healthcare advisory
RE-IMAGINING HEALTHCARE FOR MID-MARKET COMPANIES
Sustainable savings while improving benefits—redirecting millions back to growth, innovation, and your people.
About UBF Consulting
Founded in 2014, UBF Consulting is a national healthcare advisory firm specializing in custom health plan strategies for mid-market private sector employers (500-5,000 employees). Unlike traditional brokers, we work for you—not the carriers.
Our founding mission was to revolutionize healthcare procurement by empowering growing organizations with transparent, unbiased solutions. We stand apart from traditional brokers by prioritizing client needs over carrier commissions, ensuring strategies are tailored for sustainable cost reduction, enhanced employee benefits, and talent retention.
Who We Serve
- Mid-market private companies (500-5,000 employees) seeking budget stability and competitive advantage
- Organizations with complex staff needs and diverse local providers
- Companies looking to maximize healthcare ROI and redirect savings to business growth and talent development
Our Expertise
- Health Plan Design & Tiered Networks
- Pharmacy Strategy & 340B Integration
- Care Navigation & Member Advocacy
- Actuarial Analysis & Risk Management
- Employee Wellness Programs
- Compliance & Regulatory Guidance
Why Mid-Market Companies Choose UBF
Unbiased Advocacy
We operate independently, ensuring our recommendations are solely in your company's best interest, free from carrier influence.
Proven Track Record
Millions saved and successfully redirected to business growth, innovation, and talent retention, demonstrating tangible impact and sustainable results.
Personalized Approach
Customized strategies built around your company's unique demographics, financial goals, and employee needs.
Comprehensive Support
From initial analysis to ongoing management, we provide end-to-end guidance and dedicated client service.
Proven Impact
Results That Speak for Themselves
Our healthcare strategies deliver tangible financial outcomes. We significantly lower the average Per Employee Per Year (PEPY) cost, providing substantial savings that can be reinvested into your business growth, innovation, or employee development.
We are 100% Healthcare-Focused, ensuring strategies are always independent of carriers and tailored to your company's unique business objectives.
Strategic Impact for Your Business
Redirect Funds
Savings from healthcare costs can be reinvested into strategic business growth, innovation, talent development, or profit margin improvements.
Budget Stability
Lower expenses contribute to predictable financial planning and resource allocation year-over-year, improving ROI and competitive positioning.
Enhanced Talent Advantage
An efficient and effective health plan leads to better employee satisfaction and retention, attracting top talent and strengthening your market position.
UBF Consulting remains dedicated to providing unbiased, transparent solutions that prioritize your company's unique needs and deliver measurable, lasting results.
Proven Impact
Improved Healthcare + Lower Costs
Our commitment to optimizing your healthcare strategy is reflected in tangible financial outcomes for mid-market private companies. The "Per Employee Per Year" (PEPY) cost is a critical metric for evaluating health plan efficiency. By significantly lowering the average PEPY to $6,780 compared to the industry benchmark of $8,435, we demonstrate our ability to deliver substantial savings for your business without compromising quality of care. This difference represents a direct financial benefit that can be reinvested into your business growth and innovation.
$6,780
Client Average PEPY
$8,435
Industry Benchmark PEPY
100%
Healthcare-Focused
What This Means for Your Business
Every strategy is built to support your company's strategic business objectives—completely independent of carriers.
1
Funds previously allocated to inflated healthcare costs can now be redirected to strategic business growth, innovation, talent development, or profit margin improvements.
2
Lower healthcare expenses contribute to budget stability, allowing for more predictable financial planning and resource allocation year-over-year.
3
Investing in a more efficient and effective health plan can lead to improved employee satisfaction, better retention rates, enhanced benefits competitiveness, and attracts top talent to your company.
Industry Landscape
Navigating the Healthcare Landscape: Challenges for Mid-Market Companies
Mid-market private companies face unique and growing pressures when managing healthcare benefits. These include:
- Rising healthcare costs that continually outpace revenue growth.
