Model Optimal Care opens fiduciary scoring tool for self-funded health plan advisers

Model Optimal Care has launched MOC Fiduciary Intelligence Advisory for brokers, consultants, TPAs and PEOs that manage self-funded health plans. The platform scores each plan against 32 fiduciary indicators and turns claims, contract and compliance data into a client-ready report.

Why it matters: - Self-funded health plans now cover 67% of workers with employer health coverage, and 80% of workers at firms with 200 or more employees, according to the KFF Employer Health Benefits Survey published in September 2025. - CMS estimates U.S. health spending reached $5.7 trillion in 2025. - Model Optimal Care is targeting the advisers and administrators who are expected to show oversight of that spending. - The company is pitching a tool that replaces spreadsheet-driven reviews with a continuous fiduciary scoring system.

What happened: - Model Optimal Care opened MOC Fiduciary Intelligence Advisory to brokers, consultants, third-party administrators and professional employer organizations that advise or administer self-funded health plans. - The platform is live at fiduciaryIQ.ai. - Every new account includes a free one-month trial and does not require a credit card. - The product assigns each plan an MOC Fiduciary Score from 1 to 10. - The score is built from 32 indicators tied to the five principles in the Model Optimal Care framework, plus obligations under ERISA and the Consolidated Appropriations Act. - The platform ranks an adviser’s book by fiduciary risk exposure and produces one report per plan for client filing.

The details: - MOC-FI Advisory reads 100% of the medical and pharmacy claims on each plan, instead of reviewing a sample. - The platform also reviews plan documents, including the administrative services agreement, pharmacy benefit manager contract, stop-loss policy, broker compensation disclosure, Form 5500 and gag clause attestation. - The audit logic is built from the client’s own contract language rather than a fixed rule set. - In one sample plan, MOC-FI flagged $5.23 million in savings opportunity and $1.24 million as immediately recoverable. - Every finding cites the provision it is based on, so the recommendation can be placed directly in the fiduciary file. - The platform records what was examined and when. - Review runs continuously across the claim stream, rather than once a year. - ERISA and CAA exposure is flagged as it appears. - MOC-FI tracks legislation across all 50 states and shows where ERISA preemption holds and where self-funded, PBM and fully insured arrangements face risk as rules change. - Sponsors and advisers can ask questions in plain language and get answers cited to the relevant page in their own contracts. - The system uses de-identified data that meets HIPAA Safe Harbor standards. - Multi-factor authentication is enforced on every account.

Between the lines: - The launch reflects a broader push to turn fiduciary oversight into an always-on workflow instead of a renewal-time exercise. - The company is also positioning its software as a way to surface plan-specific waste that generic auditing tools can miss. - The claims-processing context matters: the American Medical Association has documented a claims-processing error rate near 20% among commercial insurers, and sample-based audits can leave most errors untouched. - The release cites separate research estimating $191 billion to $282 billion in savings from interventions already available.

What’s next: - The full feature set and scoring methodology are available at modeloptimalcare.com. - Firms that resell MOC-FI to clients will operate under a partner addendum covering co-branded materials, tracked attribution and margin. - Model Optimal Care is offering the platform as a trial entry point for firms that want to test the scoring and reporting workflow before wider rollout.

The bottom line: - Model Optimal Care is giving self-funded health plan advisers a single scorecard for fiduciary risk, claims waste and compliance exposure, with continuous monitoring built in.