Patient Advocate Success Story: Rx Savings

Patient Advocate Success Story: Rx Savings

Every day we talk to hundreds of members about a wide variety of issues. One of the issues we constantly help with is medication. Prescription drugs account for about 20% of a company’s total spend, so to address medical costs you have to examine pharmacy spend. With over 7,000 approved drugs in the U.S., it can be complicated for both doctors and patients to know what’s covered by their insurance.

A member recently came to us because they were denied coverage for a prescription. Their doctor prescribed Restasis eye drops to increase tear production. The insurance plan initially said that the member did not meet requirements for prior-authorization (PA) approval. Without permission from the plan, the member’s health insurance would not pay for the service, so she was stuck paying the bill herself.

The member was a new patient at the doctor’s office, and after a thorough examination the doctor determined that Restasis was the appropriate form of treatment. But without PA she would be responsible for over $300 each month for a drug the doctor considered medically necessary. The member would only be responsible for a $50 copay were she to have authorization.

The member clinically satisfied all of the prior authorization requests but one – history of failure or intolerance to at least one over-the counter eye lubricant – and the provider was unwilling to submit an appeal on the member’s behalf. Since this was a new plan for 2017 with a different set of providers, it would have been difficult and time-consuming for the member to challenge the plan herself. The member would have been paying an expensive monthly medication due to a disagreement between the provider and the insurer, and where no generics or alternatives were available.

Prior-authorization approval exists in most insurance plans to minimize costs to the insurer. In a self-funded or coalition health insurance plan, the employer can determine what is covered or not. In this case, HealthJoy worked with the plan administrator to earn an exception for the member. The employer made the final decision on granting coverage adjustments, and our member can now afford her prescription at the $50 copay per month. 

Our Concierge staff spent considerable time working with all parties to make sure the member was taken care of and received the required medication in a cost-effective manner. Helping both employers and employees save money on Rx is one of our core missions. Our medical team has actually spent considerable time in the development of our proprietary algorithm to identify lower cost alternatives. Our prescription algorithm takes into account the following data to identify the best options:

  • Therapeutic alternatives – Doctors prescribe drugs without understanding a patient’s drug formularies. Our doctors can recommend alternatives that are as effective and deliver huge savings
  • Manufacturer coupons
  • Prescription assistance programs
  • HealthJoy’s Rx savings program
  • Mail-order via PillPack
  • International Mail-Order for certain high tier drugs
  • Pharmacy optimization
  • Dosage optimization
  • Generic alternatives

In this case, we were able to deliver savings by just picking up the phone and speaking to everyone. With all of our cost-saving options, we are able to save an average of $65 per month per medication for our members that submit a long-term medication for review.

Healthcare App Adoption & Blue Collar Workforce

Healthcare App Adoption & Blue Collar Workforce

When you think of an employee using a smartphone, the first image that comes to mind is probably a white-collar worker dressed in a suit. If you search “Person using a smartphone at a company” in Google Images that’s all you’ll find. But the stereotype that blue-collar workers don’t use technology is far from reality.

HealthJoy initially serviced the individual space, helping people who had purchased an ACA insurance plan. We signed up over 20,000 members in our first year, and the majority were blue-collar and lower-income individuals eligible for subsidies. We conducted much of our user testing with this audience when developing our app. Our decision to move to a chat-based interface came in part from working with a blue-collar audience. All our metrics demonstrated a huge uptick when we moved to putting the smartphone at the center of our strategy. We still offer phone support, but usage has declined as we’ve improved our mobile offering.

Below we’ll address some of the common questions we receive regarding blue-collar workers and healthcare.

Smartphone Adoption in the United States

According to a study conducted by the Pew Research Center, nearly nine in ten Americans are online today, up from about 50% in the early 2000’s. Almost 77% of all Americans now own a smartphone. Lower-income individuals and those over 50 years showed the largest jump in 2016. High school graduate ownership grew to 69%, almost matching average smartphone ownership. Desktop/Laptop usage, at 78%, also neared smartphone ownership.

What about more physical jobs? Are people still using smartphones?

