Premier Consulting Associates Selects HealthJoy as Employee Guidance Platform

Premier Consulting Associates Selects HealthJoy as Employee Guidance Platform

HealthJoy has partnered with the dominant agency in Western New York and we’re excited to share the news. Premier Consulting Associates has selected HealthJoy as their preferred technology solution for employee guidance. They are an independent consulting firm that works with employers of all sizes to manage their healthcare benefits. Premier manages over $1 billion in insured, self-funded and prescription drug claims. Their clients will now be able to add HealthJoy as part of their benefits package and leverage artificial intelligence to lower their healthcare costs.

“Premier has a track record of selecting the best technology solutions for their clients,” said Doug Morse-Schindler, President and Co-Founder of HealthJoy. “Healthcare costs continue to rise and the executives at Premier understand that the only way to tackle the problem is to help empower employees to make better healthcare decisions. Their reputation for bringing forward-thinking approaches to benefits attracted us to partner with them, and we’re glad to work together to bring our solution to market.”

HealthJoy has the ability to help companies contain healthcare costs by redirecting care to higher quality, lower cost providers. For example, we can encourage the use of an online doctor consultation rather than have an employee go to the emergency room in the middle of the night. Or our concierge staff can recommend that an employee go to a specific MRI facility that uses the same equipment but charges thousands of dollars less than other facilities nearby (sometimes this difference can be 10X.) Both employees and employers benefit from HealthJoy’s easy-to-use and time-saving resources.

“In today’s on-demand world, employees expect a better experience from their employee benefits. HealthJoy has built the most advanced healthcare guidance platform on the market,” said William Brothers, CEO and Founder of Premier Consulting Associates. “Their use of technologies like artificial intelligence are years ahead of the competition. They can provide personalized communication at the member level based on their specific healthcare benefits.   We are excited to bring this solution to all of our clients.”

For more information about how we’re helping Premier Consulting Associates clients transform benefits for their employees and contain costs visit:

Meet HealthJoy at BAN’s Winter Conference

Meet HealthJoy at BAN’s Winter Conference

Are you heading to Miami for the 2018 BAN Educational Winter Conference? So are we! We are very excited to join some of the industry’s finest insurance agencies for three days of learning, networking, knowledge-sharing, and fun.

We’re sending the dream team to Miami: Let’s talk! Meet us at table 9 or schedule a meeting to sit down with us in person.

HealthJoy has made some exciting strides since announcing our national partnership with BAN six months ago: introducing new integrations with powerful technology partners like SpringBuk, new functionality like in-app provider appointment scheduling, and powerhouse hires like our Director of Data Science, Scott Murdoch.

We are excited to share what we’ve been working on, what’s to come, and what that means for the success of your agency, your clients, and your benefits strategies. Interested in seeing the platform in action? Request login credentials for your own demo account.

HealthJoy Attendees:

Chad McMahon, Senior Director of Partnerships
Brian Astrachan, Business Development Manager
Doug Morse-Schindler, Co-Founder and President
Dave Mallen, VP of Sales

Rose & Kiernan Selects HealthJoy as Engagement and Cost Containment Platform

Rose & Kiernan Selects HealthJoy as Engagement and Cost Containment Platform

We’ve teamed up with a powerhouse agency in Upstate New York and Connecticut, and we couldn’t be more excited to share this exciting partnership. Rose & Kiernan has selected HealthJoy as their preferred technology solution for cost containment and employee engagement. The strategies they deliver to their clients are top-notch, and now their clients will be able to access their benefits through HealthJoy, leveraging a modern technology and advocacy experience for their employees.

For more than 145 years, Rose & Kiernan (R&K) has been a leading general agency in the Northeast, highly regarded for their insurance expertise in New York State, New England, and beyond. With almost $1B of benefit premiums and premium equivalent under management, Rose & Kiernan’s employee benefits management group (EBMG) has a demonstrated ability to deliver high quality, cost-effective solutions with prompt, dependable, value-added service.

“As we evaluated agencies for strategic partnership in upstate New York, it became clear that Rose & Kiernan had everything we were looking for. This is an agency with a long history of unmatched expertise and excellence in insurance strategy and a dedicated culture that embraces innovation on behalf of their clients,” said Doug Morse-Schindler, Co-Founder and President at HealthJoy. “Our core values are completely aligned, and we couldn’t be more excited to go to market with this team.”

As an additional benefit to Rose & Kiernan clients, HealthJoy will integrate United Concierge Medicine (UCM), offering their Virtual Concierge Medicine services through the platform. As Rose & Kiernan’s preferred virtual care partner, this means UCM’s services will now be available to all current and new clients through HealthJoy.

