- 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.
- 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.