you’re interested in learning more, contact us to request a complimentary benefits consultation.      

Privatizing Single Payer Healthcare
Oct 20, 2016   07:30 AM
by GM&A Corporate Healthcare Consultants

Privatizing Single Payer Healthcare

There are less than two weeks until the presidential election, and the final debate included some discussion on healthcare – specifically, which candidate would “repeal and replace” the Affordable Care Act and which one would simply amend the existing law. Remember, though: If the existing law were to be altered, the result would still be some form of a single payer system that would cost taxpayers just as much money as the ACA already does (whether it’s in the form of higher premiums for covered individuals or higher taxes across the board). Meanwhile, repealing and replacing is not as easy as it sounds. Either way, America has a hard road ahead of itself when it comes to perfecting its healthcare system.

In the meantime, we urge employers to look at the private market healthcare solution we offer at GM&A. It is almost a form of single payer, only the “payer” is a private entity that simplifies processes, lowers costs and improves care – not a government bureaucracy that complicates, charges and delays.

Our method, direct contracting, gives employers the opportunity to affordably cover their employees with healthcare plans that make sense for the organization and everyone in it. It is designed to make it easier for employers to comply with the existing Affordable Care Act, while still helping them drive down costs. It even gives them the ability to create a customized network of providers in their local area, as opposed to subjecting them to only one or two providers to choose from. No presidential candidate can feasibly promise that to anyone, but a private entity can; GM&A can.

We have a message for employers throughout the United States: If you are tired of the political back-and-forth on healthcare, contact GM&A to request a no-obligation health plan consultation. We will be happy to speak with you!

HR Malpractice | Failing to Do Right by the Company Can Cost Everyone
Oct 14, 2016   07:30 AM
by GM&A Corporate Healthcare Consultants

HR Malpractice | Failing to Do Right by the Company Can Cost Everyone

Everyone knows what the term “malpractice” means when it comes to the healthcare industry. But what about other fields – like human resources, for example? It is entirely possible to commit malpractice in a field like that, specifically if the HR administrator is failing to carry out due diligence to find services that are in the company’s best interests – and, the interests of the employees who are receiving those services. A perfect example of this is failing to make sure the company is paying for the most affordable and effective healthcare plans possible.

Why would an HR person do this? Often, the HR administrator works directly with a broker on setting up the company healthcare plan – and often, that broker is tied firmly to an insurance company. There’s nothing inherently wrong with that, but for the fact that the specific insurance company the broker is affiliated with will be sure to incentivize him heavily for getting them business. That means, of course, that the broker may recommend insurance carriers that:

  • Charge more than the company can      afford
  • Don’t offer all the coverage options      the company needs
  • Don’t have enough providers in the      company’s local area

…but the HR administrator will only know that if he or she carries out due diligence to find out what the specific insurance carrier can provide. If all the HR department does is meet with a broker, look at a single insurance carrier and negotiate for the lowest rates before signing on the dotted line on behalf of an entire company – well, that’s hardly in the best interest of the company or its employees. Failing to save the company money, failing to make sure employees get the right coverage…that’s HR malpractice.

Now, compare that to the experience of working with a healthcare consultant that is not tied to any specific insurance carrier. At GM&A, we give the HR administrators we consult the opportunity to reduce costs for the companies they work for by forming their own customized healthcare networks. The providers are in the company’s local area, and the plans are set up to cover the needs of the company based on its employees’ own past claims. And on a regular basis, we perform audits of our clients’ cases to make sure no one is being overbilled for care an employee receives. We don’t just help companies get set up with a healthcare plan; we also help them manage it.

Thinking outside the box takes some courage in any field, including human resources. Rather than committing HR malpractice, we at GM&A hope that HR professionals will keep an open mind and consider meeting with us to see what we can do for them. Contact GM&A at (325) 224-3245 to request more information or schedule a complimentary appointment at your location. We service employers throughout the United States.

Aetna Pulls out of Obamacare – What it Means for the Future
Aug 23, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Aetna Pulls out of Obamacare – What it Means for the Future 

As you may have heard, the large insurance provider Aetna is the latest insurer to announce that it is pulling out of several Affordable Care Act state healthcare exchanges. Aetna withdrew from 11 states last week, leaving approximately 167,600 patients without healthcare coverage – many of them in rural areas where access to care was already compromised. In fact, Aetna’s decision has created another fascinatingly gloomy development: Pinal County, Arizona, has just become the first county in the nation to have no Affordable Care Act providers. Which county will be next? We are all but certain that more will follow.

Once again, we see that the Affordable Care Act is doing precisely the opposite of what it was designed to. It was implemented to give Americans healthcare coverage, and yet because of the costly impact it has on insurers and employers, the ACA is actually taking coverage away. If you thought we needed healthcare reform prior to 2009, look at the extent to which we need reform now. As you may know, we at GM&A Healthcare Consultants believe the path to that reform is our direct contracting health plan model.

