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EKA Planning Services Professional Services
EKA Planning Services uses three core principles to service and manage your employee benefits plans. We provide to our client’s professional value-added services that are based on strategic planning, five-star service and cutting-edge technology.
Strategic Planning
Five-star Service
We pride ourselves on the level of knowledge and service we provide to our clients.
Contact: We meet with clients regularly to ensure carriers, coverage and costs are meeting expectations.
Education: We conduct employee meetings and provide custom communication materials for employees.
Advocacy: We work on your behalf to bring an unbiased perspective to all situations, with no allegiance to any specific carrier or vendor.
Personnel: We hire and maintain a professional, experienced staff and ensure that they are up to date on all the latest trends and information.
Information: We possess the information and expertise that allow us to negotiate comprehensive, competitive benefits programs and we know where to find answers to your insurance, employee benefits and human resources questions.
Technology
- We offer professional services in the following areas:
- Plan Strategy
- Data Analysis
- Pharmacy Benefits
- Plan Administration and Legislative Compliance
- Employer Education
- Human Resources
- Employee Communications
- Wellness Services
- Marketing/Marketing Action Plan
Plan Strategy Capabilities
Actuarial Services
Plan Design Advisor
Eliminate guesswork from your benefits renewal process. EKA Planning Services can provide tools that can help you make educated benefit plan decisions, balancing cost and value for your company and employees.
Through this process, we can help you:
- Analyze your benefits plan costs and utilization against reliable benchmark information
- Project the impact of medical and dental plan design changes
- Estimate your renewal costs
- Streamline the plan selection process for your employees
- Compare yourself with other employers by region, size and industry
Benchmark Surveys & Statistics
Our benchmarking data provides you a standard to which you can compare your benefit programs. We will make recommendations to help you enhance your plan while at the same time remaining competitive and reducing your overall plan costs.
Valuable benefit trend statistics and surveys are one of the core pieces of information that we provide to our clients to help support your benefit plan design strategy and decisions. These surveys and statistics provide benchmark data from leading consulting organizations around the country and cover the following topics:
- Ancillary Benefits
- Benefit Costs
- Benefit Management
- Health Care Costs
- Health Care Reform
- Health Plans
- Prescription Drugs
- Retirement Plans
- Wellness Benefits
- Paid Time
Plan Design
Data Analysis
EKA Planning Services has managed medical benefits programs for over one-thousand employer groups in an effort to keep costs below comparable levels experienced by other employers. Our aggressive management technique includes several internal medical management and preventive health initiatives.
As the healthcare industry continues to change, our firm has remained ahead of the game. With leading-edge technology, we are able to obtain meaningful information that helps us evaluate cost drivers, trends and savings opportunities associated with our clients’ benefits plans. In addition, we work to evaluate the impact of various plan management initiatives and forecast the impact of future changes.
We provide employer groups with tools that will provide consistent year-to-year data, easy-to-read reports and comparative benchmarks. This highly meaningful yet understandable information enables us to work together with your data in a continuous, interactive manner as plan management issues arise.
Our Approach to Meeting Your Needs: Decision Master Initiative Database
What is the Decision Master Initiative Database?
What can the Decision Master Initiative Database do for our Clients?
- Help determine the root causes of medical cost and utilization problems
- Offer a sophisticated plan modeling tool to help measure the impact and effectiveness of plan design changes
- Benchmark your claims experience against nationally recognized norms
- Provide complex information in an easy-to-use and understand format
- Help you formulate cost-cutting strategies to implement in your workplace
Quality versus Quantity
The benefits manager of a Fortune 500 company was quoted in Business & Health as saying,
“Any benefits manager can relate to the problem. The attempt to control corporate health costs invariably is stymied by the lack of meaningful information. It’s not a problem of quantity, but the quality of the data that is available.”
Components of the Decision Master Initiative Database
Thanks in part to technological and operational advances, claims administrators are typically able to capture and report on volumes of claims data. Claims data can be provided in numerous ways but reports are typically cumbersome, lack a meaningful benchmarking process and are difficult to extract valuable information from without considerable additional effort and analysis. Benefits managers are challenged to derive value from a vast and complex array of reports and find it difficult to use the information to help their companies positively impact benefits costs.
Unorganized data from too many different sources makes it impossible to clearly focus on areas of high utilization and cost. DMID lets us take the opposite approach. One of the primary goals of the DMID system is to simplify the typical reporting process and extract meaning from your group’s claims experience.
