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Reasonableness is not a question.

It is a responsibility.

Employer fiduciaries are required to ensure the reasonableness
of their health plans, and Service Providers must assist them in
fulfilling this obligation. HealthPlanIQ is committed to supporting
all parties in assessing reasonableness while also considering
quality, services, value, and outcomes.

 

 

Talk to Us

 

 

Reasonableness is not a question.
It is a responsibility.

Employer fiduciaries are required to ensure the reasonableness of their health plans, and Service Providers must assist them in fulfilling this obligation. HealthPlanIQ is committed to supporting all parties in assessing reasonableness while also considering quality, services, value, and outcomes.

Talk to Us

Reasonableness is not a question. It is a responsibility.

Employer fiduciaries are required to ensure the reasonableness of their health plans, and Service Providers must assist them in fulfilling this obligation. HealthPlanIQ is committed to supporting all parties in assessing reasonableness while also considering quality, services, value, and outcomes.

 

Talk to Us
HPIQ Report Sample Peek

Benchmarking

 

Our benchmarking reports provide:

  • Objective, third-party validation of plan fees, performance, and competitiveness across carriers, TPAs, networks, PBMs, stop-loss providers, and wellness programs.

  • Granular peer comparisons that quantify where your plan performs well and where financial leakage, excess fees, or underperformance may exist.

  • Regulatory-ready documentation to support ERISA fiduciary requirements, plan audits, vendor oversight meetings, and committee governance.

  • Actionable recommendations, not just data, so employers and advisors can renegotiate contracts, optimize plan design, and reduce unnecessary spend.

HealthPlanIQ Methodology

HealthPlanIQ’s methodology will holistically consider the factors that allow a fiduciary to determine reasonableness.

 

HPIQ 5 Step Methodology Cost
HPIQ 5 Step Methodology Services
HPIQ 5 Step Methodology Quality
HPIQ 5 Step Methodology Value
HPIQ Step Methodology Outcomes
 
Cost
Services
Quality
Value
Outcomes
 

How do your healthcare premiums compare to what other similar plans are paying?

What services are the employer and employees receiving?

Is your plan delivering quality care to your
employees?

What value is your plan delivering to
your company and its employees?

Is your plan providing efficient
care for the dollars spent?

 

How HealthPlanIQ Works

HealthPlanIQ builds peer groups of plans based on plan type, employee count and location in order to provide an apples-to-apples analysis which will be delivered to you as a Fee Reasonableness Report answering critical questions such as:

How HPIQ Works_2-1
Share Your Plan Details

Upload your service provider contracts so we can identify your fixed costs and services being received.

  • Your data will only be used in aggregate, de-identified peer groups and held with strict confidentiality

 

AI-Enabled Analysis

HealthPlanIQ identifies your best-fit peer group based on plan type, employee count, and zip code, then uses AI-enhanced analysis to aggregate data from similar health plans and evaluate your costs, services, value, and outcomes against those peers.

  • Our algorithms evaluate your costs, services, value, and outcomes against similar plans

 

Your Fee Reasonableness Report

Comprehensive and actionable reports are delivered, including a consolidated summary if you have multiple plans, a detailed report per plan, and a causation supplement, which helps identify the “why” of your larger variances. Your reports include benchmarking of:

  • Service Provider Costs
  • Provider Services+
  • Value and Outcomes
  • Bottom Lines and Considerations
Protect Your Plan

With report(s) in hand, the next thing to do is to take action. Review the report with your committee and service providers to determine how you can optimize the value that your company and its employees are receiving from the plan.

  • Work with your service providers or consult with HealthPlanIQ’s partners to enhance your plan.

 

Book a Demo

Our Services

HealthPlanIQ's Product Suite works with employers
and their service providers to provide:

 

Benchmarking

For Employers and Service Providers

5500 Search

For Service Providers

Research

For Service Providers

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The need for a health plan reasonableness solution has never been stronger. HealthPlanIQ will be the first to market with an independent and actionable solution for determining reasonableness.

