Health Plans Consulting
With the acquisition of The Burchfield Group in January, 2018, Aon has acquired vast health plan experience derived from working with nearly a hundred different health plans. These plans range in size from small, local market to large, multi-state health plans with as few as, 1000 lives and one line of business to those with over a million lives and multiple lines of business. Our experience encompasses all lines of business, including commercial, exchanges, Medicare and Medicaid plans. We understand the real challenges facing pharmacy directors, operational areas, actuaries and compliance officers today, and we have the solutions to help.
A Health Plan Leader, And Much More.
We provide health plan clients with expert pharmacy benefit management (PBM) consulting, procurement, auditing and related services that has a direct impact on the overall pharmacy spend for the plan.
Our health plan experience expands beyond procurement and audit & compliance. By understanding the operational challenges facing health plans today, we help implement best practices, control costs, predict and manage specialty pharmacy spend, and improve operational efficiency.
As a strategic partner, clients can benefit from plan management innovations and save big on pharmacy costs – staying price competitive in an era of increasingly tight margins.
Eagle-eyed focus and negotiating leverage
The pharmacy benefits consultants and auditors of The Burchfield Group are former PBM insiders and health plan pharmacy executives who know the industry through personal experience. They know exactly which numbers to look at, what to negotiate for, and how to get it from PBMs. To top it off, all consultants and auditors are 100% independent… No ties to drug manufacturers, PBMs, or retail pharmacy chains.
Two Broad Areas of Focus – a Key Differentiator
Pharmacy Benefits Management
Oversight and Audits
Helping health plans with all aspects of pharmacy benefit management: PBM procurement, contracting, benchmarking, negotiation, auditing, and performance monitoring. We work hard to ensure that every client comes out of their RFP or Market Check process with a PBM contract that is clear, auditable, and contains market-leading pricing.
Health Plan Compliance
Audits and Operations
Helping health plans with CMS Medicare Part C and Part D compliance, mock program audits, CPE audits, data validation, and related areas while taking a deep dive into your supporting operations. Also offering compliance and operations support related to emerging health insurance exchange requirements and audits, and 340B contracting.
Health Plan Consulting Expertise
Our in-depth delegation oversight assessments help clients identify potential issues and risks and ensure PBMs or delegated entities are performing at a high level.
We conduct thorough assessments of pharmacy operations and departmental touchpoints to provide guidance on regulatory and operational issues to mitigate risk and to evaluate decisions to insource or outsource delegated activities.
Our experts are able to provide ongoing support throughout a PBM contract, act as a liaison with health plan PBM’s, monitor trend, evaluate PBM recommendations and provide strategic direction and support for ASO sales.
Our competitive analysis of network rates, fees, and manufacturer rebate yields, gives you valuable insight into the marketplace and how you stack up.
Learn more by visiting The Burchfield Group website.