- About the Client:
ABLE Equipment Rental, Inc. is a leading provider of rental equipment throughout the Northeast and Mid-Atlantic Region. As a trusted provider of equipment Rentals, Sales, Service, Parts, Transportation, and User Training, they take pride in offering the highest quality products and dependable service every day.
ABLE Equipment Rental is privately owned with more than 25 years of market experience.
Our relationship with ABLE initially started because of our superior compliance and HR Support capabilities, especially related to ACA Reporting and guidance.
The focus quickly shifted from compliance and HR to cost containment, benefit enhancement, benchmarking, pharmacy optimization and true consumerism.
The HR team at ABLE and our advisors developed five main goals:
- Reduce Employee Cost
- Lower overall healthcare costs
- Minimize member disruption
- Attract & retain talent
- Eliminate waste, fraud & abuse
- Approach:
AER and GPI evaluated the existing plan designs, contribution structure, member allocation and did a market evaluation of the existing self-insured program versus a fully insured equivalent plan.
Also evaluated was the reporting ability and flexibility of the current Third-Party Administrator (TPA) to work with outside stop loss carriers and cost containment partners to be introduced immediately or in the future.
AER and GPI agreed that all benefit or vendor changes would have to be in the best interest of the members with little to no disruption.
- Year One Results:
Plan options were reduced from four to three with enhancements to prescription drug coverage and clearer distinction between the High, Mid and Low plans. Copays, Deductibles and Out-of-Pocket limits flowed more clearly, and members more easily distinguished the best plan option for themselves.
A change in stop-loss carriers was made that eliminated hidden compensation for the existing TPA and prior broker.
A $250k laser was avoided because of the change and the stop-loss premium still decreased in premium.
An enhanced communication and exchange in data and analytics was initiated between the stop-loss carrier, TPA and cost containment solution partners.
First year claims ran at 65% of the maximum liability saving the group $536,881 in comparison to the lowest fully insured equivalent option.
- Group Details
- Total Employees: 200+
- Enrolled: 110
- Covered Lives: 220
Three Year Financial Summary
3 Year Fully insured equivalent premium (at trend) – $5,974,155
3 Year Self-Insured Maximum Exposure – $5,781,812
3 Year Total Fixed & Actual Claims Costs – $4,299,126
3 Year Savings v Fully-Insured Equivalent – $1,675,028
3 Year Savings v Maximum Exposure – $1,482,686
- Average Annual Savings
Per Covered Employee: $5,076
- Year two and beyond:
The transformation of the plan from status quo to high-performance has been nothing short of remarkable.
Since our team approach started in 2018, the AER plan has had significant success implementing several cost-control measures with others on the table for future years.
- Pharmacy Benefit Contract:
Additional discounts and reinvested rebates have lowered the relative pharmacy spend by more than $100k per year.
- Direct Contracts:
The introduction of 3rd party health plans to address significantly inflated costs for injectable medications, specialty drugs and outlier claimants such as dialysis have already mitigated medical and Rx claim spend by more than $300k in 2021.
Member out-of-pocket was eliminated entirely due to these new options
- Advanced Self-Insured Reporting & Analytics:
The introduction of outside technology allows our benefit team as well as case management to mine claims and medical management notes to address seriously gaps in care and help members avoid significant out-of-pocket costs.
- On the Horizon
Navigation tools so members are better equipped to make informed health care decisions, avoid unnecessary out-of-pocket costs and be better ambassadors of the organization.
Independent Pharmacy Benefit Manager with true pass-through model projected to reduce the Rx spend by an additional $100K leveraging enhanced capabilities such as coupon assistance, international sourcing, and clinical management.
Potential introduction of a Reference Based Pricing option with a wrap network for physician care.
- About the Agency:
Group Planners Inc. d/b/a BritePath has been helping employers and their members optimize group health plans (and other ancillary insurance products) since 1997.
The agency is committed to benefit enhancement and education. Too often employers and their brokers focus exclusively on insurance. This is a flawed strategy that plays directly into the hand of a healthcare and insurance ecosystem that attempts to maximize profits off misinformed consumers.
GPI helps employers refocus on healthcare costs and helps them develop high-performance health plans that outperform their counterparts by 20% or more.
GPI follows the essential components of a BritePath health plan: Analytics, Insights, Elevate and Engage
- Analytics:
The data belongs to the employer despite carrier resistance to share it. GPI has the tools and strategy to obtain the data, so our clients are better equipped to make informed benefit decisions.
- Insights:
Utilizing the newly obtained data our advisors can conduct true market analysis including PBM cost analysis, self-insured readiness, creative funding performance reports and make targeted benefit plan recommendations.
- Elevate:
Plans are designed with an incentive-based methodology, so members are rewarded for making informed decisions.
- Engage:
Members are contacted by a concierge team member when opportunities to enhance care and/or avoid unnecessary out-of-pocket costs are identified.
About the Agent: Louis C. Bernardi
Co-Founder & President
Health Rosetta Associate Advisor
lcbernardi@groupplannersinc.com
Direct: 516.590.0865
LinkedIn: www.linkedin.com/in/louisbernardi
Lou is a graduate of St. Johns University Class of 1989. He is a resident of Massapequa Park, NY where he resides with his wife of 29 years, Jaki and their three children Louis, Andrew & Faith.
Lou has been exclusively focused on employee benefit since 1991 both as General Agent (1991 to 2017) and President of Group Planners Inc. (1997 to present). Lou will soon be the author of his first book focused on the challenge’s employers, HR Directors and their members face in the managed care era of health care. Lou believes it is imperative that stakeholders are conscious of the misaligned incentives that artificially inflate healthcare and as a result health insurance. Lou is equality focused on helping grow awareness of the many tolls, resources and solution partners that exists that are already solving the cost and quality issues that most employers face.
Lou believes a BritePath focused high-performance health plan has the potential to forever change the trajectory of the cost and quality of most employer sponsored health plans. In fact, quite often Lou finds that he is the first advisor that has sat down with a CFO or HR Director and changed the focus from insurance rates to health care costs. Most employers are not aware of the significant rebates, spread prices and other hidden profit centers within most plans and perhaps more importantly the alternatives that exist to address these impropriates.
Lou always strives for maximum improvements with limited or no disruption. The BritePath approach is a multi-year strategy that meets employers and their members where they currently are and takes them where they want to be. Conversation is free, solutions are priceless.