Examples of Projects

PPO Savings Vendor Audits Stop Loss Insurance
Rate Increase HRA / HSA Surveys
HIPAA Privacy Improving Operations Total Compensation
Seminars Mentoring Data Analysis

Increasing PPO savings

PROBLEM: Self-insured client was advised by their TPA that they needed to increase contributions by 45%.

ACTION: Analyzed claim cost trends and found that PPO savings were below normal and that the PPO paid a marketing fee to the TPA. An objective and unbiased request for proposal process was followed which identified several PPOs with greater savings.

RESULT: Client was able to maintain current funding with only a minor adjustment for inflation with annual savings in excess of $1.5 million.

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Vendor audits to improve performance

PROBLEM: Client suspected TPA was over paying claims.

ACTION: Conducted on site claim audit of the TPA by randomly selecting claims which were manually repriced by Carlson's Consulting claim auditors.

RESULT: Determined that the TPA was not following plan document resulting in claim overpayments exceeding 8%. Implementing corrections decreased claim costs $750,000.

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Rate increase

PROBLEM: Client was given a 35% increase in administration and stoploss fees by a large health insurer.

ACTION TAKEN: Guided client through a request for proposal (RFP) process which allowed competitive market forces to identify more appropriate rates.

RESULT: Client achieved net savings of more than 25% representing over $100,000 in savings.

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HRA / HSA Plans

PROBLEM: Client wanted to evaluate the differences between HRAs and HSAs before deciding on a strategy for implementing.

ACTION TAKEN: Developed a comparison of the 2 approaches highlighting strengths and weaknesses of each along with a strategy and cost recommendation.

RESULT: Client decided on HRA approach based on the turnover limiting aspects of the approach.

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HIPAA Privacy

PROBLEM: Client wanted to bring their health plans into compliance with the HIPAA privacy laws.

ACTION TAKEN: Assisted client in all aspects of compliance ranging from training to development of various tracking logs to document compliance.

RESULT: Client's program was in compliance well before HIPAA required compliance.

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Operations issues

PROBLEM: Client was experiencing inconsistent results with the administration of their group health program.

ACTION TAKEN: Scheduled an on site operations audit which in addition to identifying claim payment inaccuracies, also uncovered significant pended claim issues and processing problems.

RESULT: Negotiated a comprehensive service improvement agreement on behalf of the client which eliminated all backlogs and guaranteed the timely and accurate resolution of all issues. Quality improvement reduced overall claim costs 2% while simultaneously eliminating employee complaints.

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Benefits training

PROBLEM: Client needed a 2 day benefits training program developed and taught at various locations across the country.

ACTION TAKEN: Developed and successfully taught course to hundreds of benefits professionals from the United States and Canada.

RESULT: Participant evaluations consistently rated both the material and the instructor as outstanding.

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Employee mentoring

PROBLEM: Client wanted to promote a key employee into a benefits management position, but needed someone to mentor the employee during the first year.

ACTION TAKEN: Worked with the management group to develop and implement a mentoring strategy that would support employee as they assumed greater responsibility.

RESULT: The employee successfully transitioned into management and went on to assume even greater responsibilities over time.

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Stop Loss Insurance

PROBLEM: Client had an employee who was eligible for a heart and lung transplant.

ACTION TAKEN: Worked with the stop loss carrier to laser the employee to reduce overall client premiums. Then negotiated a direct hospital contract with the regional transplant center capping employer costs.

RESULT: When the transplant was performed 30 months later, the actual cost was less than the premium savings over the prior 30 months. If the transplant had never been performed, the employer savings would have been even greater.

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PROBLEM: Client needed to measure employee attitudes regarding current and future benefit programs.

ACTION TAKEN: Drafted WEB based survey for the client's approval which was then distributed by e-mail.

RESULT: Within 7 days the client had information needed to develop new strategy.

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Total compensation

PROBLEM: Client wanted to tie employee compensation (cash, benefits and perquisites) to employee productivity.

ACTION TAKEN: Built a metric that allocated total employee cost to sales.

RESULT: Based on findings, client changed policy to compensate employees for productivity as opposed to position and reduced benefit cost 20%.

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Data analysis

PROBLEM: Client costs were escalating

ACTION TAKEN: Through comprehensive data analysis determined the group had a number of 60+ employees actively at work.

RESULT: Recommended a series of actions ranging from amending the plan to deny coverage to part time employees (those over 65 who could then be covered under Medicare) to implementing strategies that allowed the employer to take advantage of Medicare Secondary Payer rules. Both strategies succeeded in transferring risk to Medicare.

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Employee Benefit Solutions
14523 Muirfield Lane, Suite 100
Houston, Texas, 77095-3413
Phone 281-856-8899
Fax 281-856-0877

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