- Difficulty competing with larger enterprise companies that offer more robust benefits packages.
- A significant lack of internal HR and benefits expertise to strategically manage complex healthcare plans.
- Intense pressure to control escalating costs while simultaneously retaining valuable talent.
Against this backdrop, many companies resort to common strategies to manage health insurance costs, as highlighted by the Health Insurance Association of America. Traditional approaches often shift costs to employees rather than addressing the root causes of healthcare spending.
Common Cost-Shifting Tactics
- Higher Deductibles & Co-pays: Requiring employees to pay more out-of-pocket before insurance coverage begins or for each service.
- Narrower Provider Networks: Limiting employee choice of doctors and hospitals to those who offer lower rates.
- Reduced Coverage: Scaling back benefits for certain essential services or increasing employee share of premium costs.
- Employee Surcharges: Implementing additional fees for employees who include spouses or dependents on their plan, or for those who don't participate in wellness programs.
- Increased Out-of-Pocket Maximums: Raising the total amount employees must pay for covered healthcare services in a policy year.
While these tactics may offer short-term budgetary relief, they often lead to decreased employee satisfaction, delayed care, and ultimately fail to address the underlying drivers of rising healthcare costs. This reactive approach creates a cycle where costs are continuously shifted without sustainable solutions.
UBF's Differentiated Approach: Unlike traditional methods that shift costs, UBF Consulting focuses on identifying and mitigating the root causes of healthcare spending, ensuring long-term savings without compromising employee benefits or quality of care.
What would you want to pay?
From a CFO/HR perspective, significant variance in healthcare costs, such as for an MRI at Memorial Regional Hospital in Florida, directly impacts your employees' satisfaction and your company's bottom line. Ensuring transparency and controlling these costs are critical for competitive advantage:
$1,827
Cigna Plan
$2,455
Blue Cross Plan
$262
Cash
Strategic cost control: Implementing direct contract pricing can deliver significant savings for your company and employees, strengthening both your financial health and talent retention efforts.
THE CHALLENGE MID-MARKET COMPANIES FACE
Mid-market companies are facing immense pressure from escalating healthcare costs and the complex landscape of employee benefits management. These challenges collectively strain budgets, impact profitability, and hinder their ability to attract and retain top talent.
ESCALATING COSTS & MARGIN EROSION
Healthcare premiums and overall benefit costs are consistently rising, often outpacing revenue growth. For mid-market companies, these escalating expenses directly erode profit margins, making it harder to invest in growth, innovation, or offer competitive compensation packages compared to larger enterprises.
LACK OF INTERNAL EXPERTISE
Unlike large corporations with dedicated benefits teams, mid-market companies often lack the internal expertise to navigate the complex world of healthcare benefits. This leads to inefficient plan design, missed cost-saving opportunities, and a reliance on brokers who may not always act in the company's best financial interest, further exacerbating cost issues.
TALENT ATTRACTION & RETENTION
Attracting and retaining skilled talent is crucial for mid-market growth, but offering competitive benefits packages, especially healthcare, is a major challenge. Without the scale of larger companies, mid-market firms struggle to provide robust benefits without significantly impacting their budget, making it harder to stand out in a competitive job market and keep valuable employees.
Without a strategic intervention, these interconnected problems will continue to compound, leading to further pressure on profit margins, decreased employee satisfaction, and increased difficulty in attracting and retaining top talent.
The UBF Solution Architecture
Our comprehensive solution addresses the core challenges faced by mid-market companies through an integrated, multi-pronged approach. By combining these four essential pillars, UBF empowers growing businesses to regain control over their healthcare benefits, optimize spending, and ensure better outcomes for their employees without the typical enterprise overhead.
Direct Contracting
Partner with local health systems, enabling direct negotiation of services. This eliminates unnecessary intermediaries, driving down costs and providing enterprise-level purchasing power without the overhead typically associated with large corporations.