Some industries have been slower to adopt technology, but that’s starting to change. A survey conducted by Texas A&M in 2015 showed 72% of construction professionals use smartphones at work and 80% use them for bidding or managing their construction projects. The idea that blue-collar workers aren’t using smartphones is wrong. Even in the worst cases, smartphone adoption is within 8% of the average.

I know some of my employees don’t have smartphones, what about in those cases?

HealthJoy has a utilization rate and ROI that’s 8-10X higher than other solutions even taking this subset into consideration. For employees that don’t have a smartphone, we provide a landline option that’s available to all members. We can provide onsite posters, paycheck inserts, flyers, presentation videos, PowerPoint decks, registration drives and an optional mailed welcome kit for members (talk to your broker.) Our account managers will work with you to make sure our rollout is a success.

How can HealthJoy help a blue-collar workforce?

In 2017, manufacturers are increasingly introducing High-Deductible Health Plans (HDHPs), HSA’s, reference-based pricing plans and more to reduce rising healthcare costs. While these tactics lower the cost to the companies, they shift cost to employees that can’t afford the extra burden. These tactics also do little to address the main problem: the number and size of claims. As Chapin Collins from Sterling Thompson Company says “The only way to address the increasing health insurance premiums is to control the underlying claims costs which are driving the premiums.  Technology is likely the most valuable resource available to address and control medical claims costs.”

A survey by PolicyGenius found that just 4 percent of Americans are able to correctly define four terms that determine how much they have to pay for medical service. Whether white-collar or blue-collar, employees need guidance in healthcare. JOY and our concierge team are here to help.

telemedicine and hdhp
Telemedicine Benefits Guide

Telemedicine use is growing at an exponential rate. In this guide, we’ll share our best tips on how to make this underutilized benefit work better for your company.

Learn more »
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.

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.

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.”

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<div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_9' > <div class='gform_heading'> <h3 class="gform_title">10 Benefits Presentation Tips from TED Talks eBook - 2-Col (Pop-up)</h3> <span class='gform_description'></span> </div><form method='post' enctype='multipart/form-data' id='gform_9' action='/blog/2017/06/' > <div class='gform_body gform-body'><ul id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below'><li id="field_9_8" class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_8' >First Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_9_8' type='text' value='' class='large' placeholder='First Name' aria-required="true" aria-invalid="false" /> </div></li><li id="field_9_9" class="gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_9' >Last Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_9_9' type='text' value='' class='medium' placeholder='Last Name' aria-required="true" aria-invalid="false" /> </div></li><li id="field_9_4" class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_4' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_4' id='input_9_4' type='text' value='' class='medium' placeholder='Email' aria-required="true" aria-invalid="false" /> </div></li><li id="field_9_5" class="gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_5' >Company name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_9_5' type='text' value='' class='medium' placeholder='Company name' aria-required="true" aria-invalid="false" /> </div></li><li id="field_9_10" class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_10' >Company Size<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_9_10' class='large gfield_select' aria-required="true" aria-invalid="false" ><option value='' selected='selected' class='gf_placeholder'>Company Size</option><option value='1-100' >1-100</option><option value='100-500' >100-500</option><option value='500-3000' >500-3000</option><option value='3000-1000' >3000-1000</option><option value='10000+' >10000+</option></select></div></li><li id="field_9_7" class="gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_9_7' >What Describes You?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_7' id='input_9_7' class='large gfield_select' aria-required="true" aria-invalid="false" ><option value='' selected='selected' class='gf_placeholder'>What Describes You?</option><option value='Employer' >Employer</option><option value='Benefit Consultant' >Benefit Consultant</option><option value='TPA' >TPA</option><option value='PEO' >PEO</option><option value='Other' >Other</option></select></div></li></ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_9' class='gform_button button' value='Get Your eBook' onclick='if(window["gf_submitting_9"]){return false;} window["gf_submitting_9"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_9"]){return false;} window["gf_submitting_9"]=true; jQuery("#gform_9").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_9' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='9' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_9' value='WyJbXSIsImFkODg5MTk3ZmY1MDIyZGVjZjEyNWI2ODk1Y2YyMGZiIl0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_9' id='gform_target_page_number_9' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_9' id='gform_source_page_number_9' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> </form> </div>