Model Optimal Care launches AI fiduciary tool for self-funded plans

Model Optimal Care has opened public access to MOC Fiduciary Intelligence, an AI platform that scores self-funded health plans on 32 fiduciary indicators using the plan’s own contracts and claims data. The company is offering a free one-month trial as employers face rising fiduciary litigation risk and pressure to find claims waste.

Why it matters: - Self-funded health plans cover close to 160 million Americans and about 67% of insured U.S. workers. - Employers are under more pressure to show fiduciary oversight as litigation concerns rise. - The platform is designed to show plan sponsors what their plans are actually paying for, with dollars attached. - Researchers place U.S. healthcare waste at more than $1.6 trillion a year, or roughly 25% to 30% of every healthcare dollar spent. - About 20% of claims contain errors.

What happened: - Model Optimal Care opened public access to MOC Fiduciary Intelligence, or MOC-FI, on fiduciaryIQ.ai. - The platform reads a self-funded health plan’s contracts and claims data, scores the plan on 32 fiduciary indicators, and returns a fiduciary report and score. - Every new account starts with a free one-month trial. - The trial includes one comprehensive fiduciary report and score and does not require a credit card.

The details: - MOC-FI was built from the ground up for the self-funded community. - The platform is not a repackaged version of an existing product. - The data model, indicators, scoring math and report were designed for the health plan fiduciary. - The scoring methodology is based on Jude Odu’s book, Model Optimal Care: End U.S. Healthcare Waste, One Health Plan at a Time. - The book debuted at No. 1 New Release in Amazon’s Health Insurance category. - Five principles from the book set the weighting behind the 32 indicators. - Each indicator maps to a fiduciary duty under ERISA or an obligation under the Consolidated Appropriations Act, including the 2021 and 2026 fee disclosure rules. - The MOC Fiduciary Score uses a 1-to-10 scale. - MOC-FI manages both ERISA and non-ERISA plans. - Governmental and church plan sponsors are scored on the same framework against the standards that govern them. - The platform reviews the administrative services agreement and amendments, the PBM contract, the stop-loss policy, broker compensation disclosure, Form 5500, gag clause attestation and de-identified medical and pharmacy claims. - MOC-FI scores each indicator against the language and numbers in those documents and cites the governing provision. - The platform reads 100% of the claims it is given rather than a sample. - Users can ask questions in plain language and get answers cited to the page in their own contracts. - The system tracks state legislation across all 50 states. - MOC-FI shows where self-funded, PBM and fully insured arrangements are exposed as rules change. - Firms running multiple plans can compare them in a portfolio view. - One sample comprehensive review identified $5.23 million in savings opportunity. - The same review identified $1.24 million as immediately recoverable. - Every account includes a user guide, an in-product upload guide covering seven document categories and more than 60 document types, and a checklist showing what the platform does with each file. - Uploads must be de-identified under HIPAA Safe Harbor. - A confirmation gate appears on every upload. - Multi-factor authentication is required on every account. - The full feature set and scoring methodology are available at modeloptimalcare.com.

Between the lines: - The product is aimed at shifting fiduciary review from survey-based assessments to document-based analysis. - That approach could matter for sponsors that need evidence tied to contract language, claims data and governing rules. - The state-legislation tracking suggests the platform is trying to serve plans that operate across multiple regulatory environments. - The savings figures come from a sample review, so they indicate potential rather than guaranteed outcomes.

What's next: - New users can start the free one-month trial at fiduciaryIQ.ai. - Model Optimal Care says the trial includes one comprehensive fiduciary report and score. - The company is positioning the platform as part of a broader suite for fiduciary oversight, claims analysis, waste detection and CAA compliance. - The founder, Jude Odu, also publishes The MOC Brief and operates the CP-MOC certification program. - Model Optimal Care is based in Phoenix and says it is building AI and analytics tools for self-funded health plans.