“We are excited to partner with HealthJoy in this next step with Rose & Kiernan as they continue to put members first and to stay on the forefront of technology while remaining committed to the highest quality care,” said Keith Algozzine, CEO of United Concierge Medicine.

John Murray, President, Chairman and CEO for Rose & Kiernan said, “This partnership is a true differentiator for our agency and the strategies we deliver to our clients. Artificial intelligence has been heralded for the potential to move the needle in data-driven industries, and HealthJoy is the first to enter the employee benefits space. Our missions, values, and belief that fixing the American healthcare system starts with the member experience are completely aligned.”

“When evaluating solutions, we were impressed by HealthJoy’s focus on an integrated, intuitive experience for employees and their families. Their approach to addressing complicated and expensive challenges employees and their families face is comprehensive, pairing cutting-edge technology with expert service,” said Keith Dolan, Senior Vice President at Rose & Kiernan We are excited to roll this powerful technology out to our clients and their employees.”

To learn more about how we’re helping Rose & Kiernan clients transform benefits for their employees and contain costs, join us for a webinar on January 12, 2018 at 11am EST, and check out the coverage of this exciting partnership in the Albany Business Review.


Sick of Rising Prescription Costs? Save Big with these Rx Strategies

Sick of Rising Prescription Costs? Save Big with these Rx Strategies

“Complicated problems require complicated solutions,” and healthcare is no exception. Most employers cannot invest the time to learn about the many pieces of the healthcare puzzle. They need innovative benefit advisors who stay on top of and lead industry trends. With employers inundated by news of ever-rising prescription costs, benefit advisors introducing ways to cut prescription spend by 20% are sure to stand out from the crowd.

This article is meant to serve as an introduction to the value of several prescription programs HealthJoy has integrated into our platform for some of our clients. These programs operate as a complement to the pharmacy benefit manager (PBM) and deliver significant savings especially for self-insured, midmarket employers. Keep in mind that these are one part of a prescription strategy which is one part of a larger healthcare strategy. As employee benefits industry leader David Contorno summed it up, “There’s no silver bullet a broker or consultant can bring in that will solve healthcare. View each solution as part of a larger strategy to reduce cost, and then you get a much stronger effect.”

Mail-order, Generic vs. Brand Drugs and more
Employers can no longer afford to neglect prescription costs, as pharmacy spend now accounts for 17% of all medical spend. We can break down the larger problem of prescription costs into two parts: generic and brand name drugs. Generic drugs account for 90% of prescriptions and 28% of pharmacy spend. Generics are a more accessible pool for reducing costs due to their quantity. Brand name drugs make up only 10% of scripts, but each script has a significant impact on rising prescription costs. Mail-order prescription sourcing programs that work alongside a client’s existing PBM combat both sides of pharmacy spend.

While the cost savings are evident to self-funded employers, an arguably greater value is that to the employee and her family. For Mr. Contorno, these programs are most important in that they address prescription adherence: “Typically as medical and drug prices have gone up, employee cost sharing has gone up. That drives care and adherence down. We use programs like Rx ‘n Go and Rx Manage because they are strategies that help both the plan and the employees. That’s the paradigm you have to work in.”

Rx ‘n Go – Focusing on the generic and maintenance drugs that make up the majority of scripts, Rx ‘n Go offers access to over 1,200 generic medications as a complement to a typical employer-sponsored Rx benefit. Employers pay a flat rate per Rx for the drugs that members fill through Rx ‘n Go, while employee cost is reduced to zero. They deliver up to a 90-day supply of generic maintenance medications right to an employee’s doorstep. The company can typically demonstrate 15% to 25% in plan savings on the covered medications due to their focus on the most efficient acquisition and distribution of generic medications. Mort Jorgensen, one of the owners of Rx ‘n Go, explained, “we can’t necessarily get the prescriptions at a lower cost, but we are mission-driven. Helping employees reduce cost, access more choices, and improve medication compliance is what we do. Company savings are a great side effect of our mission.”

Rx Manage and ScriptSourcing (Internationally Sourced Prescriptions) – Addressing the other end of drug costs, Rx Manage and ScriptSourcing reduce the costs of brand name drugs for employers. Employee share is reduced to zero in these programs as well. These companies get their prescriptions through English-speaking countries that have the same quality control standards as the U.S. (referred to as “Tier 1”) – Canada, the United Kingdom, Australia and New Zealand. These countries often have lower prices because they negotiate with drug manufacturers as a country rather than as relatively tiny employers and insurance carriers. It’s also great that all drugs come with instructions written in English rather than potentially other languages.

Barriers to implementation
There are two main barriers to actually setting up the program. The first is structural – does the current plan allow the employer to integrate a third party sourcing program? Some of our partners reported that fully-insured plans and carrier-owned third-party administrators (TPA’s) can make this process difficult.