When healthcare providers (not insurance companies, and certainly not government-implemented exchanges) compete for the business of employers who provide employee benefits, everyone wins. The employer wins by saving money, the employee wins by getting outstanding coverage from local providers that were chosen specifically for their network, and providers win because they get paid quickly and fairly. Direct contracting can and should be the future of American healthcare. It’s time to get on board this train now, because if the news about Aetna is any indication, the Affordable Care Act catastrophe is only posed to get worse.

Large Employers: Start Planning for 2018 (Yes, 2018!)
Aug 08, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Large Employers: Start Planning for 2018 (Yes, 2018!)

When you’re a large employer of 1,000 employees or more and you’re interested in finding a new company health plan that can help your organization’s bottom line, you can’t afford to delay the process. If the goal is to offer a new plan in time for open enrollment of the next year, there’s bad news: Believe it or not, you’re already behind.  

In our experience, too many companies are unaware how long the process of transitioning to a new company health plan can be. While some employers are still considering their options for 2017, the reality is that it’s already time to start planning for 2018. Yes, 2018!

Too Late for 2017?

Does that mean it’s too late to develop a new company health plan for 2017? It may very well be, but you’ll never until you speak with a corporate healthcare consultant who can advise you. GM&A is a corporate healthcare consulting group that can provide an alternative way of reducing costs to your company health plan; we call that alternative method direct contracting, and it’s one of the simplest (yet most effective) health plan models you’ll ever encounter.

Regardless, industry limitations being what they are means that it takes us multiple months to put a direct contracting plan together for a large employer client. We have to meet with you, look at your company health care claims data and then begin putting a plan together that can be incorporated before the final stage, open enrollment.

What’s the First Step?

It may be too late for 2017, but you’ll only know after you ask – and if it is, then the time to start the process for 2018 is now. Contact GM&A Healthcare Consultants to request a complimentary health plan meeting, at your location anywhere in the U.S., for the decision makers in your organization. We will be glad to show you what direct contracting can do for your company! 

Covered California Raises Premiums – And it isn’t the Only One
Jul 23, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Covered California Raises Premiums – And it isn’t the Only One

Have you heard the latest news on Covered California? Last week, news broke that

California's health insurance exchange will increase its premiums by anywhere from 13 to 17 percent by 2017. This is all thanks to two major insurance companies requesting substantial rate increases from the program: Anthem, which requested a 17 percent increase, and Blue Shield, which is seeking a 20 percent increase.

These premium increases will impact a whopping 1.4 million Californians who currently receive healthcare coverage under the Covered California plan. The good news is, the proposed rate hikes are still subject to review by state regulators. The better news is, consumers can choose not to participate by seeking healthcare alternatives.

Although we primarily work with businesses to provide lower cost coverage to employees, GM&A Healthcare Consultants can also work with consumers who are tired of the rising costs of insuring themselves –not just consumers who insure themselves with a PPO, but also consumers who participate in a state exchange 

Other State Exchanges with Rising Premiums

Although Covered California seems to be getting the bulk of the media coverage when it comes to state exchanges with rising premiums, it isn’t the only state exchange to do so. Take a look at these startling rate increase projections from around the U.S.:

  • Alaska: 9.8 percent rate increase
  • Washington State: 13 percent rate increase
  • New Mexico: 25 percent rate increase


Can you believe it? So no matter where in the country you are: If you rely on a state exchange for your healthcare coverage, expect to see the amount you pay for that coverage to start rising.

What if you’re an employer?

What if you aren’t an employee, but rather an employer that has thus far been unable to cover employees? If so, it’s time to give them a better way than the state exchange. GM&A can help you provide them affordable, high quality coverage with direct contracting. That way, you’ll never lose another employee to a company that provides healthcare benefits! They can stay at your place of business, because you will provide them the coverage they need – all at a cost that is affordable for you.

We were among the many healthcare experts who predicted this would happen in the early days of the Affordable Care Act – and finally, everyone is waking up to the fact that the Affordable Care Act isn’t so affordable after all. There’s a better, more affordable way for employers and employees, and that way is directly contracting with healthcare providers. Ask GM&A for more information!

Reducing Health Plan Costs in Risky Government Jobs
Jul 08, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Reducing Health Plan Costs in Risky Government Jobs

City, county and state governments tend to get a bad rap as employers sometimes, thanks to the incorrect notions some ascribe to – you know, the mischaracterizations that government jobs are for “lazy” people. These generalities are unfair to not only the brave law enforcement officers, firefighters and emergency workers who put their lives on the line every day, but also the highly skilled professionals like city landscapers, equipment handlers and maintenance people who work for their municipalities – people who put their bodies at risk for the local government job they do.

When one of these workers gets injured in the line of duty – be it through a tragic gunshot wound, an unfortunate equipment accident, a fire, an explosion, a vehicle crash or any other various possibilities – that employee automatically becomes an emergency patient that needs both immediate and ongoing treatment. The medical costs of surgery, therapy and follow-up visits for the injured employee can be staggering, and the employer is obligated to pick up the tab. With that in mind, we at GM&A Corporate Healthcare Consultants want to make sure local governments know that direct contracting can help them save on these costs immediately, if they switch their health plans to our cost-effective model of coverage.

