EVHC creates a financially sustainable future for a mid-market employer running out of options.
The Challenge
The Challenge
Rising Costs, A Looming Deadline, and a Labyrinth of Choices

Facing an annual average health insurance premium increase of 23.5% with their current carrier, Anthem, after enduring increases for the past three years, a New York-based employer with 800 employees was teetering on the edge of eliminating medical benefits entirely—a drastic measure that could profoundly impact employee welfare and significantly damage the employer's ability to attract and retain talent. This dire financial situation jeopardized the brokers' two-decade-long relationship with the client. It underscored a critical need for innovative ideas and a transformative approach, not just to revitalize the renewal conversation but also to salvage the relationship and stabilize the client’s healthcare spending.

To understand the depth of the crisis, consider the immediate challenges facing the client:

  • Escalating Annual Premiums: A relentless climb in premiums, exacerbated by high claim years and costly pharmaceutical benefits, strained the employer’s budget beyond sustainability.
  • Recent Insurance Volatility: A tumultuous history of switching carriers each year for the past three years complicated the task of obtaining competitive quotes.
  • At-Risk Benefits: The soaring costs pushed the employer to consider cutting medical benefits for their 800-life group altogether.

The broker faced their own set of challenges, particularly their need to not only assemble but also persuasively pitch a self-funding proposal to a client who had previously been led to believe that self-funding was not a viable option:

  • Need for a Strategic Partner: The situation's complexity underscored the necessity for a strategic partner capable of introducing innovative perspectives and tangible tools for better control and transparency in managing healthcare costs.
  • Limited Expertise and Resources: The broker, though experienced, lacked the specific knowledge and resources essential for navigating the self-funded insurance landscape effectively. They needed a partner who could provide:
    • A purpose-driven approach to crafting insurance solutions
    • Strong relationships within the insurance markets
    • A meticulous and strategic review of claims data to facilitate informed negotiations
    • Expert underwriters skilled in customizing solutions for complex needs
    • A comprehensive panel of stop-loss insurers

The pressure was intense with only a few months remaining to secure a viable solution for an effective date that was just over a month away. The broker needed to quickly align with a new partner who could deliver immediate results and long-term stability, making the case for EVHC’s expertise and resources all the more critical.

The Solution
The Solution
Swift & Strategic Self-Funding Proposal from EVHC

In partnership with EVHC, the broker team leveraged the potential of partially self-funded insurance, delivering significant cost savings and enhanced coverage options:

  • Prescription Plan Overhaul: Revamped the prescription benefits plan, which anticipated annual savings of $276,266.
  • Comprehensive Market Relationships and Claims Analysis: Utilized EVHC's extensive industry connections and data-driven claims analysis to refine the client’s insurance strategy, emphasizing sustainable cost-saving strategies and long-term coverage options.

Extensive education on self-funding culminated in a significant "Ah-ha" moment for the client during the proposal presentation:

  • Breaking Down Costs: The proposal clearly differentiated between fixed costs and claims liability, demonstrating how self-funding allows for better budget control than their current fully insured model.
  • Visibility and Control: The presentation showed that with a self-funded model, the company would save on fixed costs and have clear insight and control over spending. This clarity revealed potential savings on variable costs based on actual claims data.
  • Budget Maximization: The presentation highlighted that any money set aside for maximum potential claims stays in the company’s bank accounts, meaning any unused funds can be kept by the company instead of paid out to the insurer—a key advantage of the self-funding model.
  • Operational Control: Detailed how claims management under self-funding works and the various opportunities to optimize for both comprehensive coverage and overall savings, leading to the realization: “Why haven't we done this before? EVHC is a well-oiled machine."

 

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The Results
A Victory for Cost-Efficiency and Coverage Integrity

The switch to EVHC's tailored self-funded insurance plan resulted in an anticipated total savings of $2,332,602 in the first plan year.

