A fast-growing, professional service firm with 1,300 employees was faced with a 16% increase in benefit costs. This client had a multi-generational workforce, where more than 40% of their staff provided services to clients from outside of the office. These employees were not regularly in one location, or in front of a computer. Opus was engaged to develop a solution that would help to mitigate the rate increase while maintaining the integrity of the benefits plan.
Opus implemented a high engagement model for benefit enrollment allowed the employer to dramatically exceed its goals and see:
– 36% migration to the low cost medical plan versus the 20% goal
– Projected annual savings of more than $550,000
– No additional out of pocket expenses for employees
– Over 60% participation in the new voluntary benefits, with most enrolled in more than one
– Consolidated billing and eligibility feeds from BCG to the payroll vendor
– High employee satisfaction with the enrollment process
Case Study Two
A large, self-funded financial services firm had engaged the Opus team to perform a Healthcare Oversight project shortly after their January renewal. The client was currently working with one of the largest national consultants as their TPA. This broker had assured them that all measures had been taken and alternatives considered in order to mitigate costs during the previous renewal process. The CFO felt compelled to allow Opus the opportunity to review their plans, having been referred to our team by a trusted industry contact who had a very positive experience on a similar project. The client was with Carrier A as the TPA, Pharmacy Benefit Manager, and Stop Loss vendor. Overall claim costs had increased year over year by 6% for medical and by 9% for pharmacy. And although there were no claims that had pierced the $250,000 Individual Stop Loss Limit, Carrier A’s stop loss rates had experienced an increase of 9%. Their TPA marketing spreadsheet indicated that Carrier A remained the most competitively priced stop loss carrier.
At the conclusion of our extensive research and marketing effort on behalf of the client, the Opus team effectively demonstrated several key opportunities for plan savings that had not been identified previously by the incumbent consultant:
Stop Loss Results – Four carriers provided a proposal that illustrated a considerable savings across current contract pricing terms. One competitor provided further savings opportunities via their Experience Reward Option; a program unique to this vendor that was requested specifically based on the client’s prior large claim experience. This program would return up to 15% of the premium to the client for favorable large claim experience in the current year.
Rx Analysis – After extensive review Opus identified over $150,000 in pharmacy rebates that were applied to the plan in the previous year, none of which were shared with the client. Under the current arrangement Carrier A had reduced the administration fee on the medical plan by $2.50, which had accounted for a savings of $48,000. An additional $100,000 in Split-Pricing profit was also found within the current pharmacy plan. Both components considered, Opus had identified that for each Rx claim filed by a benefit participant, Carrier A had an average of $9 in profit!
Medical Repricing Results – Based on the reprice analysis, Carrier B arrived at an average network discount of 59.5%, which outperformed the Carrier A discount by nearly 4% overall. As part of our discount analysis we also analyzed the network disruption from both a provider and cost standpoint:
– Carrier B matched 99.48% of the Carrier A participating claims
– Carrier B picked up 91.53% of the Carrier A non-participating claims