Local government employers, from police departments and fire departments to landscape and maintenance departments and more, can take advantage of direct contracting to reduce the costs of covering employees in these high risk fields. Contact GM&A today to find out more; we are happy to meet with local government employers throughout the United States who may be interested in learning how to cover their valuable employees with quality health plans for less money.

Covering Employees with a Pre-Existing Condition – For Less
Jun 22, 2016   07:45 AM
by GM&A Corporate Healthcare Consultants

Covering Employees with a Pre-Existing Condition – For Less

We are sometimes asked by employers whether we can do anything to help them offset the cost of covering an employee with a pre-existing medical condition. The answer is yes, we can – by helping the organization switch to the direct contracting health plan model. Here are some of the pre-existing conditions we are referring to:

  • Diabetes, which affects 9.3% of      Americans
  • Asthma, which affects 25 million      people or 8% of Americans
  • Heart disease, which is the leading      cause of death for both men and women
  • Cancer (37% of cancer survivors make      a work adjustment, but many remain employed)

Taking all of this into account, it makes sense for employers to find ways to cover valuable employees for less when they are affected by a pre-existing condition. Here’s how direct contracting can help.

In cases like these, GM&A acts a broker that negotiates lower rates with the providers that the affected employees rely on. Whether it’s an oncology practice, a hospital with outstanding cancer treatment or a heart specialist, we can work with them on lowering costs so they can remain part of your network – but at a rate you can afford as a benefits provider. Then, your talented employees can be covered affordably and you’ll no longer be inclined to find their conditions “expensive.” This is just another way that direct contracting can be incredibly valuable for an organization, whether it is a private or public employer.

To learn more, contact GM&A to request a complimentary health plan “checkup.” This is a free phone appointment – or in person, for large employers – that outlines all the benefits of switching your health plan to our direct contracting service. We can be reached at (325) 224-3245.

Corporate Wellness Plans: Worth the Cost?
Jun 14, 2016   11:11 AM
by GM&A Corporate Healthcare Consultants

Corporate Wellness Plans: Worth the Cost?

Corporate wellness programs seem like the thing to do when you’re an up-and-coming company striving to create a reputation of being that progressive employer everyone wants to work for. These programs certainly look good at first glance; after all, they foster camaraderie among employees who participate and encourage staff members to work towards their short and long-term health goals. But do they really make sense for the employer?

The human resources experts we talk to tell us that the big myth about corporate wellness programs is that they boost employee retention. “They really don’t,” one expert said recently. “When you consider how frequently today’s young professionals move from job to job, pouring resources into a company wellness program is hardly worth the investment.” And older employees? “They don’t always value these programs either,” the expert told us. “They tend to be more self-conscious about their wellness goals and would prefer to work on those things privately. Older professionals are very guarded about their personal lives now, especially when they’re new to a company.”

So no, corporate wellness programs don’t actually help companies retain employees. But do they save employers money? As corporate health plan experts, we have found the answer to be no. Companies that implement these programs spend more money on them than they’re worth: incentivizing employees with cash bonuses, gadgets and even vacations. Then there’s the loss in productivity that comes from employees sneaking in longer lunches for group walks, holding scheduled meetings to discuss their weight loss efforts, etc. It’s a slippery slope that many employers regret stepping on in the first place.

What we have found will save employers money on covering their employees, though, is the direct contracting healthcare model. By directly contracting with medical providers, employers can save up to 30% a year on healthcare costs. Letting the employees be in charge of their own health and using your resources to improve their coverage is a win-win. To learn more, contact GM&A at (325) 224-3245 for a free health plan consultation.

Why Public Employers Need Direct Contracting Health Plans
May 25, 2016   11:11 AM
by GM&A Corporate Healthcare Consultants

Why Public Employers Need Direct Contracting Health Plans

Self-insured healthcare plans are a popular option for public agencies that need to cover employees, but wish to avoid working with a third-party administrator. In fact, the state of California counts 2.2 million public workers that are covered by self-funded insurance policies. And on a smaller scale, 3,579 California public agencies self-insure their worker’s compensation liabilities. You know the saying: As California goes, so goes the nation. If that’s true, then self-funded health plans are where the nation’s public employers are going.

As we have previously explained, Kaiser Permanente has released studies that show self-funded healthcare plans can save employers up to $700 per member per year. That’s an incredible savings for a large employer – specifically for a public agency, where hundreds of people may be on the payroll and the agency is obligated to monitor costs because of oversight and taxpayer concerns.

