Where healthcare dollars leak, and how I find them
Every engagement starts with your data and ends with clear, actionable findings. Here is how I help self-funded employers take control of their health plan spend.
Medical & Pharmacy Claims Auditing
The problem: Employers may have limited visibility into whether claims are paid accurately. Duplicate payments, coding errors, and charges outside your plan’s terms slip through.
What I do: Review your paid medical and pharmacy claims line by line against your plan document, vendor contracts, and industry billing rules.
What you receive: A findings report that quantifies errors and overpayments, identifies who is responsible, and lays out a plan for recovery and prevention.
PBM & Vendor Contract Review
The problem: Complex contracts can make the true cost of pharmacy benefits difficult to evaluate. Spread pricing, retained rebates, and loose definitions can quietly drive up what you pay.
What I do: Analyze your PBM and vendor contracts and pricing terms, then compare them with what your claims data shows you are actually paying.
What you receive: A straightforward summary of your contract’s risks and gaps, plus the specific terms to renegotiate at renewal.
Price Transparency & Network Analysis
The problem: The same procedure can cost dramatically different amounts at hospitals in the same market, and most plans give employees no guidance.
What I do: Use available hospital pricing data to compare negotiated rates across providers in your network and identify opportunities for more cost-effective care.
What you receive: A clear view of cost-effective care in your market, with practical options for care and redesign benefits.
Plan Strategy & Fiduciary Support
The problem: Under ERISA, plan sponsors carry fiduciary responsibility, yet many lack the data and processes to show they are managing the plan prudently.
What I do: Help you put real oversight in place for your plan’s vendors and spending, and build a multi-year strategy to bend your cost trend. I work alongside your benefits broker and ERISA counsel.
What you receive: A documented cost strategy and vendor oversight approach you can confidently present to leadership and your board.
Not sure where to start?
Most engagements begin with a claims audit, the fastest way to see where your money is going. Let’s talk about your plan and what a first look would involve.