I thought it might be interesting to share a case study with you of a current client of mine. Their outcomes have been excellent, and with no change in their employee’s benefits!

Two years ago I conducted my Benefits Audit of their partially self-funded health plan. They had an un-bundled plan, meaning that they were using a Third Party Administrator (TPA), an unrelated and independent reinsurer, Pharmacy Benefit Manager, Network, etc. assembled years before by their broker.  With their permission, I was able to gather and obtain all the necessary contracts, agreements, and data from their TPA for the prior two years. I analyzed and reviewed 14 different areas within their plan that had the potential for compelling savings opportunities. Some of these areas I could actually quantify specific savings through some repricing, while others were identified as a range of savings, and the areas that I couldn’t actually quantify I labeled as moderate savings, potentially significant, etc.

For example, an area that I could not quantify in their plan was dialysis management. This would only apply to those employees and/or dependents who were actually diagnosed with End-Stage Renal Disease and on dialysis. Through our repricing program I can actually quantify savings for this service if they had actual claims. However, this group didn’t have any employees or members on dialysis-therefore I could not quantify it specifically, even though I knew was potentially significant savings.  However, we still added the necessary language needed to protect the plan, should they have a dialysis case in the future.

This client implemented only five of the 14 areas of recommendations in the first year and in those first 12 months saved $2,330 per employee per year – all the while without changing any benefits to employees.

In order to implement some of the programs, they did have to make some changes with a few of their vendors, either because their current vendors were incapable or unwilling to provide these programs and/or services. Sometimes it’s a willingness to administer and participate in these programs by vendors, and other times it’s their ability (or inability) to provide or participate in these programs.

Nonetheless the outcomes are outstanding and have exceeded the original calculations in the Audit for savings.

This company had been doing the same things, the same way for a number years, working with the same consultant and vendors, and seeing moderate to significant increases each and every year. The Benefits Audit gave them a second opinion of their plan, and we were actually able to identify and quantify opportunities that created compelling savings.

If you like to learn more about the Benefit Audit and what it can mean to your company, please feel free to contact me at [email protected]