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FiduciaHealth Governance™ Healthcare 4.0™
Stop Managing Healthcare One Renewal at a Time. Govern It.
Your healthcare plan is one of your company's largest expenses. Yet healthcare is often managed differently from every other major corporate expenditure.
FiduciaHealth Governance™ Healthcare 4.0™ changes that.
We apply financial discipline, transparency, independent vendor selection, measurable accountability, and fiduciary governance to the healthcare dollars employers and employees fund.
Identify the Cost. Follow the Money. Eliminate the Root Cause.
Ever Wonder How Much You're Overcharged for Healthcare?
For many employers, the problem isn't simply that healthcare costs too much.
The bigger question is:
Why does it cost what it costs?
Healthcare spending can include hospital price variation, pharmacy economics, administrative costs, vendor compensation, network arrangements, stop-loss costs, claims-processing practices and other revenue streams that may not be readily visible to the employer paying the bill.
FiduciaHealth Governance™ Healthcare 4.0™ follows the healthcare dollar through the system.
We identify the root causes of unnecessary spending and determine which costs can be changed.
Don't Start With the Renewal.
Start With the Money..
Why does it cost what it costs?
Healthcare spending can include hospital price variation, pharmacy economics, administrative costs, vendor compensation, network arrangements, stop-loss costs, claims-processing practices and other revenue streams that may not be readily visible to the employer paying the bill.
FiduciaHealth Governance™ Healthcare 4.0™ follows the healthcare dollar through the system.
We identify the root causes of unnecessary spending and determine which costs can be changed.
Don't Start With the Renewal.
What Does 25% Mean in Dollars?
$2,000,000
Annual Healthcare Spend
25%
Potential Unnecessary Spend
$500,000
Annual Financial Opportunity
$2,500,000
Five-Year Financial Opportunity
Healthcare cost reduction isn't about chasing another discount.
It begins by identifying unnecessary spending, determining its root cause, and changing the financial architecture responsible for it.
What Is FiduciaHealth Governance™ Healthcare 4.0™?
Traditional employer healthcare is commonly assembled around the products, networks and vendors available through a carrier or brokerage relationship.
We reverse the process.
We begin with the employer.
Then we independently evaluate the components required to build the healthcare plan.
No predetermined vendor stack.
No requirement that one carrier control the architecture.
No vendor is selected simply because it belongs to an existing carrier or brokerage ecosystem.
Every component must earn its place based on its ability to perform for the plan sponsor.
That includes:
Medical Administration
Hospital Cost Management
Pharmacy
Stop-Loss
Healthcare Advocacy
Claims Management
Cost Modeling
Data & Analytics
ERISA/CAA Governance
We use fully vetted vendors selected for their specific role within the plan.
Vendor Choice Is Not an Option.
It Is Fundamental to Healthcare 4.0™.
How Many Organizations Generate Revenue From Your Healthcare Dollar?
Your carrier may not be the only organization earning revenue from your healthcare plan.
The healthcare supply chain can include:
Insurance Carriers
Third-Party Administrators
Provider Networks
Hospitals & Health Systems
Pharmacy Benefit Managers
Stop-Loss Carriers
Brokerage & Consulting Organizations
Specialty Vendors
Carrier-Affiliated Healthcare Organizations
Each relationship should be evaluated for one fundamental reason:
Your Employees and Your Company Fund the Plan.
You Should Know Where the Money Goes
Insurance is a financing mechanism. Healthcare is the expense.
Healthcare 4.0™ manages the expense..
Before You Change Anything, Know the Numbers.
FiduciaHealth Governance™ Executive Feasibility Study
You don't need to change your healthcare plan to determine whether a financial opportunity exists.
We start with the data.
The Feasibility Study evaluates your existing healthcare spending, plan architecture, vendor relationships and identifiable cost drivers to determine where financial opportunities may exist.
We Identify:
What You Are Spending
Where the Money Is Going
What Is Driving the Cost
Which Costs Are Controllable
What Can Be Changed
The Estimated Financial Opportunity
Then management can make an informed decision based on numbers—not another renewal projection.
Fall Executive Offer
Standard fee: $6,000 — a $1,000 reduction for the Fall Executive Offer.
$6,000
$5,000
$5,000 Executive Feasibility and Decision Analysis
We analyze your current healthcare spending, plan structure, vendor relationships, and identifiable cost drivers. You receive a decision analysis showing where financial opportunities may exist and which changes merit further evaluation.
Your fee is refunded if either of these conditions is met:
- The analysis does not identify at least $50,000 in potential annual cost reduction; or
- You engage the full FiduciaHealth Governance™ Healthcare 4.0™ solution.
For the Fall Executive Offer, the refund is the $5,000 fee you paid. Findings depend on your plan data; identified opportunities are estimates until validated and implemented.
Why does it cost what it costs?
Healthcare spending can include hospital price variation, pharmacy economics, administrative costs, vendor compensation, network arrangements, stop-loss costs, claims-processing practices and other revenue streams that may not be readily visible to the employer paying the bill.