Before looking at the details, DMID lets us see the big picture. For example, the DMID process allows us to see if various cost and utilization areas are abnormally high by first comparing our clients data to nationally recognized norms. After this high-level observation is made, we can then determine why the situation exists and begin formulating solutions.
With the help of Decision Master Initiative Database, you can get the quality information you need to refine your medical benefits, plan design strategies, and make smarter decisions. With information at its core, DMID provides a structured insight into your plan and drives long-term strategies that will shape your health plan design and employee communication efforts.
Health Plan Management Reports
DMID is based on a philosophy of structured information and normative analysis. The Health Plan Management Report is designed to provide our clients with information and analysis we can use to develop broad observations and cost-saving strategies. Regional and state normative measures of health plan cost and utilization are core components of the report. Benchmarks identify where plan use, or cost is higher than average and offers the platform from which productive plan design alternatives can be examined.
Each DMID Health Plan Management Report contains nearly 33 easy-to-read and comprehensive exhibits, with approximately 68-pages, full reports available to customers looking for more comprehensive analysis. Nearly every exhibit contains descriptive and engaging charts to make the data easier to understand, as well as benchmark comparisons, advice for comprehending the data and suggestions on where to look for more detail.
- The Health Plan Management Report exhibits include:
- Total Health Plan Costs
- Health Plan Cost Trend by Month
- Total Medical Claims Cost
- Employee versus Dependent Claims
- Inpatient & Outpatient Claims
- High-Cost Claimants
- Paid Claims Distribution
- Inpatient Analysis
- Inpatient and Outpatient Surgery Procedures
- Emergency Room Visits
- Office Visit Utilization
- Inpatient Behavioral Health Utilization
- Outpatient Behavioral Health Utilization
- Analysis by Major Diagnostic Category
- Lifestyle-related Claims
- Preventive Care Utilization
- Disease Management
Ad Hoc Analysis
- Why are my office visits so high?
- Who is going to the doctor?
- Why are they going?
- Are they using in-network or out-of-network providers?
- Do my high-cost claimants represent long-term chronic conditions? Or were they caused by accidents?
- Why are my members using the emergency room so frequently?
- Who is using the ER the most—employees, spouses or dependents? Are they using it appropriately?
- What does my group’s experience show about disease management? What types of diseases should our communication pieces focus on?
Not only can we answer these questions and more using Ad Hoc Analysis but can also find answers without knowing how to program or use a complex report-writer. The Ad Hoc Analysis viewing tool makes use of intuitive, drag-and-drop technology, allowing us to easily manipulate the data. Ad Hoc Analysis even allows us to create ad hoc charts and graphs for any exhibit.
EKA Planning Services uses Ad Hoc Analysis to analyze the following categories:
- Claims History
- High-Cost Claims
- Inpatient and Outpatient Hospital
- Inpatient and Outpatient Surgery
- Inpatient and Outpatient Behavioral Health
- Chiropractic Care
- Emergency Room
- Lifestyle Claims
- Major Diagnostic Categories
- Place of Service
- Disease Management
- Pharmacy Utilization
- Specialty Drug
- Drug Utilization
- Therapeutic Class/Drug
- And more!
Plan Design Modeling
The Decision Master Initiative Database claims analysis process is designed to help our clients save benefit dollars by making plan design decisions that are based on observable claims experience. You should expect that any plan design changes you make will have a desirable financial outcome.
Our goal is to clearly present plan savings projections in a realistic format, based on your company’s actual claims experience. DMID’s Plan Design Modeling feature lets us do just that.
Once we isolate problem areas using Ad Hoc Analysis, Plan Design Modeling lets us focus on solutions. DMID’s modeling feature lets us experiment with plan design alternatives and see if plan changes can save you money. The advanced modeling capabilities even show how plan members would be affected by a particular plan change.
DMID allows us to model your plan based on a variety of plan elements, including:
- Calendar year deductibles, coinsurance and out-of-pocket maximums for both in-network and out-of-network claims
- Office visit copay, deductible, and coinsurance
- Inpatient hospital copay, deductible, and coinsurance
- Outpatient hospital copay, deductible, and coinsurance
- Inpatient surgery copay, deductible, and coinsurance
- Outpatient surgery copay, deductible, and coinsurance
- Chiropractic copay, deductible, visits, and coinsurance
- Emergency room copay, deductible, visits, and coinsurance
- Urgent care copay, deductible, and coinsurance