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Unfortunately, the quality of Form 5500 data and the ability to make it actionable has always been questionable. HealthPlanIQ will introduce a better and more innovative 5500 solution.

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HealthPlanIQ’s goal is to build the largest independent database of health plan data. The comprehensive nature of reasonableness data will offer valuable research solutions for Service Providers.

Evolution of Health Plan Oversight


The traditional approach in Healthcare today focuses on benefit level comparisons.
HPIQ brings a proven process from the retirement industry to illuminate reasonableness. 

Traditional Approach

Cost focused analysis leads to commoditization of service providers and lesser outcomes

 

Tends to include opinion(s) and bias(es)
and may be limited in considerations

Fiduciary documentation is created manually, consists of multiple documents and is not standardized

Reactive cost-cutting - cost is the only
consideration and this can have negative
impact on services, value and outcomes

Time consuming, resource intensive and costly

HealthPlanIQ Approach

Holistic approach leads to best possible
services, value and outcomes for the cost

Independent, unbiased method and data
ensures the best possible decision-making

Documentation is created systematically, is delivered in a single package and in a standardized format

Proactive value optimization - due to the consideration of quality, services, value and outcomes

Less time, resources and cost. Leave
the work to HealthPlanIQ.

Evolution of Health Plan Oversight


The traditional approach in Healthcare today focuses on benefit level comparisons.
HPIQ brings a proven process from the retirement industry to illuminate reasonableness. 

HPIQ_Comparision Chart

Health Plan Benchmarking Done Differently

 

The regulatory environment has shifted.

Today, employers must demonstrate that their health plan costs, administration fees, network discounts, and vendor arrangements are reasonable and in the best interests of participants.  Traditional market surveys and anecdotal broker comparisons are no longer sufficient.

 

A Smarter Approach
 

Traditional Approach

HealthPlanIQ Approach

Cost focused analysis leads to commoditization
of service providers and lesser outcomes

 

Tends to include opinion(s) and bias(es)
and may be limited in considerations

 

Fiduciary documentation is created manually, consists
of multiple documents and is not standardized

 

Reactive cost-cutting - cost is the only
consideration and this can have negative
impact on services, value and outcomes

 

Time consuming, resource intensive and costly

 

Holistic approach leads to best possible
services, value and outcomes for the cost

 

Independent, unbiased method and data
ensures the best possible decision-making

 

Documentation is created systematically, is delivered
in a single package and in a standardized format

 

Proactive value optimization - due to the consideration
of quality, services, value and outcomes

 

Less time, resources and cost. Leave
the work to HealthPlanIQ.

 

ERISA Compliance

A defensible, data-backed view of plan reasonableness.

Reasonableness

Most employers have been meeting their obligations under ERISA for their retirement plan but until recently most were not aware that the obligations for their healthcare plan were the same.

 

 

 

 

“The defendants “failed to exercise
prudence … in agreeing to make its ERISA
plans and beneficiaries pay unreasonable
prices for prescription drugs.”

— Lewandowski v. Johnson & Johnson

“No prudent fiduciary would agree to make
its plan and participants/beneficiaries pay
a price that is fifteen times higher…”


— Navarro v. Wells Fargo & Co.

“… cannot hide behind the plan terms,
especially where ERISA imposes specific
and independent duties on its fiduciaries to
otherwise comply with the provisions of ERISA.”

— Doe v. United Behavioral Health

HPIQ_Report Mock up

Who We Serve

As a mission, our goal is support employer fiduciaries with their obligation with health care governance.


We work with: 

- Brokers/Consultants

 - TPAs

 - PBMs

 - Stop-Loss Providers

 - Industry Data Providers

Who We Are

HealthPlanIQ is an independent provider of actionable health plan reasonableness solutions to employer fiduciaries. Our service also provides Advisors/Consultants, TPAs, PBMs, and Stop-Loss Providers with the ability to better discuss their value delivered and impact on outcomes.

Our technology-enabled service assists employer fiduciaries in meeting their obligations under ERISA to determine the reasonableness of their healthcare plan providers. Our goal is to ensure that our clients are able to achieve the best possible outcomes for their employees at a reasonable cost.