EVHC was able to accomplish this by:

  • Plan Design & Carrier Relations - The new plan, enhanced by strategic benefit changes, projected an expected increase of just +2.74%—a considerable improvement over the potential maximum increase, highlighting substantial savings and effective cost management.
  • Pharmacy - With guidance from EVHC, the broker team managed to cut the client's prescription drug expenses, yielding an additional annual savings of about $276,266.
  • Proactive Case Management - As the year progresses and claims are processed, EVHC will continue to assist the broker and client in realizing additional savings through the comprehensive '3T approach.’
  • The integrated approach - including proactive cost control and dedicated case management—helped the broker team present a convincing proposal that won them the business and positioned the client for a more financially sustainable future. The broker, now equipped with a compelling, cost-effective solution, solidified their position as strategic advisors in their client's eyes.

Recent Case Studies

EVHC Helps Company Save More Than $500,000
EVHC Helps Company Save More Than $500,000

Partially self-funded insurance reduces costs by 28% with no coverage loss Save without Sacrifice Each year, health insurance premiums go up, forcing employers to shop around and, usually, ending up right back at square one. Whatever they do, companies end up paying more than they should because the alternative—reducing benefits or limiting network access—is simply not an option. Tired of the costs and headaches associated with fully insured options, one company began to explore the benefits of partially self-funded insurance and how it could help them: -Keep their margins (the difference between claims liability and actuarially expected claims) -Cut pharmacy spending -Retain access to the nation’s largest provider networks “We needed a solution that allowed us to save money while still providing our employees with access to the best provider networks. We weren’t getting that through traditional fully-funded insurance.” EVHC’s Partially Self-funded Insurance The company turned to EVHC, which offers custom plan designs that help companies save money without losing coverage. Through EVHC, the company had: -Access to three of the nation’s four largest provider networks -24/7 concierge-level customer service, including member education programs -Flexible plan designs -Greater price transparency “EVHC was easy to work with and a true partner. They were there every step of the way, from implementation to enrollment and beyond.” Thousands Saved, No Coverage Lost In just one year, the company experienced:

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EVHC Steers Automotive Company to $1.4 Million in Savings
EVHC Steers Automotive Company to $1.4 Million in Savings

0 rate increases, great coverage, and millions of dollars saved result in a win for car dealership and its employees Drive Costs Down, Maintain Great Coverage Tired of the skyrocketing costs and headaches associated with their fully insured carrier, one of the Southeast’s largest car dealerships began to explore the benefits of partially self-funded insurance. This Georgia-based automotive company has 28 dealerships and more than 700 employees. They were paying a fully insured carrier millions of dollars per year—and the carrier planned to increase those annual costs by 38%. They were also struggling to manage plans across dealerships, all of which had their own unique coverage. This automotive company looked at partially self-funded insurance alternatives to help them: - Keep their margins (the difference between claims liability and actuarially expected claims), resulting in millions in savings - Consolidate insurance coverage across all dealerships - Retain access to the nation’s largest provider networks - Provide employees with even better coverage options “When the carrier told us about their proposed rate increase, I was shocked. How were we supposed to be able to pay those margins? We desperately needed an alternative that would provide our employees with great care without breaking the bank.” EVHC’s Partially Self-funded Insurance This automotive company turned to EVHC, which offers customized partially self-funded insurance plans that help companies save money without losing coverage. EVHC provided them with: -The ability to only pay for the actual cost of employees’ claims -Low individual deductibles -Access to three of the nation’s four largest provider networks -24/7 concierge-level customer service, including member education programs -Flexible plan designs, including home healthcare and diabetes treatment options -Greater price transparency For the first time ever our premiums remained flat year-over-year. That, combined with millions in overall savings, great customer care, and even better benefits for our employees, has made our relationship with EVHC a winner. Millions in Savings, Better Coverage In just the first year, this automotive company experienced: - A consolidated insurance plan covering 700+ employees across 28 dealerships for easier administration and better continuity - $1.4 Million in Savings - 100% of employees covered at no risk to the company EVHC is also creating a customized diabetes management program with partner Livongo that will allow diabetic employees to enjoy cost savings, direct delivery of supplies, and more, and helping this automotive company save money on internationally-sourced prescription drugs.

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