Reduce Costs

Wellness Strategies and Disease Management

Wellness is a strategy that leverages behavioral modification programs to enhance employee well-being (physical, intellectual, emotional, social, spiritual and financial) to reduce the prevalence and severity of illness so employees can enjoy a better quality of life and help reduce their health plan sponsor's claims costs. Wellness programs can be effective with the right leadership, articulated strategy and support programs for changing behavior and environment. Without careful planning and strategic implementation, almost half of wellness initiatives fail to deliver on their desired outcomes.

Time Off, Absence and Disability

Sibson understands that employee productivity directly correlates to the success of the organization. We help our clients with the strategy, design and management of time off and disability programs, including paid time off.

Provider Network Analysis, Options and Contracting

Sibson Consulting works with employers to create health care networks that are cost-effective and comprehensive. We have experience with a variety of networks, including:

  • Preferred provider (PPO) networks, both broad and limited in scope
  • Health maintenance organization (HMO) programs in which primary care physicians (PCPs) are paid a capitation rate, hospitals a per case rate and specialty physicians a fixed schedule of fees
  • Point-of-service (POS) programs in which PCPs function as gatekeepers for all in- and out-of-network care
  • Specialty networks of behavioral health practitioners and facilities
  • Dental PPOs, in which dentists are paid according to a pre-determined fee schedule, or DEMOs, in which each patient selects a primary care dentist who then coordinates all dental care needed by the patient
  • PPO networks of vision providers that offer significantly discounted rates for examinations and a selection of frames, lenses and contacts at reduced prices

Claim and Dependent Eligibility Audits

Sibson conducts scores of retrospective on-site claims reviews of private sector health plans administered internally or by third-party administrators.

Our consultants have extensive backgrounds in claims processing and review. This experience makes them uniquely qualified to evaluate established administrative procedures, suggest areas for improvement and ensure proper controls are in place for efficient plan administration.

Prescription Drug Benefit Custom Solutions

Rapidly rising prescription drug costs are driving overall increases in the cost of health coverage. Sibson Consulting can help you manage the cost of prescription drug coverage through a variety of services.

Vendor Bidding and Renewal Negotiations

Sibson Consulting works to get the most from vendors for all the clients we represent. We make it our business to know a vendor's history, financial solvency and performance to date, and we bring that knowledge to the table on behalf of your organization.

It is critical that all renewal rates negotiated with vendors are reviewed and assessed to make sure they are competitive and appropriate given the experience and plan design of your organization. Sibson uses a fair but firm approach, based on our technical expertise as underwriters and actuaries, to ensure that you receive the right renewals from your vendors.

Funding Arrangements

Some organizations with significant levels of cash reserves can reduce costs by self-funding their health plans or assuming more risk. But before doing this, you must carefully consider the ramifications and protect the plan against ordinary or catastrophic risks.

Sibson Consulting can help you determine if self-insuring or other cost-saving funding arrangements are right for your organization. We can also help plans that are already self-insured evaluate whether self-insuring is still the best choice.

Leveraging New Health Technology

Sibson utilizes technology and analytical tools to measure, monitor and predict the costs of health and welfare benefit programs. Sibson has developed a number of pricing tools to help clients assess impact. We customize our technical resources for your specific needs, ensuring that we provide the high level of quality consulting that our clients expect. Sibson is on the cutting edge of health care industry trends and relevant legislation, and we update and revise our tools and technology as needed to provide maximum value to our clients. 

Alternative Provider Reimbursement Arrangements

Sibson can help contain health costs through diligent management of provider reimbursement. As experienced consultants to plan sponsors in the areas of health insurance, managed care arrangements and third party administration, we begin by identifying networks with strong overall provider discounts, efficient administrative systems and robust ancillary program services. From there, we can help reduce or contain costs by managing and negotiating vendor contract terms more aggressively. In Sibson’s experience, it is possible to challenge a provider’s proposed premium renewal after performing independent renewal projections using different methods and assumptions. Frequently, these alternative projections uncover carrier mistakes or non-competitive terms that the carrier will reconsider.

On-site and Near-site Health and Wellness Clinics

Faced with the need for continued improvement in productivity and hampered by the tight budgets of the economic downturn, employers are taking a fresh look at implementing on-site and near-site medical clinics for employees and their dependents. The cost for implementing and operating these clinics has dropped, and clinics can now be set up on a smaller scale than in the past and require lower capital investments.

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