Improving Health. Controlling Costs. Delivering Results.
We help employers improve workforce health, manage chronic conditions and control healthcare costs, all year and not just at renewal. The work combines the well-being tools your plan already includes, programs for the conditions your claims actually show, a hard look at pharmacy and claims spend, and a quarterly review that puts all of it in front of your leadership in one place.
Once a fully insured group passes about a hundred enrolled contracts, its health starts to show up in its price.
A fully insured renewal blends two numbers: the carrier’s book rate and your own claims experience. The weight on your own experience grows with enrolled contracts, commonly reaching full weight around a thousand. Near a hundred contracts it is roughly a tenth of the number; near five hundred it is roughly half. That is why this work belongs to employers with one hundred to five hundred employees: the claims you improve this year become part of the rate you are offered next year, and the year after that.
It Compounds, It Does Not Rescue
Health work does not save a renewal that is already in your inbox. It moves the part of the number that belongs to you, a little each year, which is why it has to start before the renewal rather than in response to one.
Enrollment Is Part of the Math
The weight follows enrolled contracts, not headcount. Two employers with the same number of employees can carry very different weight on their own claims because of take-up, so participation is a cost question as well as an HR one.
The Factor Is on Your Rate Exhibit
Each carrier sets its own schedule, and the weight actually applied to your group is printed on its rate exhibit. If nobody has ever shown it to you, that is the first thing we would read.
Four parts, chosen from your own data rather than a catalog.
Every part starts from what your claims and participation already say. A program that does not answer something in the data is spending, not strategy, so we do not recommend one.
Well-Being Engagement
Most plans already include a well-being platform: health assessments, coaching, tobacco cessation, sleep and stress programs, activity challenges. Few employers use it. We plan the campaigns that get employees into it, time them to open enrollment and the calendar, and report participation against a target set in advance.
Chronic Condition Programs
Diabetes and prediabetes, weight, hypertension, musculoskeletal pain and behavioral health tend to drive a disproportionate share of spend. We match programs to the conditions your claims actually show, then measure each one against a baseline taken before it starts, so a renewal conversation can say whether it worked.
Pharmacy and Claims Cost Control
Specialty drugs, the new weight-loss medications and generic dispensing rates are now among the fastest-moving parts of a renewal. We review pharmacy spend and pricing terms, audit claims for payment errors and eligibility, and treat high-cost claimants as a plan for the coming year rather than a surprise at renewal.
A Quarterly Executive Review
One report, every quarter, built for the people who sign the renewal: participation, emergency room use, pharmacy trend, preventive care, high-cost claimant concentration and where the next renewal is heading. Aggregate and de-identified, with a recommendation attached to each number.
A plan year with four checkpoints, so the renewal is never the first time anyone looks.
The review follows your plan year, not the calendar. Each quarter has one job, and each one feeds the next.
Quarter One: Set the Baseline
Where spend concentrates, which conditions drive it, current participation in the well-being tools, and the targets we will be judged against. Nothing is measured later that was not written down here.
Quarter Two: Engagement
Campaigns running, programs enrolling, pharmacy findings acted on. The report says what moved, what did not, and what we are changing because of it.
Quarter Three: Pre-Renewal Outlook
A projection of the next renewal built from your own trend, before the carrier sends its number, so plan design, contribution and program decisions are made on data rather than on a deadline.
Quarter Four: Renewal and Reset
The renewal read against the outlook, the results against the baseline, and next year’s targets. Leadership sees what the year delivered in health and in cost, in one conversation.
What employers ask before starting.
Will we see employees’ health information?
No. Everything you see is aggregate and de-identified. The reporting shows where cost and risk concentrate across the group, never who a claim belongs to.
How long before it shows up in cost?
Participation moves within the first year. Condition programs usually take a year or more to show in claims, and the effect on your rate is scaled by the weight your carrier gives your own experience, so it builds across several renewals.
What if we are under a hundred employees?
Claims detail is thinner at that size, so the rate lever is smaller. Well-being engagement and pharmacy review still pay, and the baseline we build now is the one you will need as you grow.
Further Reading
Preventive Care and Wellness Incentives
Using incentives to raise preventive care, within the rules.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
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