But while these self-insured health plans can be great, there are ways to make them even better. One of those ways is with the direct contracting health plan model. When there is a contract in place directly with the healthcare provider, employers have access to discussions with providers that just aren’t available in a traditional insurance model. In short, it’s easier to find out what you’re paying for and how much you’re paying for it because providers have a direct relationship with you – the employer. Not the insurance company, not a third-party administrator…but the agency that it is providing healthcare services to. In public sectors, that’s crucial – because as any public employer knows, the public is always paying attention to where the money goes.

Public employers that take advantage of both self-funded health plans and direct contracting simultaneously enjoy a more transparent relationship with healthcare providers. There’s less red tape, fewer layers of bureaucracy – in fact, there is little to no bureaucracy at all. Direct contracting is simple healthcare coverage, the way things should be. To learn more, contact GM&A for a free health plan checkup. We will be glad to explain more to you.

Direct Contracting: A Completely New Payment System in Healthcare
May 24, 2016   11:11 AM
by GM&A Corporate Healthcare Consultants

Direct Contracting: A Completely New Payment System in Healthcare

By now, many of us realize that the Affordable Care Act was simply a bandage applied to a healthcare coverage system that was already spiraling into failure. For all the work that was done in Washington, D.C. to pass it in 2009, the ACA was really nothing more than a “best we can do right now” initiative. In states like Colorado and Oregon, residents are torn between supporting proposed legislation that would allegedly cover everyone vs. deciding that the universal healthcare model at the federal level - the ACA, also known as Obamacare - is simply not working, and therefore it would not work at the state level either.

Maybe that’s the reason why many healthcare experts are currently advocating for a completely new payment system. They don’t always offer specifics, though, and that’s where we come in. GM&A has over a decade of success with the direct contracting system, an innovative healthcare payment model that always ensures the two most important healthcare goals are accomplished: 1.) patients get covered, and 2.) providers get paid. It’s not insurance, but it complements insurance services so that providers are paid upfront rather than reimbursed (unless a different customized plan is chosen; there are numerous options for health plan customization). It’s not government subsidized, but it is a system that employers can use to meet their newfound Obamacare obligations for covering employees while still remaining profitable.

Unlike the ACA, direct contracting gets the job done. It’s not a bandage; it’s a solution. It’s the “completely new payment system” that healthcare experts are advocating for. To learn more, contact GM&A to request a complimentary health plan consultation (also known as a health plan checkup). We will be glad to speak with you.

Single-Payer in Colorado? Subsidies vs. Direct Contracting
May 12, 2016   11:11 AM
by GM&A Corporate Healthcare Consultants

Single-Payer in Colorado? Subsidies vs. Direct Contracting

Voters in the state of Colorado will vote this November on a proposed amendment to the state’s constitution – one that would make Colorado the second state to complete its attempt at a single-payer, state-subsidized healthcare system. The proposed system, “Colorado Care,” would be operated solely by the state’s government and funded by its taxpayers.

The fiscal impact of such an endeavor, if it were to pass into law? Colorado Care would increase the state income tax to 14.63 percent, which includes a 6.67 percent tax on the total payroll of all employers and a 3.33 payroll tax on employees – and, an increase that is exempt from Colorado’s Taxpayer’s Bill of Rights law (in other words, residents would not be given the opportunity to approve any future tax increases related to Colorado Care that would inevitably incur). And if an (unlikely) surplus ever accumulated, taxpayers would not receive a refund.

Sounds like a raw deal for the residents of Colorado.

In fact, Vermont’s single-payer healthcare model is already showing signs of unsustainability. The state’s Green Mountain Care program already needs an additional $1.6 billion in new revenues to keep it going, and that’s just for a single year.

And we haven’t even begun to touch on the manner in which Colorado Care would seriously compromise the quality of healthcare in the state. At the state level, the best doctors will leave the Colorado in favor of states where they stand a chance of getting paid. It’s happening in Vermont now. At the federal level, Obamacare is setting America on a slippery slope course toward care healthcare rationing – and counties like Canada have been there for years. Single-payer systems don’t work when the single payer is the government; history has proven it.

A much better alternative is the direct contracting model, which involves private businesses employers or a local government agency employer such as school districts, cities and counties directly contracting with healthcare providers as part of their employee benefit packages. This isn’t single-payer; the employee will contribute, just as employees do in traditional coverage models. Regardless, it’s a far superior model to single-payer subsidies: better care, immediate cost adjustments when savings can be achieved, and of course, endless plan customizations. Which option sounds better to you? To learn more, contact GM&A for a free healthcare consultation.

Private Exchanges vs. Direct Contracting
Apr 25, 2016   12:07 PM
by GM&A Corporate Healthcare Consultants

Private Exchanges vs. Direct Contracting

Private exchanges have become a hot ticket in healthcare over the past few years, thanks to the Affordable Care Act making the “exchange” a household word. Unlike the ACA’s public exchanges, a private exchange is owned and managed by a private entity rather than a government agency. It is essentially a marketplace for selling healthcare plans; when an employer joins a private exchange, employees choose from the handful of insurance carriers that are authorized to participate. Employees may also be able to purchase extra coverage in a private exchange, including:

  • Disability coverage
  • Supplemental plans
  • Long-term care insurance

The idea behind private exchanges is that they offer lower healthcare costs to the employer because they are set up to include defined contributions. They also are supposed to have fewer administration costs than traditional employer-sponsored plans; administrators are typically insurance agencies, private healthcare consultants or (in the case of self-insured employers) third-party administrators. And of course, proponents of the private exchange model say that they offer employees more health insurance options than other benefits models.

