Healthcare Consulting Services
End-to-end analytics and consulting for self-funded employer health plans.
Risk Assessment & Business Intelligence
Understanding where your healthcare dollars go starts with knowing who drives the costs. Med-Vision uses Milliman MARA risk predictors to identify high-cost members before claims spike, giving you the intelligence to act proactively rather than react to budget overruns.
Our predictive modeling analyzes member risk scores, historical claims patterns, and demographic data to forecast future cost exposure. This allows benefits teams to allocate resources strategically, target interventions where they matter most, and negotiate stop-loss coverage with real data backing every decision.
Every assessment includes a comprehensive business intelligence dashboard with drill-down capabilities, trend comparisons, and benchmarks against industry norms.
Healthcare Data Analytics
Through our partnership with Cedargate Technologies, Med-Vision delivers deep claims analysis that goes far beyond standard carrier reports. We ingest medical, pharmacy, and ancillary claims data with monthly refreshes and unlimited storage, building a longitudinal view of your plan's performance.
Our analytics platform identifies cost outliers, utilization anomalies, and network leakage that carriers have no incentive to surface. You get actionable reporting dashboards, not dense spreadsheets, designed for benefits committees and C-suite decision makers.
Because we are independent, our analysis is never filtered through a carrier or broker lens. You see the data as it is, not as someone else wants you to see it.
Cost Transparency
The federal Transparency in Coverage rule now requires hospitals and insurers to publish machine-readable files with negotiated rates. The problem? These files are massive, complex, and nearly impossible for employers to interpret on their own.
Med-Vision partners with Deerhold to analyze these machine-readable files and translate them into clear, comparable pricing data. We show you exactly what hospitals charge for specific procedures, how your network discounts compare to market rates, and where you may be overpaying for common services.
This intelligence powers smarter network design, reference-based pricing strategies, and direct provider contract negotiations.
Learn more about cost transparency
Vendor Contract Analysis & PBM Audit
Your TPA, stop-loss carrier, and PBM contracts contain clauses that can cost hundreds of thousands of dollars annually. Financial abuse provisions, auto-renewal traps, and opaque pricing language are common, yet most employers never have these contracts independently reviewed.
Med-Vision conducts line-by-line contract analysis to identify pass-through pricing failures, spread pricing, hidden administrative fees, and rebate retention practices. Our PBM audits verify that your pharmacy benefit manager is delivering on its contractual guarantees and not profiting at your expense.
We have identified millions in recoverable overcharges for our clients through these audits, often paying for our entire engagement with a single finding.
Population Health Management
Seventy percent of healthcare costs are driven by just ten percent of members. Population health management is about identifying those members early and deploying targeted interventions before costs escalate.
Med-Vision uses risk stratification models to segment your member population by cost trajectory, chronic condition burden, and engagement likelihood. We then design prevention and care management programs that reduce high-cost member transitions, lower ER utilization, and improve health outcomes.
Our approach is data-driven and vendor-neutral. We recommend programs based on what your data shows, not based on which wellness vendor pays the highest referral fee.
Disease Management & Rx Compliance
Pharmacy costs are the fastest-growing component of employer healthcare spend, driven by specialty drugs, GLP-1 medications, and biosimilar adoption gaps. Med-Vision provides independent pharmacy cost optimization that addresses both clinical outcomes and financial sustainability.
Our team analyzes formulary design, therapeutic alternatives, and medication adherence patterns to identify opportunities for cost reduction without compromising member care. We specialize in GLP-1 management strategies that balance access with affordability, a challenge facing nearly every self-funded employer today.
We also evaluate disease management program effectiveness, measuring ROI on chronic condition programs and recommending adjustments based on actual claims outcomes.
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