Issue
The client faced rising healthcare costs, administrative inefficiencies, and a major disruption in provider access due to the exit of a key HMO. With a dispersed workforce and inconsistent benefits delivery, they needed a long-term solution to control costs, unify plan administration, and ensure employees had reliable access to care. Key challenges included:
- Fragmented benefits delivery. Employees across regions were enrolled in different networks and carriers, creating inconsistencies in access and administration.
- Provider disruption. The exit of a key HMO left gaps in care access for a large portion of the workforce.
- Rising healthcare costs. A 15% renewal increase would add $2.09 million in annual spend.
- Limited cost-control levels. Traditional plans offered little flexibility to manage long-term healthcare expenses.
- Lack of unified reporting. Multiple administrators hindered visibility into plan performance and cost drivers.
Solution
The client transitioned to a self-funded health plan through Pinnacle, a group captive powered by CBIZ. This approach provided greater cost control, access to high-performing provider networks, and enhanced plan flexibility — all while streamlining administration across the workforce.
Outcome
- Pharmacy cost management. An Rx carve-out unlocked stronger rebates, improved pharmacy discounts, and strategies to reduce high-cost drug spend.
- Reference-based pricing. A dual-option model enabled access to quality care at competitive reimbursement rates, with strong employee participation.
- Centralized plan administration. Moving all employees to a single administrator improved communication, data visibility, and overall plan efficiency.
- Seamless provider transition. Despite the HMO exit, no access issues were reported, ensuring a smooth employee experience.
| Company Information | |
|---|---|
| Industry | Government Contractor |
| Geographic Footprint | Multistate Operation |
| Number of Employees | 534 |
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