The Plan Design Audit Framework
- Claims experience analysis: Review prior year claims data to identify cost drivers
- Plan design benchmarking: Compare current plan design to industry peers
- Cost-sharing analysis: Evaluate whether cost-sharing is optimally designed
- Network analysis: Evaluate network type, adequacy, and utilization
- Pharmacy analysis: Evaluate PBM contract, formulary, and specialty drug management
- Compliance review: Identify compliance gaps and risks
- Employee communication assessment: Evaluate benefits communication effectiveness
The Audit as a Prospecting Tool
A well-executed plan design audit is the most effective prospecting tool available to plan design consultants. It demonstrates expertise, identifies specific problems the prospect has, and creates a compelling reason to engage you as their advisor. Offer the audit as a complimentary service to qualified prospects — the investment is typically recovered many times over in the advisory engagement.
The Audit Report
Pro Tip
The audit report should be specific, quantified, and actionable. "Your ER utilization rate is 180 visits per 1,000 members — 40% above the industry average for manufacturing companies your size. Implementing a telemedicine-first protocol could reduce ER visits by 20%, saving approximately $180,000 annually." This level of specificity is far more compelling than a generic observation that ER costs are high.