It sounds great, doesn’t it? But we have an even better option.

When it comes to top-notch healthcare benefits, direct contracting has all of these things and more. While most employers are still waiting to find out if they are saving any money by switching to a private exchange, GM&A is showing employers how they can start saving by 30% or more immediately by switching to direct contracting. We are also able to show employers that direct contracting offers truly consumer-driven care, because the private networks we form for our clients uses the claims data of the company’s own employees. It’s the best form of customized coverage available.

While private exchanges only hit the scene in 2009, GM&A has been providing direct contracting services for over a decade – so we have a proven model that employers can trust for the long-term. To learn more, contact us for a free health plan analysis.

Lowering Per-Member-Per-Month Healthcare Costs
Apr 21, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Lowering Per-Member-Per-Month Healthcare Costs

Employers: When was the last time you thought about how much you pay every month to cover your employees? Here’s a slice of truth that might be hard to swallow: In 2015, U.S. employers paid an average of $486 per month for each covered employee. If you cover 10 employees, that’s $4,860 per month; if you cover 100 employees (as many of the companies that contact us for a health plan analysis do), that’s $48,600 per month. Staggering, isn’t it?

One of the questions we may hear from someone who sees that data is, “But that’s just the national average, right? The cost must be lower in my state.” Not necessarily. In the state of Texas, the per-member-per-month average is $478 per month – just $8 less than the national average. To find the average per-member-per-month cost figure for your state, use the Kaiser Family Foundation calculator – and prepare to be shocked at how much you are paying per month to cover each individual employee.

Now, here’s the good news: You don’t have to pay that much! With GM&A’s direct contracting health plan service, you can pay an average of $260 per-member-per-month. That’s it! Multiply that by your number of covered employees and see if you like that figure better!

Direct contracting slashes the per-member-per-month cost of covering employees by at least 30%, and it offers employers a customized network of providers that meet the needs of employees. This is the best possible way to insure your workforce with affordable healthcare. To start paying less now – per employee, per month, all year long – contact GM&A to request a free health plan analysis. We look forward to showing you more!

As Insurers Pull out of Exchanges; Obamacare Alternative
Apr 18, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

As Insurers Pull out of Exchanges, an Obamacare Alternative

Here’s yet another aspect of the Affordable Care Act (ACA) that the federal government didn’t account for: the financial sustainability of the state exchanges. As major media outlets have reported, health insurance companies are warning are losing money so quickly from their participation in the Obamacare exchanges that they are compelled to pull out.

The most prominent example took place in April 2016, when United Health Group – the largest health insurer in the United States – announced that it will be withdrawing from the Obamacare exchanges in most states. Following United Health’s lead, other insurers are saying they may need to follow suit.

What the Experts Say

When the Kaiser Family Foundation speaks, we in the healthcare consulting community listen. Here’s what the foundation has to say about the sustainability of the Obamacare exchanges. “Something has to give,” said Larry Levitt, an ACA expert at the Kaiser Family Foundation. “Either insurers will drop out or insurers will raise premiums.” But even if those premiums increase in 2017, there’s no guarantee that the insurers will recoup their losses; plus, patients will be inevitably forced to change doctors (there’s no “you can keep your doctor, you can keep your plan” in this scenario). And if the insurers drop out of Obamacare, there is virtually no possibility that the exchanges will sustain themselves.

Not coincidentally, United Health pulled out of Obamacare exchanges the day after the Kaiser Family Foundation analysis report. In order for insurance companies to remain profitable, there is no way they can participate in the Obamacare state exchanges for the long-term. Clearly, there is a deep need for an Obamacare alternative.

Other Serious Problems

Of course, the Affordable Care Act is only compulsory for those who are not covered by an employer or individual health plan. According to a March 2016 Blue Cross/Blue Shield Association report, new ACA/Obamacare enrollees have 22% higher medical costs than those covered by employer health plans. That said, it is still preferable to have coverage from one’s employer – but as employers know, covering employees comes with all kinds of caveats in the Obamacare era.

A Real Obamacare Alternative

The only viable way for employers to avoid the burdens imposed on them by the Affordable Care Act is to seek out an alternative solution like direct contracting. Direct contracting is a healthcare model that gives employers an affordable way to cover their employees, while giving employees a customized network of providers to choose from. This is the best Obamacare alternative there is. Contact GM&A to request a free health plan analysis; we will be glad to tell you more.  

A Free Healthcare Seminar for Employers!
Apr 15, 2016   02:30 PM
by GM&A Corporate Healthcare Consultants

A Free Healthcare Seminar for Employers!

