Health and welfare benefits consulting

Custom solutions for payers, providers and employers

Remain competitive with innovative strategies

Our Health and Welfare consulting practice brings unique perspectives and insights through a combination of actuarial, clinical, marketplace and operational expertise.

Working across the healthcare market with employers, payers and healthcare providers, we collaborate with our clients to create unique solutions to address your business needs and provide value to your organization and your members.

Emerging technologies and solutions are changing the healthcare landscape

As healthcare continues to become more complex and more expensive, companies are looking to increase value, empower stakeholders and improve engagement and convenience. New dynamics have opened the door for innovative strategies, while emerging technologies and solutions are making it easier to navigate the healthcare ecosystem.

Our health and welfare consultants can help you understand emerging trends and new entrants. We collaborate with you to find solutions that work and we can help you connect your company’s culture, values and purpose to your health and welfare initiatives.

How we can help

Employers

 

Employers are focused on improving employee benefits and making benefits part of their solutions for a variety of emerging workforce challenges. PwC can help set a strategy and manage the benefit programs. Our services include:

  • Benefits strategy, plan design and communications
  • Program cost management
  • Actuarial
  • Vendor selection and performance management
  • Data analytics and reporting
  • Well-being strategy
  • Employee preference surveys
  • Claims payment assessments
  • Regulatory compliance

 

Payers

 

PwC helps payers manage financial risk and capture opportunities to offer competitive and sustainable products. Our services include:

  • Product strategy, development, and pricing
  • Value based contracting
  • Market entry strategy
  • Care initiative identification/savings analysis
  • Financial reporting/Reserving valuation
  • Risk adjustment
  • Capital management & Risk-Based Capital strategy
  • Actuarial and market due diligence
  • Claim assessments
  • Operational excellence and Actuarial Modernization
  • Cost driver and population health analytics
  • Compliance

 

Pharmacy

 

Pharmacy trend impacts employers, providers, PBMs and payers, with each stakeholder trying to mitigate trends and drive more value. Our services include:

  • PBM selection and vendor management
  • Market checks, renewal negotiations and detailed procurement activities
  • Operational reviews and improvement
  • Claim assessments and cost-driver analysis
  • Pricing and contract review
  • Carve-in vs. carve-out evaluation
  • Specialty drug diagnostic and overall management (medical and Rx benefit)
  • Pharmacy program stewardship
  • Fraud, Waste and Abuse (FWA) evaluation
  • Medicare Part D, PDE and IRE/IRO assessment
  • Mock ⅓ Financial Assessment

 

Leading the pack

PwC named a leader in Health and Wellness Benefits Consulting 2019

PwC was announced as a Leader in ‘Health and Wellness Benefits Consulting 2019’ by ALM Intelligence, a company that assesses consulting firms in defined markets on the basis of their breadth and depth of service capabilities and ability to deploy those across highly-complex client requirements.

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Contact us

Christine Randazzo

Christine Randazzo

Partner, Transformation, PwC US

In Sung Yuh

In Sung Yuh

Principal, Transformation, PwC US

Jinn Feng Lin

Jinn Feng Lin

Principal, Transformation, PwC US

Eric Michael

Eric Michael

Partner, Transformation, PwC US

Derek Skoog

Derek Skoog

Partner, PwC US

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