Interested in double-digit rate decreases?

A regional car dealership in North Carolina with approximately 1,900 members on their plan was struggling with unsustainable annual increases in member premiums and decreased benefits. After a great deal of analysis and consultation, the leadership team made the decision to move to reference based pricing.  Ahead of the 2018 plan year, they determined ClaimDOC’s solution would provide the best opportunity to meet their goals of controlling costs and minimizing disruption. An internal memo stated, “To meet our goals of providing great health care benefits to our employees, we’ve made several important changes. These changes put our Plan in a position to negotiate fair, reference-based pricing structures with health care providers.”

The client trusted ClaimDOC would deliver and reduced premiums by 8.3% to employees in anticipation of the savings to come. The Plan also provided a “premium holiday” in December putting extra money in employee’s pockets.

After the savings exceeded expectations, the plan reduced premiums again in 2019 by an additional 10%! They recognized savings with ClaimDOC went beyond the basic re-pricing of claims other RBP programs offered and wanted to educate members. The client sent out communication on the value of the claim auditing taking place on their behalf. They noted the audits are an “extra step that is catching many errors, over-charges and mistakes in billing for services not provided. Cutting out this waste and needless expense to our plan is saving us a great deal of money and helping us hold down the cost of premiums!”

As the plan moved into 2020, the decision was made to keep premiums flat (at a level nearly 20% below 2017); however, to continue to pass savings to members, the plan contributed $50 per month into employees’ Health Savings Accounts, adding an annual employer-sponsored $600 contribution to offset incurred medical expenses. Lastly, the plan increased the post-deductible employer coinsurance level from 80 to 90%.

The plan’s memo ended by saying, “We thank you for all your efforts to be smart consumers of health care and to keep our Company strong and successful!”

Successful programs like this highlight a number of factors ClaimDOC deeply believes in:

  1. Plan savings is about putting money back with employees.
  2. There is no successful RBP program without engaged and strong client leadership.
  3. Line-by-line auditing matters
  4. Take care of members by thoughtfully managing all their pre-service and post-service needs

There is no “perfect” in RBP, however, if the desire to control costs can be met with the desire to do it the right way with ClaimDOC, a rich and sustainable benefit is available.