Case Study Report: Car Dealership
How One Company Saved on Health Insurance Without Cutting Benefits
See how one company lowered their healthcare spend while offering better benefits, including free prescriptions and imaging.
Key Takeaways:
-
Reduced total healthcare costs by $314,129 in the first year.
-
Secured free prescriptions & imaging for employees, at no extra cost.
-
Optimized stop-loss coverage to reduce risk and lower premiums.
-
Implemented smarter claims strategies to control costs long-term.
Curious about the exact strategies that made this possible? See the full breakdown below.
Plan Overview
Third Party Administrator
The client initially collaborated with a small regional third-party administrator. C. B. Wood Financial made the strategic decision to transition to a national third-party administrator. The shift was driven by the advantages a large third-party administrator brings to the table. With a substantial economy of scale, the larger administrator can secure more contracts with vendors, negotiate more favorable pricing contracts, devise better strategies, and have enhanced negotiating power in dealings with healthcare providers.
Pharmacy Benefit Manager
Pass-through PBMs operate with transparent fixed administrative fees per prescription, consistently below $10 per prescription. The fixed fees of a pass-through PBM ensures that the formulary doesn't pressure employees into high cost and high profit driven prescriptions; the Pharmacy Benefit Manager's revenue remains constant regardless of the prescription purchased. This approach leverages manufacturer discounts, coupons and international sourcing, providing cost-effective alternatives and contributing to overall cost savings.
Stop-Loss Protection
The company has established pooling with over 100 like-minded employers who share similar claims management strategies with over 20,000 members in 38 states. This collaborative approach enhances stop loss purchasing power, allowing the group to effectively mitigate the impact of a challenging claims year. In the event that one group experiences higher-than-expected claims, the risk is collectively distributed across the pool. This strategy serves to stabilize renewal increases with a 3% average renewal rate and a 69% year-over-year loss ratio, and contributes to more favorable terms, ultimately fostering financial resilience and predictability for the company.
Medical Bill Negotiation
Utilizing a proprietary contract to strategically isolate high-cost claims and negotiate payment at a fraction of the PPO rate. This proprietary contract has access to the largest national networks in the country and allows for effective cost containment, ensuring that payments for significant medical bills are achieved at a more favorable rate, ultimately contributing to enhanced financial efficiency.
High Claim Management Program
Our Claim Carve-Out Program focuses on the 1-4% of total claims
that tend to drive up to 50% of the total claim spend.
Below is a real example of a Spinal Cord Cancer claim.
$229,545.00
$195,113.25
$16,237.12
$178,876.13
Total Savings
Hospitals and Doctor’s Offices bill the insurance
carrier/administrator for the medical service incurred.
PPO Network Discounts are based on a percentage of the
Medicare Fee Schedule. On average, this rate is 250-350%
of Medicare, but often much higher.
C. B. Wood Financial has proprietary contacts that allow us
to pay the company’s claims at 100% of Medicare.
Alternative Prescription Purchasing Program
REAL EXAMPLE: STELARA
The car dealership had an employee requiring a double dose of Stelara, a high-cost specialty drug with an expense of $21,742.17 per fill. Leveraging the pass-through Pharmacy Benefit Manager and an innovative alternative purchasing program, C. B. Wood Financial facilitated a connection between the employee and a charitable organization that covered the entire cost of the prescription.
This not only resulted in substantial savings of $130,453 for the employer but also ensured that the employee received the necessary prescription at a $0 copay. This approach emphasizes C. B. Wood Financial’s commitment to cost-effective and strategic solutions in managing prescription expenses.
REQUEST MORE INFORMATION
Address
1000 Johnnie Dodds Blvd.
Ste. 103-109, Mount Pleasant, SC 29464
