A unique health services management and information company whose programs are committed to the belief that consumers and employers are best served by creating incentives and rewards that recognize best performing physicians and hospitals. The company creates and manages a tiered healthcare network that differentiates physicians and hospitals on the basis of quality, cost and service.

Pendulum Health can help manage your HMO, PPO, and Managed Care offering for your employees and evaluate the results.

In the early 1970s HMOs mandated employers to offer one or more types of plans under the HMO act of 1973. Multiple offerings were difficult to administrate and created confusion in the billing and communication area. As HR and benefits staff became occupied in other complexities single carrier arrangements for multiple PPO and HMO products became the norm. Unfortunately, not having mutual options also drove up cost for many employers who are now reconsidering local or regional plans as an option in order to keep health plans price increases under control but also improve a level of choice to employees seeking different panels of physicians or hospitals. These multiple offerings require a specific level of sophistication with both selection and implementation of this open enrollment period to meet the needs of both plans and employees.

This can be accomplished by having your benefits department delegate the entire annual enrollment process to Pendulum as an outsource function. First, Pendulum can help evaluate the plans you are now offering or are proposing to offer. Our background and knowledge of the health plan business allows us to check financial ratings, determine customer complaints, anticipate benefit problems and even assist in negotiating the agreements. Then we construct a benefit comparison of all coverage, exclusions and costs to employee and employers so employees understand the ins and outs of membership.

As the offering takes place we can conduct open enrollment meetings to include health plan reps or employee reps to answer questions and assist in the enrollment process. Working with your HR department we can match enrollment to eligibility and then match eligibility to the premium billing insuring that you are not paying for ineligible employees.

Once the open enrollment period is closed and employees have selected their options, Pendulum obtains claims information submitted by providers to the health plan and groups for analysis based upon quality indicators and prevailing charge data we obtain from our local database specific to your area. On a quarterly or annual basis, we can analyze best panels and best outcomes by health plan and even by physician so that you and your employees have a feel for which plan may offer the best value in terms of quality outcomes and price. In select cases, we have been able to back into a recommended premium amount for a select health plan to charge for the next year. Some employers use this during negotiations and some even recommend that a custom panel of providers be created for their workers in order to avoid substandard care. These datasheets and annual analysis allow the employer the overall capability to actually predict care costs in advance.