Dark Data:
Unknown or untapped data across an organization;
Data that companies lack the expertise to extract value from.
Dark Data:
Unknown or untapped data across an organization;
Data that companies lack the expertise to extract value from.
Two-thirds of U.S. workers with employer coverage are in self-funded health plans that cost employer sponsors up to $12,000 per employee per year.
These costs increased 6.7% in 2023, 8.5% in 2024, and are projected to rise 5.8% for 2025.
Self-funded plan sponsors and their executives are ERISA Fiduciaries required to act solely in the interest of plan participants, carry out duties prudently, follow plan documents, hold plan assets in trust, and pay only reasonable plan expenses.
Class-action lawsuits for health plan fiduciary breach were filed in 2024 against Johnson & Johnson
and Wells Fargo.
According to the U.S. Dept. of Labor:
“The duty to act prudently is one of a fiduciary’s central responsibilities under ERISA. It requires expertise in a variety of areas. A fiduciary who lacks that expertise will want to hire someone with the professional knowledge to carry out those functions.”
Self-funded employers rely on Administrative Services Only (ASO) carriers and Third-Party Administrators (TPA) to process and pay medical claims with employer funds.
To avoid fiduciary breach, self-funded employers must know exactly what they are paying for, but this oversight requires healthcare-specific expertise.
To deploy this oversight, employers must obtain paid claims data and other financial information from their ASO or TPA to be analyzed by retained healthcare experts.
The Consolidated Appropriations Act of 2021 made clear that ASOs/TPAs must share this data with employers and employers may share it with their Business Associates.
ASOs/TPAs have not historically shared this data. When requested, they offer a "standard" layout with several key data fields missing.
To obtain all necessary data, you must explicitly request each required field. ASO/TPA claims processing is heavily varied, often home grown, and produces hundreds of data fields under different naming conventions.
Dark Data Health Insights has acquired and interpreted medical claims data from over 40 of the most prominent "BUCA" ASOs and TPAs in the country.
Our detailed Data Aquisition Process was built to help self-funded employers obtain all medical benefit data necessary to understand their true plan cost and deploy fiduciary oversight.