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M3’s contract management services complement our claims data reporting. Instead of looking back at the numbers, contract management looks at the facts and options in front of you.
M3 uses several contract management tools to provide oversight and direction for your plans. We look your contracts over to ensure that they are doing what you expect them to do. We also offer other options to point out how your plans could do better than you expect.
| Making Every Dollar Count |
| Contract analysis — A painstaking review of the details in a plan’s contract. These include eligibility, pre-existing condition exclusions and reinsurance. M3 does this review for health and welfare plans to check the contracts for completeness.
Prescription Benefit Manager (PBM) Audit — Performed at renewal, the audit summarizes utilization and all the pricing elements of the PBM contract: the discount, rebates, and dispensing and processing fees
PPO Analysis — This report offers an overview of costs, access and utilization under your PPO contract. It may also show comparative information from another area network.
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Contract Management Works for You
You don’t have to be an actuary to make sense of M3’s contract management reviews. We select the pertinent information that you need for decision-making and present it in an executive report format.
Whatever type of plan you have, your contract management reports put hard data behind your decisions and our discussions with your carrier.
- We conduct a contract analysis at renewal, examining the carrier’s contract to be sure it is complete. We also do this analysis for plan transitions by comparing the old and new contracts. We know that missing one small detail when adding a new group, or changing plan design or carriers can leave you exposed to thousands in claims costs or leave some employees without coverage.
- M3 created the Prescription Benefit Manager (PBM) Audit to provide an overview of your current PBM contract. The audit also compares it with what we believe to be your ideal PBM contract. It tells you if you’re getting what you believe you’re paying for and whether you could gain your firm some savings.
- The PPO Network Analysis helps you judge the pricing, service and savings you get from your current PPO network. If there’s another network in your area that could offer more cost-effective service or improve employee access, the report will also show its data.
You don’t have to figure these reports out on your own. Your account executive reviews them with you to explain the results further and counsel you on how to use them. Then, whether you are talking to your board or your carrier, you’ll have data and facts that you can rely on.
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