FAQs

• Does BenefitsWatch have to be simultaneously applied to medical and prescription drug plans?
  Yes. In order for BenefitsWatch to deliver value as promised, the process must include data from your TPA and PBM. When we analyze the data from these two sources amazing “exceptions” present themselves.
  
  
• What are the essential differences between BenefitsWatch and your other main service, BenefitsAudit?
  There are four essential differences:
  
  1) BenefitsAudit is a retrospective audit that requires one data download from your Third Party Administrator(s) (TPA) and Pharmacy Benefits Manager (PBM). The Audit addresses whether or not your plan administrators are in compliance with the ASO and SPD they’ve agreed to with you and measures past administrator performance. BenefitsWatch is a concurrent, continuous monitoring service that requires a data feed, and not only identifies compliance errors and fraud, but looks at two other critical areas of plan performance – financial management and cost and utilization.
  
  2) With BenefitsAudit, savings can be realized and corrective taken year-to-year. With BenefitsWatch, savings are realized and corrective action can be taken quarter-to-quarter.
  
  3) With BenefitsAudit, the deliverable is one report, accompanied by recommendations and consultation. With BenefitsWatch, the deliverable is quarterly reports, recommendations and consultation for continuous monitoring through the life of the contract, usually two to three years.
  
  4) BenefitsAudit can be utilized for either medical (including dental) plans, prescription drug plans or all three. BenefitsWatch requires both medical and prescription drug data in order to deliver maximum savings and value to the client. Dental data also can be included.
  
  There is one common element to BenefitsWatch and BenefitsAudit... our unique five-step protocol that analyzes 100-percent of claims for the audit period. HDM’s protocol has been proven in an independent study to be far superior to random sampling. To find out more, click here to download the study.
  
  
• How do we get started with BenefitsWatch?
  You review and execute a service agreement. We then assign you to a BenefitsWatch Analyst, who will work with you to assure the efficient exchange of data from your administrators. We do the rest.
  
  
• How long does it take to get up and running with BenefitsWatch?
  Normally, about two months.
  
  
• I’m not sure that our administrators will cooperate with 100 percent of their data. Will they?
  By contract, they have to. In our nearly two decades in business, we’ve audited most of the TPAs and PBMs in America. We’re familiar with their data and they are comfortable with us.
  
  
• How do you assure the integrity of the data you’ll take in from our administrators?
  Our in-depth knowledge of administrator systems assures the efficient exchange of data. We have exchanged data with most administrators in the U. S. at least once.
  
  
• Will we have to hire one or more people to interface with HDM?
  No. You simply have to designate who in your company should be the point person, and who should receive the quarterly BenefitsWatch report.
  
  
• Will we need to involve our IT people?
  Some companies do. However, since BenefitsWatch is not ASP-delivered, and since our software will not reside on our client’s servers, most clients choose not to involve their IT departments.
  
  
• Who then needs to be involved at our end?
  Representatives from finance to assure that your quarterly reports are customized for your needs and representatives from EE benefits to assure the efficient transfer of the ASO and SPD.
  
  
• Will BeneftsWatch work enterprise-wide? Can we compare health plan performance by company or division?
  Absolutely. You not only can compare your plan’s performance by business unit, you can also compare each business unit’s plan performance to industry benchmarks in these critical areas of plan performance – compliance, financial management and cost and utilization.
  
  
• Will you help us interpret the quarterly reports?
  Count on it. We’re the leader in employee health benefit plan audits and analytics. Our experience and recommendations are part of the package.
  
  
• Why do you report quarterly, and not monthly?
  We’ve done our homework on this. Quarterly reports provide the optimum cost/efficiency balance, while allowing for accurate trend tracking.
  
  
• Who will be responsible for our account?
  We’ll assign your account to an HDM analytics team. You may have direct access to every team member, if you like.
  
  
• You estimate a 4-to-1 average ROI. How do you measure it?
  That’s an average ROI for a company or enterprise with 2,000 or more covered people. The ROI becomes clear from...
  
  1) the findings that result when we mine your administrators’ data in your customized data warehouse with our Business Rules Engine. (On average, we find five to eight percent waste in the health plan spend.)
  
  2) the opportunities we uncover for improvement in utilization and plan performance.
  
  
• Are you going to be able to consistently deliver savings year after year?
  Yes. Plans are dynamic. Employees come and go. Plan governance is an on-going process. You must continuously monitor your plan’s performance, to assure that your plan your plan is performing to goals and benchmarks in all areas. For the first time, BenefitsWatch gives you absolute quarter-to-quarter control.
  
  
• Is there any limit to the size of the health plan BenefitsWatch can monitor?
  No. However, the complexity of large enterprises sometimes dictates multiple quarterly analyses.
  
  

To discuss how HDM’s cost containment solutions for self-insured employers can benefit
your organization, contact HDM today at 800.859.5119 ext. 1 or e-mail your inquiry to: info@HDMinc.com.