Transparent Pharmacy
Ensure complete transparency in prescription drug costs, guaranteeing all rebates are returned directly to your plan. This offers mid-market companies significant, data-driven savings on overall pharmacy spend, turning an opaque expense into a clear cost-saving opportunity.
Care Navigation
Guide employees to high-value care. Our dedicated navigators provide expert guidance, helping your team access the most effective and affordable healthcare services, improving outcomes and preventing unnecessary expenditures – all without the need for additional internal HR staff.
Data Oversight
Continuous monitoring, claims audits, and benchmarking provide actionable insights. This data-driven optimization allows for proactive adjustments and flexible implementation, ensuring your benefits plan evolves with your growing business needs and delivers maximum value.
Individually, each component offers significant advantages. Together, these four pillars create a powerful, synergistic system that not only resolves current healthcare challenges but also establishes a sustainable, transparent, and employee-centric benefits program tailored for mid-market companies.
Case Study
Imagine the Possibilities for Your Business
Consider a mid-market technology firm with 3,000 employees struggling with escalating healthcare costs and a decline in employee satisfaction due to opaque benefits. Before partnering with UBF, they faced mounting operational expenses and challenges in retaining top talent, directly impacting their profit margins.
Illustrative results from a mid-market technology client:
15%
Mid-Range Cost Reduction
Achieved through strategic direct contracting with local providers and initial transparent pharmacy negotiations, leading to immediate operational cost reductions and improved bottom-line performance.
30%
Significant Cost Optimization
Realized by fully implementing advanced care navigation programs, comprehensive claims auditing, and leveraging deep data insights to significantly optimize overall healthcare spend and enhance profit margins.
Improved Profit Margins
Enhanced Talent Retention
Stronger Competitive Positioning
With UBF, plan sponsors can offer their employees more robust healthcare options without increasing costs. This includes access to a wider network of high-quality providers and reduced out-of-pocket expenses, significantly boosting employee satisfaction and contributing to higher retention rates for valuable talent.
By guiding employees to high-value care and proactively managing chronic conditions, UBF helps improve the health and well-being of the entire workforce. Healthier employees lead to less absenteeism, increased productivity, and a more engaged and competitive business.
Our comprehensive data oversight and transparent reporting empower company leaders with unprecedented control over their healthcare spending. They gain clear insights into claims data, allowing for informed decision-making and continuous optimization of their benefit plans, ultimately strengthening their competitive edge in the market.
Timeline to Results
Companies typically begin to see initial savings and improvements within the first 6-12 months of implementation, primarily from direct contracting and transparent pharmacy solutions. More significant, sustained savings and health outcome improvements usually become evident within 18-24 months as care navigation and data oversight programs mature and influence employee behavior and plan design.
High-Cost Claim Mitigation
How UBF Safeguards Mid-Market Private Companies from Devastating Shock Claims
High-cost claims pose a significant threat to mid-market private companies, driving up premiums and creating financial instability. Traditional insurance models often fall short in proactively managing these catastrophic events, leaving companies vulnerable to unexpected financial burdens that can devastate smaller budgets and undermine employee trust. UBF's innovative approach tackles this challenge head-on, transforming risk into predictable outcomes and protecting business financial stability while maintaining employee benefits.
01
Voluntary Program
Confidential support for members with severe conditions. Our care navigation team engages directly with members facing complex or chronic health issues, offering personalized guidance and support. This proactive intervention ensures members receive appropriate, high-quality care, often preventing conditions from escalating into more expensive treatments.
02
Premium Funding
Help eligible members access coverage assistance. For qualifying high-cost claims, UBF identifies and facilitates access to alternative funding sources or programs. This strategic approach offloads portions of significant claim costs from the company's self-funded plan, directly reducing exposure and preserving plan reserves.
03
Claims Exit
High-dollar claims move to separate solutions. Once alternative funding or specialized programs are secured, specific high-cost claims can be transitioned out of the primary self-funded plan. This protects the company from future liability for these particular claims, ensuring that ongoing costs do not impact the core benefits budget or stop-loss limits.