We at GM&A are excited to announce a limited time offer to large scale employers. As healthcare consultants specializing in direct contracting - a service that can save employers up to 30% per year in healthcare costs, and one that delivers better care services to employees as patients - we are launching an offer to present a complimentary educational seminar, onsite at the location of any large employer that is interested.

If you are a decision-maker at a large employer, public or private, the GM&A team will fly to any location in the U.S. to provide this free seminar to your employees. We feel it is a valuable thing to offer not only your executives, management and HR, but your entire company - all employees. Why? Because the employer health plan affects all employees!

During this complimentary presentation, your organization can learn:

  • Why traditional health insurance and health plan models are phasing out
  • Why direct contracting is the healthcare delivery model of the future
  • How GM&A’s proprietary software can use the claims information of an organization's employees to analyze what the parameters of your coverage should be - and, how that can save the employer money
  • What healthcare services may not be covered by your current plan - but can be covered in a direct contracting plan

As stated, this is a complimentary seminar that can be highly valuable for any large employer interested in saving money while still delivering a high quality employer-sponsored health plan to employees.

Best of all, there is no obligation; we are happy to present to you with no commitment required on your part. We understand that employers may look at a variety of options, and we are just one piece of the puzzle. That’s why we would like the opportunity to present to you, follow up with you to answer your questions and let you tell us how we can best meet your needs. Contact GM&A today to learn more! We can be reached at (325) 224-3245.

What is a Health Plan Checkup?
Apr 01, 2016   02:30 PM
by GM&A Corporate Healthcare Consultants

What is a Health Plan Checkup?

Believe it or not, it isn’t an exam in your physician’s office. It’s an entirely different kind of checkup – more of an analysis, really. And, to make a more important point: It’s designed primarily for employers who provide health insurance to employees and self-insured individuals.

A periodic health plan checkup is an analysis of your current health plan, whether it’s the plan you provide for your employees or the plan you insure for yourself and your family. More often than not, it’s self-insured employers who will need this type of analysis. During this appointment, we will help you:

  • Analyze new trends for insurers and providers
  • Make informed projections about the future
  • Identify ways you can save more money on your health plan

Think this is a waste of time? Think again! On any service that requires a large investment, you should want to sit down and analyze where the money is being spent, in addition to examining ways to save more money in the coming year. Some employers wait until the open enrollment period to do this, but in reality, a health plan checkup can happen any time of year.

For instance, school district employers may want to do their health plan check up now before the end of the school year – in time to make any necessary adjustments before breaking for summer. That way, there can be a fresh start when school picks back up in the fall. For any business that slows down in the summer, now is a great time to schedule a health plan checkup so that things are squared away before you start thinking about vacations.

Last of all, employers and individuals who still haven’t taken advantage of direct contracting can make their appointments for health plan checkups. To make an appointment for your health plan check up, contact GM&A. No matter what your current health plan is, we will be glad to examine it and identify ways where you can save money by directly contracting with healthcare providers.

Direct Contracting in Healthcare | Real Value for Employers
Mar 24, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Direct Contracting in Healthcare | Real Value for Employers

Direct contracting is not a "new" healthcare service; at GM&A, we’ve been doing it since 1999. But for a variety of reasons, mainstream HMOs and PPOs continue to be the default organizations for servicing corporate health plans. One of those reasons, we believe, is recognition. If the decision makers at a given employer have never heard about the concept of establishing direct contracts with healthcare providers, they may be inclined to reject looking into it any further when someone brings it to their attention. A common, instinctive reaction is, "If direct contracting so great, why isn’t everyone doing it?"

We understand that – and the truth is, we don’t want every employer to do it. If they did, then providers might not be as willing to negotiate with us on behalf of our clients. A healthcare provider’s willingness to contract with our clients for deeply discounted services is dependent on direct contracting staying out of the mainstream. It’s the law of supply and demand: If there is enormous demand for direct contracting and it eventually becomes the norm, providers will respond to the demand by raising prices – just because they can. It happened with HMOs, and it can happen to direct contracting if the service begins to permeate the healthcare marketplace.

The good news for employers is that direct contracting is still a valuable, niche service that can save them an enormous amount of money. At GM&A, our research shows that our clients’ healthcare costs reduce by an average of 30% by switching to a health plan that relies on direct contracts. That isn’t the only benefit; direct contracting healthcare services also allow employers to have the valuable cost and performance discussions that just aren’t possible when going the "traditional" health plan route. If an employer wants to know why a healthcare claim was filed by a specific employee, that information is obtainable when there is a direct contracting relationship.

An employer that wants to see hard data on its employees’ health claims isn’t going to get it with a traditional plan; with direct contracting, though, virtually anything is possible. Acting as a broker between provider and employer, GM&A can request the facts and figures the employer needs to make practical, cost-conscious health plan decisions. It’s real value that no other type of health plan provides.

