County government with 100 employees.


The client was experiencing rising and unsustainable health care costs while their revenue stream was capped.

In 2015, two years prior to hiring Apex, the organization’s health care spend was $1,743,856 million. That spend increased to $1,753,936 million in 2016. The cost of the benefits plan was unsustainable. The county had attempted to solve this dilemma by altering benefit plans, which put more of a burden on employees, but the cost of health care was still not contained.

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A conservative estimate of savings based on the county’s pre-RBR health care spend is savings of $3,573,879 over the 6 years since partnering with Apex — an average savings of $595,646 per year.


Apex analyzed the county’s historical claims and recommended moving from their fully insured model to a more cost-effective Capitalize Reference-Based Reimbursement (RBR) plan in 2017. The change created no disruption for county employees — the benefits package was unchanged, and deductibles remained the same from the previous year.


After moving to RBR in 2017, the county’s spend dropped to $1,165,103, a reduction of $588,833. By 2019, the client’s health care spend dropped into the 6-digit range at $951,290. They also saw a reduction in per employee per month (PEPM) health care costs. In 2016, the PEPM was $1,428, and dropped to $866 by 2019.

The county was able to sustain their level of savings over the next three-year period, with an average health care spend of $1,239,128 — a decrease of $514,807 or 29% from their pre-RBR peak. During this same period the county’s PEPM costs averaged $1,100 — $328 or 23% below their pre RBR rate.

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