Case Studies

Cost Containment

Equilibrium Pricing
Pharmaceutical Industry  |  122 Employees on the Health Plan

  • Challenge:  HCW midsize pharmaceutical client needed to compete with big pharma companies while getting the best value for their benefits.
  • Analysis:  HCW Underwriting and Risk Management team reviewed claims data to determine if group had a significant surplus with existing carrier.
  • Solution:  Client used HCW’s Equilibrium Pricing model to negotiate minimal renewal increases without going to market every year.
  • Evaluation:  Process created market excitement when client ultimately released an RFP. Accepting the renewal increases, as they were, would have resulted in a 44% increase over 4 years. HCW’s Equilibrium Pricing model allowed a negotiated savings of 20% without changing carriers or mitigating benefits.

Claims Utilization Analysis
Legal Industry  |  189 Employees on the Health Plan

  • Challenge:  HCW client wanted to engage in wellness and modify the behaviors of their employees, but needed guidance on what areas would impact their workers.
  • Analysis:  HCW Underwriting and Risk Management team reviewed utilization data that showed a 5% increase in the number of claimants in the $2,500 to $50,000 range. That group of claims increased the client’s total claims by 7.4%. HCW also reviewed a disease management summary to identify key categories driving claims within that cost range.
  • Solution:  Employer implemented an onsite clinic to increase employees’ awareness around their health including health coaching and physician’s assistant services, and gave them access to data that will allow them to measure future results.
  • Evaluation:  Group has experienced two straight years of below trend medical renewals.

Eligibility Issues
Technology Industry  |  700 Employees on the Health Plan

  • Challenge:  New HCW client had eligibility issues that caused carrier to threaten termination.
  • Analysis:  Client had not been reconciling their carrier bill, creating an issue of not terminating employees in a timely manner.
  • Solution:  HCW Client Manager facilitated a complete audit by the carrier, coordinated development of a new carrier feed that would transmit data more accurately, and researched and resolved issues regarding the client’s enrollment system.
  • Evaluation:  The client was credited $250,000 toward their bill.

Acquisition
Manufacturing Industry  |  275 Emmployees on the Health Plan

  • Challenge:  HCW client purchased another company.
  • Analysis:  HCW Consultant and Client Manager researched comparative data, client liabilities and state-specific benefit mandates.
  • Solution:  Marketed benefit plans based on increased enrollment, provided HCW’s compliance attorney to support the process, created custom communication pieces and held meetings with new employees in multiple locations and shifts to explain the benefits changes.
  • Evaluation:  Client experienced a smooth transition during the acquisition.

Medicare Reimbursement
Nonprofit  |  48 Employees on the Health Plan

  • Challenge:  HCW client received a notice from Medicare indicating they owed $27,000 in overpaid claims for an employee.
  • Analysis:  HCW Client Services team determined when Medicare should have paid as primary.
  • Solution:  HCW requested that carrier reprocess the claims correctly, had hospital resubmit a bill and reimburse Medicare when they received correct payment from carrier. Spoke with collection agency multiple times.
  • Evaluation:  $27,000 claim reimbursement request reduced to $500.

Increase Revenue
Manufacturing Industry  |  100 Employees on the Health Plan

  • Challenge:  HCW client wanted to grow revenue by increasing production while maintaining profit margins. Client also desired improved health of employee workforce and lower costs of benefit plan without rationing benefits.
  • Analysis:  HCW Consultants realized company had access to a limited supply of skilled workers. A much larger community corporation was hiring all of the dependable labor. The company’s benefit plan costs were increasing at more than 20% per year as their population aged.
  • Solution:  HCW Consultant incorporated an intensive wellness plan into the culture of the organization, improved the cost platform of their medical plan by moving to a branded network, and moved from a self insured environment to a hybrid risk-sharing program.
  • Evaluation:  Over a 3-year period, group’s benefit costs are down more than 15% without rationing benefits. Biometrics of employees have all improved with significant reductions in smoking, weight and blood pressure. Employees have developed a trusting relationship with their health coach and the company is expanding their wellness program due to employee requests. Despite the continued pressure from the large local employer, group has been able to recruit and retain the employees required to set all-time highs in sales and production marks.

Stability While in Major Growth Mode
Pharmaceutical Industry  |  122 Employees on the Health Plan

  • Challenge:  HCW client wanted to capture and deliver major contracts in the market, retain key employees (who were very stable in an ultra-competitive business environment) and remove as many distractions for them as possible.
  • Analysis:  HCW Consultant recognized that the company was a mid-market employer in the pharmaceutical world, competing with much larger organizations. Company had been capturing very large contracts and needed to make sure they retained their employees to fulfill the requirements.
  • Solution:  HCW Consultant kept changes with the employee benefit platform to a minimum by maintaining a contribution strategy that was very attractive to families. Also, a corporate concierge program and EAP were installed to reduce distractions.
  • Evaluation:  There were no changes to benefits or carriers for more than 5 years. During that time, cost increases averaged 4% per year. Employer still pays for 80% of family cost and more than half of employees elect family coverage. Utilization of the corporate concierge program is high and employee remarks on it are very positive. Company continues to secure and deliver long-term high volume contracts with the leaders in the pharmaceutical market.

Medical Review of Lasered Claims
Retail  |  305 Employees on the Health Plan

  • Challenge:  HCW midsized self funded employer had 2 large claimants lasered from its stop-loss coverage for an additional risk of $600,000.
  • Analysis:  HCW Health Management Officer obtained the appropriate medical releases and then collected and analyzed claims on medical records. It was determined that the prognosis for the claimants were significantly better than reported from carrier.
  • Solution:  HCW Health Management Officer created a medical review summary and submitted it to the reinsurer for review.
  • Evaluation:  One laser was completely removed and the other was reduced from $400,000 to $150,000. Client experienced a net savings of $450,000.

Claims Utilization Analysis
Legal Industry  |  189 Employees on the Health Plan

  •  Challenge:  HCW client wanted to engage in wellness and modify the behaviors of employees, but needed guidance on what areas would impact behaviors the most.
  • Analysis:  HCW Health Management Officer reviewed utilization data that showed a 22% change in the number of claimants in the $2,500-$10,000 range from 2008-09. Medical plan costs increased 17% over that timeframe with a loss ratio running at 92.6%. Claims review showed occurrences over norm for heart disease, diabetes, cancer, depression and obesity.
  • Solution:  HCW helped the client implement an onsite nurse practitioner clinic to include health coaching and co-management of chronic conditions, coupled with free acute care.
  • Evaluation:  Per claimant per month expenses in the $2,500-$10,000 rage have decreased more than 12% from 2009 to 2010. Group has experienced two straight years of below trend medical renewals.