Political Candidates and Healthcare | Who’s Best for Your Corporate Health Plan Costs?
Mar 21, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Political Candidates and Healthcare | Who’s Best for Your Corporate Health Plan Costs?

One of the biggest misconceptions we have heard from potential clients lately is the idea that one political party or the other can "save" them from healthcare cost ruin. If you’re a CEO, CFO or HR professional, we want you to hear this: It really doesn’t matter who wins the election this year when it comes to saving money on your company’s health plan. No matter what anyone says, none of the candidates would have any control as President over the rising costs of healthcare. Was there something to be done about it before the Affordable Care Act? To an extent, yes. But now, what’s done is done. Repealing the ACA, if that were to happen (which is unlikely), would not bring about the sweeping healthcare cost changes that politicians promise it would. It’s just too late for that now.

Here’s what can be done, though, no matter who wins the election. You, as a corporate leader, can implement a company health plan model that saves money year after year. It’s called direct contracting, and it’s the only guaranteed way to reduce your current health care expenditures by 30%. By contracting directly with physicians, hospitals and other providers, you can save substantially on your company health plan while keeping the coverage in place for your employees.

There’s a lot to worry about in an election season – but your company health plan costs shouldn’t be one of those things. No matter what party you’re a member, you can remove healthcare costs from your list of reasons to vote for any particular candidate because it’s all the same. What isn’t the same is direct contracting. It’s a service that can save companies on their healthcare costs time and time again.

The Freedom of Owning Your Healthcare Network
Mar 09, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

The Freedom of Owning Your Healthcare Network

As we see it, one of the most appealing benefits of direct contracting is the flexibility it offers. It comes down to owning your own network, which is exactly what our clients do when they choose the direct contracting healthcare management model. Just as owning your own home or business has its benefits, owning your own healthcare network does too – and secondary to cost, the greatest advantage is the flexibility.

As your direct contracting healthcare consultants, we are entirely different than an insurance company (the healthcare network model you may be used to dealing with). For example, if you need to make a change to the plan – virtually any change – then we can do it, any time of the year. We don’t have to wait until, say, a Blue Cross, Blue Shield or other insurance contract expires. Because you are contracting directly with providers, that gives you the say about your company health plan!

From directors to managers to the human resources department, that benefits administrators greatly – and those benefits will quickly trickle down to the employees covered by the plan. Think about it: If there’s a popular doctor the employees would like to add, you can do that for them immediately. This is just another way direct contracting helps with your benefits package and employee retention. When you own your own network, it just makes life easier for everyone involved.

And of course, the cost benefit to the company can’t be underestimated here. If we find a way to save your company money in the middle of the year – anytime of the year at all – we can make that change right away so you can start saving right away. We don’t have to wait for the end of the year, open enrollment or any other milestone. That’s the freedom that owning your own network offers, and it’s only available with direct contracting. Have questions? Call GM&A today; we will be glad to answer them!

ACA Compliance for Colleges and Universities
Feb 16, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

ACA Compliance for Colleges and Universities

These days, everyone’s talking about the push for more affordable tuition, student loan forgiveness and other breaks for college students – but what about the healthcare coverage concerns of higher education? The good news for college students is that their institutions may offer student health insurance, which typically involves the school paying at least some of the premiums for them. The bad news? Colleges and universities face some real issues when it comes to complying with the Affordable Care Act, not the least of which is the new red tape involved with administering student health plans.

For students who work for the school, it gets even more complicated because the premium reduction arrangement that comes with the student health plan is considered an employer payment plan (EPP) – and that’s a violation of the Affordable Care Act. Why? In short, the government doesn’t want college and university employees participating in student health plans because it is viewed as a form of insurance coverage "double dipping."

ACA Compliance for Colleges | A New Grace Period

In fact, this has become such a concern that as recently as February 5, three federal agencies (the Department of Labor, the Treasury Department and the Department of Health and Human Services) released Notice 2016-17: a federal provision of temporary transitional relief specifically for student health plans that offer premium reduction arrangements for school employees. The provision states that for plan years beginning before January 1, 2017, school employees who participate in student health plans with premium reductions will not receive a penalty. The idea is to give students time to make alternative arrangements and bring their plans into ACA compliance.

Avoiding Penalties for ACA Non-Compliance

For colleges that fail to comply during this grace period, there will be an excise tax of $100 per day, and that’s for each affected employee. If numerous students are employed by the school, those fees can add up quickly!

For colleges and universities that employ students, this issue must be addressed immediately. School administrators are encouraged to contact GM&A to inquire about ACA compliance for colleges now. We can help you determine the best course of action to get in compliance with the ACA and help you avoid stiff government penalties.

Zika Virus in Texas: New Consequences Emerge - Can the Zika Virus in Texas Raise Healthcare Costs?
Feb 09, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Zika Virus in Texas: New Consequences Emerge 

Another week, another barrage of media coverage on the Zika virus – but today, we want to present another side of the story that some people may not have considered: the economic impact of Zika here in the United States, specifically when it comes to healthcare.