FiduciaHealth Governance™ Healthcare 4.0™ follows the healthcare dollar through the system.
We identify the root causes of unnecessary spending and determine which costs can be changed.
Don't Start With the Renewal.
ANNUAL PAID CLAIMS
CATEGORY 1
Healthcare architecture / unnecessary spending Opportunity: up to 35% in certain employer situations
and separately:
CATEGORY 2
Variable hospital procedure pricing / claims adjudication opportunity
THE HEALTHCARE 4.0™ ARCHITECTURE
Hospital Cost Management
Control variable procedure pricing and evaluate claims-payment methodology.
Pharmacy
Evaluate PBM economics, drug acquisition cost, rebates, formulary strategy and alternative sourcing.
Healthcare Advocacy
Help employees navigate to appropriate, high-value care before unnecessary costs enter the plan.
Claims Management
Evaluate how claims are priced, adjudicated and paid.
Stop-Loss & Risk
Structure risk financing around the employer rather than treating stop-loss as a commodity renewal.
Cost Modeling & Analytics
Measure healthcare spending against a defined financial baseline.
Vendor Governance
Independently select and continuously measure vendors against defined performance standards.
ERISA/CAA Fiduciary Governance
Create documented processes for healthcare-plan oversight, vendor review and fiduciary decision-making.
It Is Fundamental to Healthcare 4.0™.
How Many Organizations Generate Revenue From Your Healthcare Dollar?
Your carrier may not be the only organization earning revenue from your healthcare plan.
The healthcare supply chain can include:
PAYVIDERS
When the Organization Administering Healthcare Dollars Also Owns Healthcare Providers
HEALTHCARE PRICE VARIANCE
How Can the Same Procedure Have Radically Different Prices?
Healthcare 4.0™ in 90 Seconds
“For more than four decades, I've worked inside employer healthcare. The problem employers face today isn't simply insurance. It's the cost of consumed healthcare and the financial architecture surrounding it...”
Why does it cost what it costs?
Healthcare spending can include hospital price variation, pharmacy economics, administrative costs, vendor compensation, network arrangements, stop-loss costs, claims-processing practices and other revenue streams that may not be readily visible to the employer paying the bill.
FiduciaHealth Governance™ Healthcare 4.0™ follows the healthcare dollar through the system.
We identify the root causes of unnecessary spending and determine which costs can be changed.
Don't Start With the Renewal.
Measured Results Matter.
0%
Renewal increase — long-term client
0%
Renewal increase — second long-term client
5 of 6
Stop-loss lasers eliminated in the referenced case
And where we have the documentation to substantiate it:
$821,234
Three-year documented savings opportunity/result for the referenced employer case.
Then:
Individual employer results vary. Every financial opportunity is established from the employer's actual data.
Why does it cost what it costs?
Healthcare spending can include hospital price variation, pharmacy economics, administrative costs, vendor compensation, network arrangements, stop-loss costs, claims-processing practices and other revenue streams that may not be readily visible to the employer paying the bill.
FiduciaHealth Governance™ Healthcare 4.0™ follows the healthcare dollar through the system.
We identify the root causes of unnecessary spending and determine which costs can be changed.
Don't Start With the Renewal.
Four Decades Inside Employer Healthcare Led to a Different Model.
D. Scott Hettesheimer has worked in employer healthcare for more than four decades.
Rather than accepting the traditional carrier-centered model as the only way to construct an employer health plan, he developed a governance architecture centered on the employer, independent vendor selection, transparency and measurable financial performance.
- Healthcare Governance Consultant
- Architect of Healthcare 4.0™
- Creator of FiduciaHealth Governance™
- Co-Author, Amazon #1 Bestseller, C-Suite Solutions
Healthcare Governance Also Creates a Fiduciary Responsibility.
ERISA Academy
Education, documentation and fiduciary governance resources for employer health-plan sponsors.
ERISA Education
Fiduciary Governance
CAA Responsibilities
Plan Documentation
ERISA Wrap Plan Documents
Our People
Our clients value clarity over complexity and discipline over novelty. They seek a thoughtful partner to manage capital with care and perspective.
FAQ
Employer Healthcare Consulting: Common Questions
What is healthcare governance?
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Why are self-funded employer healthcare costs increasing?
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How can an employer reduce healthcare costs without reducing employee benefits?
How can an employer reduce healthcare costs without reducing employee benefits?
What is a fiduciary healthcare advisor?
How can an employer reduce healthcare costs without reducing employee benefits?
How do PBMs make money?
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Why can hospital prices vary for the same procedure?
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What is a payvider?
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What should a CFO review in a self-funded health plan?
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Your Healthcare Dollars Are Already Being Spent.
The Question Is Whether They Are Being Governed.
You don't have to change your broker.
You don't have to change your plan today.
And you don't have to accept another renewal without first understanding the numbers.
Start With a 30-Minute Conversation.
We'll discuss your current healthcare structure, the financial questions worth investigating, and whether a FiduciaHealth Governance™ Feasibility Study makes sense for your organization.
Call: 513-720-4400
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