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Self-Funded Plans

DMA is an expert in designing and implementing Self-Funded health insurance plans.  We start with an analysis of the employer's existing medical program to determine if it would be beneficial to become self-insured.  While self-funding is not the best alternative for all employers, it is definitely one of the most effective ways that employers can control the rising cost of health care coverage. 

DMA can help employers understand the advantages and potential risks of having a Self-Funded plan that offers the employer significant control over the design and administration of the plan.  One of the ways to more effectively manage the costs of the plan is through Medical Management oversight and clinical intervention, which is a key advantage to a self-insured plan.

Why DMA's Medical Management Oversight?

DMA has developed a unique Clinical Consulting Model for medical management oversight that sets us apart from other major consulting firms.  DMA has a team of in-house RNs that apply their clinical knowledge and medical expertise in analyzing claims data received from self-funded clients.  This Clinical Consulting Model provides the following management and intervention benefits:

  1. Identifying and addressing medical claims cost drivers
  2. Predicting future high cost claimants and identifying appropriate medical management opportunities
  3. Tracking and accelerating the payment of stop-loss claims
  4. Designing or enhancing wellness programs to focus on the key medical conditions impacting the health of each respective employee population
  5. Carrier/TPA oversight

DMA offers the following Specialized Reporting, Analysis and Intervention Services for its Self-Funded Clients:

  • Clinical consulting
  • Review of weekly hospitalization reports
  • Trend analysis
  • Funding projections and Modeling
  • High dollar claimant monitoring and reporting
  • Stop-loss claims monitoring
  • Stop-loss accelerated payments
  • Benefit design interpretation from a clinical perspective
  • Annual Audits of:
    • Medical claims
    • Pharmacy claims
    • Dental claims
    • Eligibility
    • Hospital Payments