The Healthcare Rules Have Changed
Three quiet (but very important) Federal Acts have been enacted that will have far-ranging impacts on employers that offer a health plan to their employees. Not only does the Consolidated Appropriations Act make employers fiduciaries to their health plan, but these new regulations also empower employers and employees by enforcing the transparency of health care
How We Help
Caveat Emptor Consulting LLC is a healthcare strategy firm created to help all healthcare constituents (employers, employees, payors, providers, brokers, and solution providers) become active managers and better stewards of their healthcare costs through innovative, actionable and accountable consulting solutions.
Our Solutions
Fiduciary Oversight of Health Plans
With the passage of the Consolidated Appropriations Act (CAA), employers / group health plan sponsors will need to address a number of new health plan requirements to be in compliance. We are here to help employers of all sizes manage their new responsibilities with a vetted process.
Ongoing Health Plan Strategy
Other new regulations, such as the Hospital Transparency Act and the Transparency In Coverage Rules Act (TICRA) are creating unprecedented access to your health plan and pharmacy data. With this access, Caveat Emptor Consulting LLC can help employers develop and implement new strategies to impact both the cost of their healthcare and the health of the population in remarkable ways. Whether it is finding the lowest cost / highest quality health services, or negotiating directly with health care providers, we have knowledge and practical experience to positively impact your bottom line.
Meaningful Data Analytics
Data without insight and actionable solutions is frustrating. Our data is configured to identify healthcare inefficiencies, health trends, set benchmarks, and build meaningful KPIs and OKRs for the population's health, risk, and cost. This will for the first time, allow you the ability to objectively measure and report your Return on Investment ratios for your health plan investment.
Who We Serve
Employers
Our team will not be your benefits broker, as neither your broker or your health plan can be a fiduciary. Caveat Emptor Consulting, in partnership with OneVision, a corporate fiduciary consulting organization, will be your advisory team focused on helping you, the employer, navigate the complexities and risk of your new responsibilities as a fiduciary to your health plan. We will guide you, your broker, and your health plan with ongoing support, helping you monitor and report your outcomes to stay in compliance and avoid litigation.
Healthcare Providers
Historically, health care providers have been walled off from the real payer of healthcare services - the employer. Caveat Emptor has built a practice of helping healthcare systems and independent practices think differently about their patient acquisition strategy. This includes allowing access to unfettered market data, creating strategies for alternative financing, building strong partnerships between the employers and employees that pay for healthcare, and the healthcare providers in the communities they serve.
Benefit Brokers
The role of healthcare brokers and health & welfare consultants is changing. More and more is being asked of the broker, from the traditional health plan negotiation, to managing the ever-changing compliance landscape, to employee communications, and more; brokers and consultants are needed now, more than ever. With the broadening focus on transparency, brokers and consultants are now under a microscope. Caveat Emptor can help your firm re-think your data acquisition and outcome driven strategy so you can thrive in the post CAA environment.
Healthcare Start-Ups
Health plans and TPAs cannot be all things to all clients, and due to the Minimum Loss Ratio rules, they cannot afford to include many meaningful solutions. This is why there is an explosion of healthcare related start-ups aimed at helping employers manage everything from employee communication to helping participants manage their health conditions. Having 35+ years of working with health plans, employers, brokers, and healthcare providers enables Caveat Emptor to think differently about market strategies and how your solutions can fit in the healthcare eco-system.
