Client

An Indiana county with over 800 employees

Challenge

The county was previously an Apex client and had built healthy reserves. After another benefits consultant promised savings, the county decided to change consultants. Unfortunately, the new broker was unable to help the county contain costs for their two-year tenure, and total plan costs ballooned to over $7,582,000. The county’s high claims experience forced them to dip into their reserves. As a result, the county re-engaged Apex for cost-saving solutions.

Solution

Save More

Apex worked with the client to move the plan to a reference-based reimbursement (RBR) model. Our team doubled down on our best-in-class RBR practice with new innovation and negotiation tactics. We delivered a new pricing tier through the Community Health Direct Network with a competitive discount and no balance billing, along with much deeper discounts (Medicare plus 40%) than major carriers could provide for services obtained at non-Community facilities.

Our pharmacy consultants evaluated the county’s pharmacy benefit manager (PMB) along with current pharmacy contracts. With their previous broker, the county had relationships with three PBMs and was not receiving rebates. Our team consolidated the plan to work with a single PBM and tightened up the contract to ensure rebates were passed along appropriately.

Do More

One of the concerns employers commonly expressed about an RBR approach is the disruption it may cause for their members. We take a hands-on approach to minimizing disruption and enhance benefits for employees, holding monthly advocacy meetings to help plan members navigate any challenges with health care benefits and billing.

Savings also allowed for enhancements to benefits. The county was able to add a new PPO plan with copays for prescriptions and doctors’ visits and increase the coinsurance on the high-deductible plan by 10%, improving affordability for members.

Results

In the first year after reengaging Apex, the county saved $1,832,508 —a savings of 24.2%. These savings included delivering pharmacy rebates of $151,806 to the county through PBM contract improvements. Per-employee-per-month savings were also significant, dropping from $1,309 to $1,035 — a reduction of 21%. Working with Apex has allowed the county to enhance benefits for employees and start replenishing its reserves.