The second barrier is educating an employer on the value and appropriateness of such programs. Some companies have a hard time understanding the incredible value these programs can provide. Or they are indifferent to the value stories whether around cost or benefit to employee health and wellbeing. Employers may also be concerned with importing prescriptions. Bill Hepscher, owner at Rx Manage, explains to potential clients the difference between “filling your prescription while on vacation in London, and stereotypes around buying prescriptions south of the border. When people think prescription importation, they default to the latter. Once they understand where the prescriptions are coming from, most employers get on board.”

Keys to a successful program
When rolling out one of these programs, you will face the same obstacle as with most other strategies. You have to figure out how to get employees to learn about and use it. How do employees learn that they can save $50 each month? How do you monitor and follow up so that they follow through, especially for high income individuals not motivated by zero cost? It cannot be just another component that’s a phone number contained in a benefits packet that’s thrown in a drawer. You need an outlet for employees to say, “Hey, I got prescribed this drug. Where do I fill it?” ScriptSourcing founder Gary Becker consistently focuses on engagement “because 70% of American households have $1,000 in savings or less. They don’t have time to focus on their benefits. We need to make sure they leverage zero copay programs, adhere to their medication, and don’t ultimately end up in the emergency room.”

Cutting-edge consultants and brokers are not just going to educate, inform and incentivize employees to make better decisions. Mr. Contorno, for example, takes in the pharmacy data each month and proactively reaches out to employees who could fill their prescription through one of these programs. HealthJoy also serves as that communication platform in addition to being the employee’s resource for all of their benefits. Employees know where to turn when they get a new script, and HealthJoy’s timely and personalized reminders won’t let them forget. Additionally, HealthJoy’s prescription optimization algorithm contains 7 other strategies to save employers money.

Our recommendations

  • Identify members up front and communicate to them from the start
  • Dedicate a resource for employee benefits questions and decisions; keep that resource top of mind
  • Track and follow up with those who received a recommendation to fill their prescription through one of these programs
  • Report on client success so that the value you delivered doesn’t go unnoticed!

Take Action
The most important recommendation is to take action. Make steps toward stopping rising prescription costs, whether they are one of these programs or one of HealthJoy’s seven other techniques. If you would like to connect with any of these programs or learn about how HealthJoy boosts engagement and ROI, schedule a demo below. We at HealthJoy work with a variety of vendor partners and do a fair amount of education and introductions for our benefit advisors. If there is a topic you are interested in, I’d love to hear from you.

Coalitions: The Secret to Reducing Employee Benefits Cost?

Coalitions: The Secret to Reducing Employee Benefits Cost?

This post provides an introduction to funding in a coalition, also known as captive-funding, and discusses best practices from leaders in the field. Coalition use is skyrocketing as employers in coalitions can see double digit savings and the agencies embracing coalitions are attracting new business. The primary sources of coalition success are reducing fixed cost, spreading risk, providing stability and leveraging solutions like concierge services to manage costs.

To break this down, let’s start with a game. You have 3 options:

  • Option 1: Pay $40 to not play
  • Option 2: Flip 1 coin. If it lands on heads, pay $45. If it’s tails, pay $30.
  • Option 3: Flip 3 coins. If they all land on heads, pay $45. If not, pay $30.

Which would you choose? In the first option, you lose $40 every time. In the second option, your average payout is $37.5. The clear winner is Option 3, where your average payout is $32 and you have a low chance of paying $45.

What this means for small to mid-size employers
This game is a simplified version of choosing between fully insuring your plan, level/self-funding, and self-funding in a coalition. When you fully insure, you’re basically paying an insurance carrier to not play the game at all. You have no variable risk with excessive claims but you pay dearly for that privilege while rates climb 10-20%. Employers are starting to get savvy about how much they can gain by taking control of the game. With self-funding, you reduce your fixed costs and gain control but end up accepting more risk in claims. This inherent risk comes from having a smaller employee pool, something a company like Apple wouldn’t have with its 116,000 employees. Self-funding is like the single coin flip in this game. The last option and the one with the least risk while reducing costs is joining a coalition. A coalition works by combining multiple companies to create a more predictable single pool of risk.  A few dozen companies could band together in a coalition and reduce their risk in a way similar to Apple.

Coalitions have been around for decades in other lines of insurance, and since the early 2000’s companies like Roundstone have proven that coalitions can break rising medical cost trends.

The client cost savings and rate of growth for agencies embracing coalitions is so great that they are actually turning down employers as clients. There’s no doubt that coalitions are here to stay.

Two conclusions I’ve made from working with our benefit advisor partners:

  • If you’re not considering alternative funding with your clients, you’re behind the curve.
  • If you’re not bringing tools to address claims cost and employee decisions, you’re falling even further behind.

