Not-for-profit client saves $200,000
The client:
A not-for-profit organization with multiple locations and 800 employee and retiree lives.
The concerns:
1) Underperforming third party administrator and one common PPO for all locations.
2) Lack of integration and ineffective plan design structure.
Strategies and solutions:
Benefit Associates implemented a TPA transition that offered a service model, style, and efficiencies that fit well with the culture of this client. Claim payments moved from daily complication to virtual non-issues for management and employees. Additionally, the chosen TPA's technological capabilities accommodated full electronic integration of plan tools such as medical management, disease management, wellness, and more.
Benefit Associates conducted an extensive PPO analysis comparing current provider fee schedules and average hospital discounts to determine the best available options. The incumbent PPO network was retained for Indiana locations along with a specially negotiated direct contract (additional 6 percent in excess of the PPO discount) with a preferred Indiana hospital. A national PPO network was implemented for locations outside of Indiana.
The review of the prior plan performance yielded changes to the deductible, network benefit differential, point of service option for routine lab work, and replacement of the prescription drug card vendor. The changes resulted in savings in excess of $200,000.
Results:
By restructuring the medical plan platform, this client is now well positioned with an excellent TPA, strong PPO networks, and full integration of all available resources to achieve both short- and long-term goals. |
