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Advanced Benefit Design Institute · FiduciaHealth Governance™
Employer Healthcare Consulting Built on a Governance Standard, Not a Renewal Cycle
Healthcare is your second-largest expense after payroll. Every other cost center at your company is governed with data, accountability, and vendor discipline. Your health plan should be no different.
Fiduciary Focused
Your Interest. Our Priority.
Transparent Economics
Clarity in costs. Confidence in decisions
Vendor Accountability
Aligned incentives.
Stronger outcomes.
Data-Driven Strategy
Smarter insights. Better results.
MEasurable Results
Proven impact. Sustainable savings
A Better Way Forward
Legacy insurance companies, legacy brokerages, and their vendor ecosystems were built for a different era - with different incentives. FiduciaHealth™ was built for today and tomorrow. We empower employers with the governance, transparency, and strategy needed to control costs, eliminate waste, and improve healthcare outcomes - without compromising employee benefits.
20-40%
Typical Total Cost Savings Identified
20-40%
Typical Total Cost Savings Identified
20-40%
Typical Total Cost Savings Identified
Fiduciary Oversight. Transparent Solutions. Measurable Results.
What is FiduciaHealth Governance™?
For decades, CFOs have been trapped inside a healthcare system dominated by legacy carriers, legacy brokerages, and vendor arrangements engineered to maximize their profits — not yours. The result is double-digit annual renewals, hidden compensation structures, inflated claims costs, and zero fiduciary accountability.
Advanced Benefit Design Institute introduces FiduciaHealth Governance™ — a next-generation Healthcare Governance platform replacing the fragmented, conflicted legacy model with a fully integrated system operating with 100% transparency, delivered to a fiduciary standard across your entire healthcare supply chain.
We are not another broker quoting your insurance. Every component of FiduciaHealth Governance™ is aligned toward one objective: lower total healthcare spending while improving employee benefit satisfaction and increasing EBITDA performance.
The 8–12 Revenue Layers Your Current Plan Is Funding
Every legacy carrier arrangement generates income through a stack of embedded revenue mechanisms most employers have never seen itemized:
- Administrative fee overrides — carrier-retained margins that exceed the actual cost of administration
- Network discount differentials — the gap between the discount the carrier negotiates and the discount it passes to the employer
- Pharmacy spread pricing — the margin between what the PBM pays the pharmacy and what it bills the plan, retained on every prescription fill
- PBM rebate retention — manufacturer rebates negotiated on formulary placement; the employer funds the drug cost, the PBM keeps the rebate
- Stop-loss margin layering — attachment points structured to maximize premium income while limiting claim reimbursement
- Data monetization fees — compensation the carrier receives for licensing your employees' claims data to third parties
- Vendor incentive arrangements — referral fees and administrative bonuses paid between carrier-affiliated entities
- Broker volume overrides — compensation paid to the broker by the carrier based on book-of-business volume, not your plan's performance
The Fiduciary Risk Scoring Model™: Quantifying the Gap
The vendors profiting from your claims have no structural incentive to reduce them. The Fiduciary Risk Scoring Model™ makes that misalignment visible — benchmarking your current plan against a fiduciary governance standard across every dimension listed above, and scoring it on a single scale. A legacy fully insured plan typically scores a 4.2. An independently structured self-funded plan with full fiduciary oversight scores a 1.0. That distance is the recoverable opportunity inside your current plan — and the Advanced Benefit Design framework is the operating model built to close it.
Our People
Our clients value clarity over complexity and discipline over novelty. They seek a thoughtful partner to manage capital with care and perspective.
How the Engagement Works
Step 1: The Cost Modeling Report
Scott analyzes 24 months of your actual claims data and vendor economics to identify every recoverable dollar. Engagement fee: $6,000. If $40,000 in recoverable spend isn't identified, the fee is returned.
Step 2: Fiduciary Risk Scoring
Your plan is benchmarked using the Fiduciary Risk Scoring Model™ — documenting where fiduciary risk is concentrated, which vendor relationships are generating misaligned revenue, and what the governance gap looks like before any transition begins.
Step 4: Transition Management
Scott manages the full transition. Your HR team is not handed a new plan and left to administer it without support.
The Cost Leaks FiduciaHealth Governance™ Eliminates
The Fully Insured Illusion™
Why fully insured plans keep compounding — and what a governed alternative actually looks like.
Stop-Loss Insurance
Independently selected stop-loss structuring with employer-favorable attachment points
Pharmacy Benefit Management
PBM audit, spread pricing elimination, and rebate transparency reform
Claim File Repricing
Overpayment recovery and claims re-adjudication to reclaim dollars that already left your plan.
Chronic Disease Management
Population health strategy and high-cost claimant intervention
Medical Tourism & High-Value Care
Clinical-grade high-value care steering in partnership with Dr. Maria Todd, PhD, MHA
One Standard. One Advisor. No Carrier Relationships.
Scott Hettesheimer has spent more than forty years developing the Advanced Benefit Design framework and the FiduciaHealth Governance™ model — proprietary operating systems built on a single premise: that employer healthcare spend can be governed with the same discipline and accountability applied to every other major cost center. He is an Amazon #1 bestselling author, NAHU CDHC Certified, NAHU Self-Funded Plan Certified, and operates under a written fiduciary standard with no carrier contracts and no volume-based compensation.
Employers ready to replace the renewal cycle with a governed alternative reach Scott directly at
513-661-7581.
FAQ
Employer Healthcare Consulting: Common Questions
How does Advanced Benefit Design reduce employer healthcare costs?
By eliminating the 8–12 embedded revenue layers inside legacy carrier arrangements and replacing them with independently selected, transparently compensated vendors. The mechanism is structural: when vendor compensation is no longer tied to utilization volume, the economic incentive to keep claims high disappears. The Cost Modeling Report identifies which specific layers are present in the employer's current plan before any changes are proposed.
What is healthcare governance for employers?
Healthcare governance is the application of the same financial discipline a CFO applies to every other major cost center — vendor accountability, data transparency, performance benchmarking, and documented spend authority — to the health plan. The FiduciaHealth Governance™ model operationalizes this through the Fiduciary Risk Scoring Model™, independent vendor selection, and quarterly CFO reporting against a documented baseline.
How do I stop annual renewal increases for my employer health plan?
Renewal increases are the output of a vendor economics structure, not a market inevitability. Eliminating the revenue layers that scale with utilization — spread pricing, rebate retention, stop-loss margin layering, broker overrides — removes the mechanism driving the increases. The Cost Modeling Report identifies which layers are present and what their annual dollar impact is in your specific plan.
Is there an employer healthcare consultant who works on a savings guarantee?
The initial engagement is anchored by a written guarantee: a $6,000 fee produces a Cost Modeling Report identifying $40,000 in recoverable spend, or the fee is returned. The ongoing relationship operates at 25% of documented savings over a three-year agreement — no flat fees, no carrier compensation, no income that isn't tied directly to your plan's performance.
Can a fiduciary employer healthcare consultant serve employers in multiple states?
Yes. Self-funded plans operating under ERISA federal preemption function consistently across state lines, governed by federal law rather than state insurance mandates. Scott serves employers nationally in 37-plus contiguous U.S. states where ERISA preemption applies.
