High Performing Health Plans
Services
It’s certainly not news to any employer that the upward trajectory of health costs has been steady and relentless. On a per-capita basis, health spending has increased over 38-fold in the last four decades, from $355 per person in 1970 to $13,493 in 2023.
In the last 20 years, the average individual insurance premium has increased from $2,196 to $8,435, representing a 284% increase.
In the last 20 years, the average family premium has increased from $5,791 to $23,968 representing a 314% increase.
The average worker contribution for family coverage has increased 25% over the last five years, and 71% over the last 10 years.
In 2023, the average deductible amount for single coverage is $1,735 which has increased 10% over the last five years, and 53% over the last 10 years.
As a result of the statistics above:
- There has been a significant transfer of wealth from employers/employees into the healthcare system.
- Take-home wages have stagnated for the past 20+ years.
- Healthcare costs are a significant contributor to bankruptcy, even among insured workers.
- Hyperinflating healthcare costs have significantly reduced retirement savings.
- Employer spending on capital expenditures has dramatically reduced.
IT’S TIME TO LOOK AT IT ALL DIFFERENTLY. IT’S TIME FOR HIGH-PERFORMING HEALTH PLANS.
With the cost containment strategies of our solution, employers in a variety of industries have been able to control or reduce healthcare spend by 20 to 40% over time. Our High-Performing Health Plans eliminate waste and redundancy, streamline processes, reduce costs, improve quality and create better experiences for the plan’s members.
How Does it Work?
- Transparent Advisor Relationships – Aligning financial incentives
- Active Independent Plan Administration – Optimizing spend
- High-Performance Plan Design – Incorporating incentives and risk management
- Patient Stewardship – Expertly navigating the healthcare ecosystem
- Value-Based Primary Care – Providing the front-life defense against downstream costs
- Transparent Open Networks – Lowering costs by focusing on outcomes and known prices
- Major Specialties & Outliers – Helping patients detect issues like cancer and heart conditions earlier, and avoid unnecessary procedures
- Transparent Pharmacy Benefits – Sharing the facts and data to enable patients to make the best decisions
WHERE ARE THE SAVINGS?
Medical Cost Containment Strategies
Savings: 10-20%
Highly accessible primary care significantly reduces urgent/emergency room visits, duplicative tests and hospitalizations. Members have same day-appointments and unlimited time with their primary care physicians.
Savings: 10-20%
Members can feel confident in their sub-specialty provider choice with proven improved outcomes and reduced costs. Most plans offer incentives like reduced cost-sharing for those who choose high-quality providers.
Savings: 20-30%
Reference-based Pricing (RBP) is a powerful tool that allows the plan sponsor to set its reimbursement schedule using multiples of Medicare.
Savings: 10-20%
Common for routine procedures, imaging, healthcare commodities or densities of populations with nearby healthcare systems, direct contracting leverages mutually beneficial relationships to offer reduced costs, steerage and lessened administrative burdens.
Savings: 5-10%
Sound medical management ensures evidence-based guidelines for pre-certification, utilization management, case management and disease management.
Savings: 5-10%
These programs are designed to target specific diseases like cancer, MSK (musculoskeletal conditions), diabetes, etc., and provide high-quality specialized care.
Pharmacy Cost Containment Strategies
Savings: 10-20%
This service provides the oversight to control the many layers of costs of Pharmacy Benefit Managers (PBMs) Contracts, specify that the PBM will only receive an administrative fee, and is obligated to provide the most cost-effective medications as well as a pass-through of all rebates.
Savings: 5-10%
This program provides expert assistance in streamlining the process of obtaining and containing the costs of medications from Canada, the United Kingdom and Australia.
Savings: 5-10%
This program reduces cost on eligible brand name and specialty medications by utilizing manufacturer-provided coupons.
Savings: 75%
This program assists qualifying members (based on household income) in obtaining high cost specialty medications directly from the prescription manufacturer at no cost to the member.
Savings: 10-15%
This service assists patients in contracting directly with pharmacies for medications related to hip replacement, hernia repairs, sinuplasty and multiple imaging.