• ACA Marketplace Problems
  • Cost Modeling
  • Healthcare Consumption Audit

ACA Marketplace Problems

imagePresentation identifies the cost drivers, by design, that drive fully insured group health insurance premiums. Our business is conducted to a Fiduciary Standard and all service is classified as “concierge.”

Our focus is on the ERISA Self-Insured market, beginning at 25 covered employee lives in some markets. We are experts in crafting benefits to match employer’s culture; all alternative funding concepts, Direct Primary Care Networks, Networks, and Reference Based Pricing integration. We have all the “Next Generation” administration, services and products. 80% of group health solutions are now self-insured! The number is increasing.

Read More

Cost Modeling

imageCost Modeling - Self-insured employers with 50+ employees on their plan: Claim repricing and vendor vetting for replacing vendors with 100% transparency and business to a Fiduciary Standard. Implementing “Best in Class” vendors reduces spending up to 25% and improves Benefit Satisfaction. Data mine 24 months of Healthcare and Rx Claims. Reprice all consumed healthcare. This will illustrate any overcharging in your current claim adjudication process. Checking your PBM’s charges per script written will expose excess profiteering. Check your benefit vendors for accuracy and integrity. Recommend new vendors when needed for claim adjudication, network, administration, and Pharmacy Benefit Management. Recommended vendors are 100% Transparent & do business to a Fiduciary Standard which will increase benefit satisfaction and reduce benefit cost.

Read More

Healthcare Consumption Audit

imageIs there a new simpler approach to Health Plan Financial Analysis or Healthcare Consumption Audit?

I believe so.

Scott Hettesheimer has 43 years of experience as a consultant and strategist helping employers evaluate and select health benefit plan service providers. This discussion is intended to illustrate the complexity wrapped in "Healthcare Business As Usual."

Read More
1RatedLevel
Group Agent Resources
Sell Level Funded Health Plans that return 100% of unspent claims funding to employers.

Sell No-Network every provider is in and Transparent Pharmacy delivered from a fiduciary standard.

Read More
1time and money
Brokers

Support with a Full Array of Self Insured & Cost Containment Solutions

Read More
greyarrowsandgreen
Winning Employer Presentation

Best Practices in Designing Your Benefits Portfolio

Read More
1cellblocks
Unique
Differentiate & Be the Superior Healthcare Consulting Firm.

"The End of Healthcare Business as Usual."

Read More

Pass-Through Rx

Most PBM partnerships are fraught with conflicts of interest, the plan is misdirected and the goals of the employer and PBM are out of alignment.

PBMs often keep hidden revenue streams that should be returned to the plan sponsor and intentionally make it difficult to see how they are really making their money.

Traditional PBMs try to sell value through low administrative fees, high pharmacy discounts, low dispensing fees and artificially inflated rebate payments. But additional pharmacy discounts, hidden markup or "spread" pricing, rebate earnings, and other pharmaceutical incentives may not be completely disclosed; leaving you guessing as to the real cost of your plan.

Our transparent pass-through model focuses on helping clients understand the industry and manage drug spending. The complexity of the traditional model vanishes and a productive partnership is the new result.

 

Bottom line - "Next Generation" Pass-Through PBM can create up to 20% reductions in your pharmacy spend.

Our Passion for Design

Interactively procrastinate high-payoff content without backward-compatible data. Quickly cultivate optimal processes and tactical architectures. Completely iterate covalent strategic theme areas via accurate e-markets.

Completely synergize resource sucking relationships via premier niche markets. Professionally cultivate one-to-one customer service with robust ideas. Dynamically innovate resource-leveling customer service for state of the art customer service.

Learn More

About Scott Hettesheimer

Mr. Hettesheimer is a "Master" in custom-crafted, safe, LEVEL FUNDED, MINIMUM FUNDED, MAXIMUM FUNDED Traditional and Captive self-insured solutions. Our cost containment tools and tactics are the best available in the country. We are a collaborative group of professional entrepreneurs fixing healthcare benefits and controlling cost. We are an information technology management solutions innovators. Applying a systemic approach to healthcare management strategies, level funded self-insured contracts and performing population health management, and healthcare consulting of all aspects of employee benefits. We can become your “Outsourced HR” benefit partner. Our solutions significantly lower healthcare spending and improve all members "State of Health;" initiating a change of culture to begin eliminating healthcare need. Increased benefit satisfaction, retention, and attracting talent.

GAR is a National, Boutique Healthcare Benefits Solution vendor, offering every variation of Self-insurance, alternative funding and cost containment. Our business is conducted to a Fiduciary Standard and all service is classified as “concierge.”

Our focus is on the ERISA Self-Insured market, beginning at 25 covered employee lives. We are experts in crafting benefits to match employer’s culture; all alternative funding concepts, Networks, and Reference Based Pricing integration. We have all the “Next Generation” administration, services and products. 80% of group health solutions are now self-insured! The number is increasing.

We are a National group of private entrepreneurs; Advanced Benefit Design Institute, solving the U.S. health-care crisis today for employers like yourself. Insurance companies, Networks, and Pharmacy Benefit Managers are the problems.
We understand:

  • The minutiae of an insurer
  • Crisis management
  • Risk management
  • Regulation hurdles
  • Technology
  • Drug pricing abuse
  • Stop loss coverage
  • Claim adjudication
  • Networks and contracting
  • Benefit satisfaction

Reducing drug spending up to 30%... Reducing hospital spending up to 35%...Eliminating networks!
3 steps to keep small group health plans afloat:

  • Get out of the community pool – stop paying other groups’ catastrophic medical bills
  • Enjoy your own private pool – pay only for the medical care your members use
  • Stay out of the deep end – pay as little as necessary for the quality care your members need

“Next Generation” healthcare solutions are available today! Crafted to improve your bottom line and increase benefit satisfaction and outcomes!

We have fully insured alternatives to Anthem, BCBS, Humana, United Healthcare and all another current fully insured offerings. 2 to 50 employee sized groups.

I’m Scott Hettesheimer, a 41-year veteran in healthcare delivery. I have earned a reputation for self-funding expertise, leading-edge technology, cost containment, and legendary customer care. GAR is small enough that we know our contacts by name, yet we are part of large A+ (Superior) health insurance groups, providing deep resources. Contact me on my direct line at 513-661-7581 to arrange a time to learn more. Your renewal is monthly, start reducing your spending immediately!

 

Schedule a Call with Scott Today!