A 200 employee provider healthcare group had been self funded for a number of years with medical insurance costs for their employees that were below market trend. That started to change over the last few years when a small number of their population began utilizing high cost specialty medication. As a result, their healthcare costs skyrocketed. They needed to explore their options including going back to a fully insured setup (not ideal).
Background
- 200 employee sized group of high end provider specialists that had little time to consider their own healthcare options
- Their prescription drug spend was $1.6m with 80% of it coming from high cost specialty drugs
- Pharmacy benefit was not effectively managing the spend
- Needed to understand their options quickly to execute on a long term strategy
Results
- Followed the Bluestone process by first conducting a series of discovery calls to understand their business, employee benefit needs, current health insurance setup, and growth plans
- Performed a deep analysis on their prescription drug costs to identify the high cost medications and utilizers. Pinpointed that less than 10% of the utilizers were driving the vast majority of the spend.
- Replaced the Pharmacy management vendor with another and layered in targeted cost containment programs uniquely tailored for their needs
- Resulted in a 50% prescription drug cost savings with little employee disruption.
