Specifications include, but are not limited to: A. Corporate Structure of Quoting Carriers Ownership Provider Compensation Philosophy and how it ties into overall goals in healthcare delivery B. Medical Care Delivery Cost Containment Quality Initiatives Network Composition Options for Out-Of-Network care for PPO/POS Members Provider Contracting Approach Access to Providers & Appointments (PCP/Specialist/Urgent/Emergency Care) TeleMedicine or other options Near-site or Onsite Employee Clinic Ability and experience to negotiate discounted medical procedure rates with local and regional medical providers Experience to offer and to encourage employees to consider lower cost options for medical procedures Robust data analytics C. Pharmacy Care Claims Administration Information related to preferred copay approach, step therapy, and coverage, if any, for nonformulary medications Integration with Medical Care/Delivery How is Formulary Developed and Monitored Management of Specialty Pharmacy Top challenges with pharmacy expense management Cost Containment strategies for prescriptios
