Risk Reduction:

Eliminating $800k of Claims Expenses

190%

Initial fully-insured renewal from carrier

2 CLAIMANTS

Identified 2 high-cost claimants

12%

Crumdale’s risk control brought the group’s renewal to 12%

The Situation

A lumber company in the Northeast had been offering a fully insured medical and prescription drug program for over 50 years. During that time, they tried to find a balance between price and competitive plan design options.

In the midst of a worldwide pandemic, the company received a 190% renewal increase from their insurance carrier. Absolutely shocked to receive such an increase, they asked their broker to conduct a market survey and contact DOBI.

Not surprisingly, the market was hesitant to provide a quote to an employer receiving such a large increase. The broker contacted Crumdale Partners to see if there was an alternative approach to handling this employer’s health plan.

The fully insured carrier was unwilling to provide any de-identified claims information, so the broker partnered with Crumdale to promulgate an Individual Medical Questionnaire process to better understand the employer’s risk profile

Goals

CLIENT:

Allow the broker to have more control over the health plan to continue balancing plan costs with design changes.

BROKER:

Obtain the ability to better manage high-cost claimants to avoid significant increases in the future.

Before & After

Before After
Program Structure Fully Insured (12 equal premium payments) Self-Funded
Third-Party Administrator (TPA) Highmark BCBS Independent TPA
Network Highmark BCBS National Network
Pharmacy Benefit Manager (PBM) Highmark BCBS Transparent PBM Contract
Medical Stop Loss Highmark BCBS Resolute Underwriting Strategies
Claim Review & Monitoring None Franklin Health
Pharmacy Oversight None Franklin Health
Data Analytics None Franklin Health
Plan Document Review None Franklin Health
ERISA Guidance & support None Franklin Health
Compliance Review None Franklin Health
Patient Advocacy / Engagement None Franklin Health
Alternative Funding Programs (RX) None Franklin Health
Data Analytics None Crumdale Custom Reporting

The Results

Current Incumbent Renewal Crumdale Renewal
# of Employees 54 54 54
Max Spend $461,214.24 $1,334,515.92 $519,054.24
Differential @ Max + 190% + 12%

The Group saved $815,461.80 vs renewal with a 12% increase from current costs.

Pricing

FAVORABLE DISCOUNTS, TERMS, AND CONDITIONS

Stability

DECREASE RENEWAL VOLATILITY

Control

ALLOWS FOR STRATEGIC PLANNING & FINANCING

How We Did It

THE CLIENT HAD MANY ISSUES WITH THEIR PRIOR FULLY INSURED HIGHMARK BCBS PLAN.

The fully insured carrier was unwilling to provide any de-identified claims information

The fully insured renewal saw the
employers cost almost triple

No risk assessment or identification

No insurance protection for unknown risks

No supplemental risk insurance

N