The basics of a coalition
Most relevant to small and medium-sized businesses is the turnkey stop loss captive solution. Companies like Roundstone have already done the heavy lifting in legal, administration and compliance to set up the coalition. Employers can then remit a premium and minor collateral contribution to join and gain access to the risk pool. They also gain transparency into claims and buying power for stop-loss and other products. How it works:

  • Risk Taking – The chart below represents the employer’s risk in the program. Each employer purchases two forms of stop loss: specific and aggregate. Specific stop loss is the cap an employer would have to pay for an individual’s claims. In the image below, if an employee’s claim was $15,000, the company would be responsible for $10,000 of that. Aggregate stop loss is the limit an employer would have to pay for all of the company’s claims. After that point, the captive layer kicks in.
  • Risk Sharing – The next region is the captive layer, or captive loss fund. This region is made up of premium and collateral (~2-3% of an employer’s fully insured premium equivalent) from all the coalition participants, plus investment income. Losses in the captive layer are first paid from the premium and if necessary from the collateral, although none of the coalitions we’ve spoken with have ever had to dip into collateral. At the end of the year, participants collect distributions from their coalition contribution and interest on the collateral and premium. Distributions can average 12% depending on the coalition provider you work with.
  • Risk Shifting – In the event of a catastrophic event for multiple participants, the coalition’s reinsurance covers costs exceeding what is payable from the captive layer.

Risk and Coalitions Source: Roundstone. The composition of a coalition.

Factors critical to success
Using alternative funding structures like a coalition is only one aspect that makes these programs a more cost-effective solution. Coalitions also provide greater transparency into and control over claims spend. From that point, you need to invest in strategies and tools that address claims dollars. Mike Schroeder, President and Founder of Roundstone, made this message clear at Roundstone’s recent Captive Forum. After careful selection, Schroeder provided attendees access to vendors like HealthJoy with the latest innovations in controlling healthcare costs.

Andy Neary of Captivated Health emphasizes the need to focus on claims: “If you’re going to self-fund and aren’t proactively managing your claims, don’t self-fund.” Captivated Health, like Roundstone, is successful in no small part because of this philosophy. Neary has a simple equation for healthcare costs:

Number of units of care x Cost per unit of care = Total Healthcare Cost

According to Neary, wellness programs reduce the number of units of care and concierge solutions address the cost per unit. You need to have a program in place to help compare price and quality to choose the best option.

Mick Rodgers of Axial Benefits Group in Burlington, MA is a leader in leveraging coalitions to reduce client healthcare costs. Mick takes an incremental approach that prepares clients for participation in a coalition. “Our clients hire us to get into one of our coalitions; however, some may not be ready right away. In that case, we lay out a detailed plan to get them there. The extra time allows us to study the group’s utilization data so we can really affect and begin to lower their claims. Once that work is done it’s a seamless transition to the coalition model.” The proof is in the premiums, as Axial’s clients spend less than half on a PEPY (per employee per year) basis than their industry counterparts.

Coalitions and Employee Benefits

Source: Roundstone. The difference in medical trend for captive-insured employers.

Emerging thought leaders
John Sbrocco of The Benefit Bureau has coupled the Achieve Health Alliance coalition with employee guidance tools to the advantage of clients and agency growth. Sbrocco points out the need to look at claims cost: “How can employers expect to reduce their healthcare spend without addressing the underlying factor – the claims!” Without transparency, employers are navigating the complex world of healthcare “with a blindfold on.” Once you change the funding structure, you take the employer’s blindfold off and see that employees are even more in the dark on how expensive their choices are. Sbrocco touts the need for concierge services: “You have to give employees direction on where to go based on quality and price transparency because that’s a lot less disruptive than a 10% rate increase with a higher deductible.”

Some of the more experienced players in the field are helping to bring up the next crop of leaders. Mick Rodgers has advised Nolan Waterfall on Waterfall’s coalition-focused agency Campfire Health on the west coast. Waterfall is combining psychology, technology and education to identify and treat the causes of rising healthcare costs. “In the fully insured market, you’re treating symptoms. Cost – that’s a symptom. With a coalition, you identify causes of increasing costs. Then you can use technology and other programs to treat them.”

Sam Walters, a regional practice leader at Roundstone, introduced me to the details of captive funding. Walters’ example sums up the benefits of joining a coalition: “I’ve seen groups paying $1.1 million in premium and only $500 thousand in claims. Those groups get 15% rate increases. That’s almost criminal. In a coalition, they’re keeping that money.”

Next step…

To learn more about how HealthJoy is helping control healthcare costs or to connect with our coalition or captive partners. Schedule a demo today!