Employee Benefit Brokers and Consultants
 
The Health Plus Approach

Health Plus Consulting Services will develop a specific Request for Proposals (RFPs) to present to potential carriers. Essential to obtaining an attractive, competitive bid will be the quality of the RFP, which must be comprehensive and complete. Also crucial, is managing the bid process in a professional manner, so as to assure the bidding entities that they will have a fair chance at being successful.

In many regards, the RFP should “sell” a potential customer to a vendor. It should be designed to highlight the merits of the organization, while providing enough bid process rules and minimum service requirements to structure an “apples-to-apples” comparison. It should allow the bidding organizations enough flexibility to highlight their strong suits, and provide the framework for Health Plus to conduct a thorough financial analysis. The bidding organizations must also be assured that the analysis of the proposals will be conducted in a fair and equitable manner.

Within the provision of bidding services, we will provide a detailed list of data needed from your company to perform this project. This will include such information as detailed descriptions of current and prior plans, financial experience, administrative and insurance costs, contracts and agreements, enrollment history, employee census, employee location, claims utilization data, and descriptions of administrative procedures. Our proposal assumes that the needed data is readily available in a usable format.

Develop Specifications/Conduct Competitive Bidding

After collecting all required data, the Request for Proposal (RFP) will be released to potential bidders. This process will include the following steps:

  • Draft detailed specifications including the history and culture of the firm; a detailed description of requested services, both with respect to claims administration and utilization management; a description of current benefits, claims experience, eligibility, and other related plan information; as well as a detailed questionnaire to ensure understanding of and compliance with requested/required services. The RFP may solicit alternative plan design quotes, which are identified earlier. We will also solicit information about provider contract arrangements, pricing arrangements, cost management techniques, quality, and historical performance as they relate to the present or alternative plan design.
  • Release RFPs to selected list of organizations. For purposes of this proposal, we will solicit no more than 10 to 12 vendors capable of responding in the manner requested.
  • Respond to inquiries from administrators and carriers.
  • Receive and evaluate proposals. Meet with representatives of carrier to refine there proposals or clarify any issues that are unclear in the proposals.
Our review of medical plan bidders will include
  • The competitiveness of cost as compared to benefits and services.
  • Availability of non-network and out-of-area benefit.
  • Determination of ability to provide services requested.
  • Flexibility and sophistication of claims system and utilization reporting capabilities.
  • Customer satisfaction of other clients.
  • Customer satisfaction of other clients.
  • Provider network/plan participant location match.
  • Wellness promotional components of the benefit plan.
  • Renewal calculations methodology.
  • Alternative risk sharing arrangements and the benefits such would afford
Our review of the effectiveness will focus on
  • The pricing structure, making certain that the proper mechanisms are in place to deliver care in a quality manner.
  • The reimbursement system (DRG, per diem, or discount from billed charges).
  • Physician and hospital contracts (if available) to determine provider responsibilities and financial incentives.
  • Quality assurance programs to determine specific criteria utilized in determining the place of treatment and delivery of health care.
  • Physician groups to evaluate what percentage are board certified or board eligible and make certain that all practice types are fairly represented.

We will provide our clients with an analysis of the vendor responses identifying the top three to four bidders. From this, we will determine your interest in interviewing any of the finalists and facilitate such meetings.