Employee Benefits

Employee Benefits

Employers are seeking more collaborative approaches in the management and design of their employee benefit programs.  Plan cost management, talent acquisition, administrative efficiency, and regulatory compliance are a few of the areas that often require expert guidance from internal and external resources.  “Connecting the dots” can make the difference between success and disappointment.

So while we bring you years of employee benefits plan experience, insurance carrier market clout, and an outstanding service team it is our stewardship process and consultative mindset that set us apart from others.

Stewardship Process

To effectively “connect the dots,” The Fedeli Group implements a stewardship process.  The stewardship process is a series of procedural steps that maximize accountability.  Our business practice standards require that we begin meetings with an agenda, provide meeting notes, and develop a work plan that outlines tactical and strategic goals.  This protocol encourages peer review to reduce errors and misunderstandings.

Annually, we prepare a stewardship report.  This 16-page report provides a succinct but thorough review of benefit plan results and activities.  Included are financial results, clinical analysis, benchmarking, service documentation, and status of work plan objectives.

What is your benefits philosophy?

A simple benefits philosophy statement can be an effective starting point in developing a longer-term benefits strategy.  Benefit philosophies need to be rooted in both economic reality and the cultural aspirations of the employer.

Used as a strategic springboard, a well-crafted benefit philosophy can help benefit managers optimize plan offerings while satisfying organizational objectives.

Plan Details Matter

Many employer-sponsored plans will appear to be running fine for years until there is that one claim that is not covered or covered at a lesser amount than expected.  While cost is always a consideration, contract provisions need to be vetted carefully.  Lack of diligence is particularly pronounced in the areas of life insurance and disability where pure “spreadsheet” decisions can lead to unhappiness at time of claim.

Alternatively funded health care plans are increasingly popular for mid-sized employers.  While these type of arrangements can be an excellent platform, what-if scenarios need to be considered in the event of termination or significant claim activity.  Too many times, employers will enter into arrangements without considering claims reserves, stop loss contract provisions and carrier quality, or additional regulatory requirements with self-funded arrangements.

Data with a Purpose

Traditional reporting tools available to employer health plans through insurers or brokers are limited to basic accounting and claims information.  The lack of transparency in health care has led to employers lacking effective decision support tools.

To overcome these challenges of inadequate plan data, The Fedeli Group uses data warehouse software supported by a highly technical analytics team.  The data warehouse (NavMD) receives HIPAA protected claim feeds from most major medical and pharmacy insurers and third-party administrators.  Using algorithms from OptumInsight claims can be grouped by type of chronic condition and episodes of care.

With robust clinical and financial information, more accurate forecasts, reserve calculations, and assessment of volatility (risk) is possible. Trends in severity, frequency, cost by service, and provider utilization can be evaluated, and potential benefit planning strategies developed and implemented.

Access to data is powerful, but the interpretation and recommendations that come from our experienced and collaborative team will ultimately make goal attainment possible.

Regulatory Compliance

The Affordable Care Act (ACA) has added yet another level of complexity to a heavily regulated environment that includes oversight from multiple federal and state government agencies, including the Department of Labor, the IRS, and State Departments of Insurance.

As part of a regulatory compliance risk management strategy, we recommend a periodic regulatory compliance review.  Areas covered include ACA, HIPAA, COBRA, ERISA, Medicare Part D, FMLA, and non-discrimination rules.

The Fedeli Group is particularly well versed in the Affordable Care Act, having done extensive research and client consultations since 2010.  We work with clients on a regular basis to address technical issues in the areas of affordability, minimum value, part-time worker definitions, plan fee calculations, coverage issues, the “Cadillac” tax, the application of wellness rules, and facilitation and guidance in the area of Forms 1094 and 1095.

Our regulatory compliance resources include internal experts and strategic partnerships with well-qualified legal resources and administrative service companies.

Wellness that works

Our experience indicates that employers should tailor wellness programming to their unique needs, expectations, budgets, and philosophies. But the promotion of wellness programming often takes the form of proprietary services and products that may or may not be in alignment with your culture.  We work with employers to identify and facilitate “best fit” wellness programming that works for them!  We provide insight, facilitation, vendor assessment, coordination, and planning.

Setting expectations and goals is an important part of the wellness journey.  Expectations set purely on cost will surely fail.  However, expectations set on employee well-being and the corresponding increases in productivity and eventual reduction in the severity and frequency of chronic conditions can work.  A cultural commitment combined with proactive and ongoing education is essential.

Our capabilities in clinical analytics put us in a unique position which allows us to measure and track wellness results over time.

The importance of client service

A helping attitude combined with an organized process is key to our client service model.  First and foremost, we are here to serve you.  Our focus client service includes a stewardship process built around team work, documented communication, client workflows, and accountability.

We are not beholden to public shareholders or a corporate bureaucracy.  Our energies are focused on building relationships, solving problems, adding value and networking.

Ultimately, it is our goal to have client relationships that are collaborative, trusting, and energizing.

Removing burdens and defining opportunity

We remove the burden of an increasingly complicated and regulated industry.  We do this through a stewardship business model that is driven by dedicated specialists in the areas of regulatory compliance, wellness, client service, analytics, and consulting.  It is our goal to be both a valued advisor and a practical solution provider.

With a pulse on the industry, technical competence, and a culture of curiosity we bring forward ideas, insight, and perspective that will help you design benefit plans that retain and attract a qualified workforce.

Associate Spotlight

Andre Lukez

Chief Consulting Officer