04
Lower Premiums
Reduced stop-loss costs and future claims. By proactively mitigating and exiting high-cost claims, the company's overall claims experience improves significantly. This favorable claims history leads to substantial reductions in stop-loss insurance premiums in subsequent years and lowers the likelihood of future shock claims, creating sustainable savings.
3-Year Gross Savings: $4.5M – $5.3M
Real-World Impact
- Enhanced Member Well-being: Employees with severe conditions receive dedicated, confidential support, leading to better health outcomes and a higher quality of life.
- Predictable Budgeting: Companies gain greater financial predictability and stability, minimizing the impact of unforeseen catastrophic health events on their budget.
- Improved Plan Sustainability: By effectively managing the most expensive claims, the overall health plan becomes more sustainable, allowing for continued robust benefits without increasing premiums.
Proactive high-cost claim management is not just about saving money; it's about protecting the long-term health of both employees and the company's financial well-being. By taking control of these significant expenses, organizations can ensure a more secure and healthier future for their entire community.
NAVIGATING PHARMACY COST TRENDS FOR MID-MARKET COMPANIES
ADDRESSING CRITICAL PHARMACY CHALLENGES
Mid-market companies are increasingly challenged by skyrocketing specialty drug costs and the emerging financial impact of GLP-1 medications. Many struggle with insufficient resources to ensure their Pharmacy Benefit Manager (PBM) offers transparent pricing and contractual adherence. This often results in budget volatility, missed savings opportunities from PBM guarantees and rebates, and difficulties in managing high-cost drug categories effectively without compromising employee access to vital medications.
Strategic PBM Procurement & Contract Transparency
UBF orchestrates a competitive PBM procurement process, ensuring complete contract transparency. We secure robust discount and rebate guarantees, clear definitions, comprehensive audit rights, and specialized provisions tailored for high-cost specialty drugs and GLP-1 medications, optimizing economic terms for maximum savings.
Continuous PBM Performance Oversight & Verification
We implement an independent, ongoing oversight model to systematically monitor PBM performance, pricing accuracy, and contractual adherence, particularly for specialty and GLP-1 drug claims. This proactive approach identifies and remediates discrepancies, ensuring timely recovery of overcharges and maximizing cost-effectiveness.
"Controlling the Controllables" Cost Management & Access
UBF applies a strategic framework focusing on data-driven formulary design, utilization management, and member engagement programs. This approach controls costs—including those for specialty and GLP-1s—by ensuring appropriate use and exploring cost-effective alternatives, all while safeguarding employee access to necessary medications and improving overall plan sustainability.
Illustrative Results from Blinded Analysis
A blinded PBM market check revealed a modeled first-year improvement potential ranging from 4.89% to 14.38% in total pharmacy spend across various PBM options. The analysis also highlighted significant gaps in retail brand discounts and rebate levels compared to market averages, indicating substantial negotiable upside.
RICK NILES
Vice President, Client Strategy
RICK'S BACKGROUND
- Extensive experience partnering with mid-market private companies.
- Specialized expertise in manufacturing, technology, professional services, and healthcare sectors.
- Proven track record in optimizing health benefit plans while balancing cost control with competitive benefits.
RICK'S APPROACH
- Partnership Focus: Builds strong, collaborative relationships with clients to understand unique challenges and objectives.
- Strategic Benefit Optimization: Develops innovative solutions that balance rigorous cost control with attractive, competitive benefits packages.
- Data-Driven Strategies: Utilizes in-depth analytics to inform decision-making and develop effective, measurable solutions.
- Proactive Risk Management: Implements forward-thinking strategies to mitigate client financial exposure and ensure long-term plan sustainability.
- Employee-Centric Design: Crafts benefit plans that prioritizes member well-being and access to high-quality care.
REDEFINE HEALTHCARE
Partner with UBF Consulting to unlock significant healthcare savings and reinvest in what matters most—your people, your growth, and your competitive edge.