As you may be aware, the Zika virus starts with symptoms that are not unlike some other commonplace illnesses: fever, rash, joint pain and conjunctivitis (pink eye). But if a woman affected by Zika virus is pregnant or becomes pregnant, the virus can cause a birth defect called microcephaly, a serious defect of the brain. The effects on the patient’s child include brain damage, unusually small head size and other irreversible developmental consequences.

For the adults transmitting it, the Zika virus has short-term effects – but for any children conceived during the transmission, the damage is permanent.

Can the Zika Virus in Texas Raise Healthcare Costs?

Now, there have sadly been three cases of Zika virus confirmed in Texas. This is not media hype: Officials have confirmed that the third case of the Zika virus was confirmed in Dallas County on February 10. The first was reported on February 2, when Dallas County Health and Human Services reported the first case of sexual transmission of Zika in the county (Zika is an insect-borne disease, but may be sexually transmitted as well).

So today, the Zika virus is not just a South American problem; it is a global problem that American employers have to be prepared to address in their corporate health plans. Make no mistake, it will affect American health plans. As was the case when West Nile virus became a concern in parts of the U.S., health insurers in areas where the disease is present may raise their rates to address the emergency. It’s just one more thing for employers to think about as they examine their healthcare costs and make decisions about the way they will cover employees.

If you are in an area affected by the Zika virus (Texas or otherwise), it’s time to examine how that may affect your corporate healthcare costs. GM&A is a firm dedicated to providing knowledgeable, valuable healthcare consultation to employers like you. Contact us to see how we can help.

Direct Contracting with Pharmaceutical Companies
Feb 01, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Direct Contracting with Pharmaceutical Companies

One of the questions we receive frequently is, “Can pharmaceutical entities benefit from direct contracting?” The answer is yes, many of them can. While GM&A can’t partner with every pharmaceutical channel, we can and do provide our direct contracting service to some. The fact is, the rising cost of drugs is getting out of hand and it is becoming increasingly difficult for some insurance companies to offer those drugs at an affordable cost to patients. By negotiating with the pharmaceutical companies, GM&A can help get control over that.

Yes, negotiating. When it comes to big pharma, the thing no one wants to talk about is that there is often a great deal of leeway; generally speaking, the “prices” are not really the prices. Drugs are marked up hundreds of times over – particularly specialty drugs, which now account for 27.7% of total pharmacy spending in America. Perhaps that’s one of the reasons why co-pays greater than $60 have increased by 229% since 2010. *

So, why would they negotiate? While the pharmaceutical companies do have to make a profit, they also have to find price points that work for insurance companies and providers – as these are the means to the end users (also known as patients). And that’s what motivates them to work with negotiators like GM&A.

As stated, we can’t partner with every single pharmaceutical company – although we are actively seeking more to partner with now, and welcome their inquiries. Aside from that, what we can provide on a broader scale is an overall health plan, which includes negotiating for more affordable pharmacy co-pays. We’re living in a medicated age; there is a drug for everything, and that’s an incredible thing. That’s why it’s so important to partner with a health plan

*Source: Independent Health Specialty RX Report

New Year, New Health Plan
Jan 12, 2016   07:35 AM
by GM&A Corporate Healthcare Consultants

Now that it’s 2016, we are getting inquires on getting started with direct contracting during the open enrollment period – and that’s a good thing, because the beginning of the year is the best time to inquire. Every healthcare program requires some time to implement, and direct contracting is no exception. The truth is, if a company is serious about getting started with direct contracting for its employer health plan, then everyone should be prepared for the timeline to be up to six months in duration, from start to finish. Keep in mind, the steps include:

Consultation:

The first consult is an important appointment that provides the potential client with all the necessary information on the direct contracting healthcare model. If you are interested in being a client, you want to schedule your consultation as early in the new year as possible.

Analysis:

Once the client is on board, we perform an analysis of the company’s healthcare data – namely, examining the number of employees and dependents requiring coverage and analyzing their past claims data. This is important because it helps us identify the most appropriate providers to approach with contract proposals.

RFP:

Next, we enter the request for proposal (RFP) stage. This is when the right providers are identified and approached with proposals on contracting with your company; it is the stage where the actual healthcare services are secured.

Processing:

We then obtain signatures and process the contracts with each provider, ensuring that they are legally binding contracts for the enrollment year.

Preparation:

Finally, we prepare for open enrollment. This is a process that requires us to obtain the most up-to-date data on your employees and their dependents so we can get them enrolled during the eligibility period.

As you can see, it takes months to put a complete employer health plan program together. That’s why it is in every client’s best interests to begin the process at the beginning of the year. It’s not too late to inquire now, so we can begin creating and establishing your new company health plan. Contact GM&A to learn more today!

For a Consultation and detailed Health Plan Analysis
Call Hurb VandenHoogen at (858) 775-9170
or email hvandenhoogen@gma-usa.com