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June 23, 2020

It Pays to be Flexible!

Blog photo – June_2

If you’ve looked into self-funding before, you recognize the transparency and control a self-funded plan affords.

Keeping an eye on your costs and learning how to contain them can impact your bottom line right now in a big way- it’s time to see just how the flexibility of a self-funded plan can deliver dramatic savings.

Today, we’re sharing success stories in which employers like you took advantage of the flexibility offered by their benefit plan to reduce expenses and retain much-needed cash.

Flexible Partners

Group A was a fully insured company looking toward moving to a self-funded plan. During Roundstone’s underwriting process for Group A, our Cost Savings Investigators (CSI) team was alerted to high prescription drug costs. Roundstone reached out to an independent PBM who provided better pricing and delivered a manufacturer’s coupon program to the employee and employer.

This group is projected to save over $60,000 annually, because when you’re self-funded with Roundstone, we find ways to manage the whole cost and get lower pricing on your behalf. The flexibility to choose your Pharmacy Benefits Manager (PBM) partners can produce big savings.

Absent the control and flexibility within Roundstone’s benefit funding solution, the employer’s renewal with a fully insured plan would have been an increase over the previous year because of the high-cost prescription drugs. The insurer would have seen the increase in spend on prescription drugs, and raised the whole group’s premium to insure against risk. This incumbent insurer would not have bothered looking for a lower cost PBM provider and the employer would not have been given the control or flexibility to make a better choice.

Flexible Supplies

Group B is a current client. While gathering data for renewal recommendations, Roundstone’s Cost Containment team noticed that Group B had an unusually high number of members with diabetes compared to benchmark data- almost 10% of their population. Unlike a fully insured plan, Roundstone’s self-funded solution gives employers access to their own member and claims data. Because this data was available through the CSI Dashboard, it was easy to identify where costs needed to be contained.

The CSI team looked for a solution that was low-cost and easy to implement. They settled on recommending a partner who would not add any fixed costs to the group, and who offers programs for both discounted testing supplies and coaching.

Through this partner’s program, testing supplies were made available at a deep discount- the cost of test strips alone was reduced over 80%. When cost plays less of a factor in deciding whether or not to test, diabetics can test as often as recommended by their doctors, and have greater compliance with their Diabetic treatment plan.

Group B will save over $4,500 on testing supplies (for over twice the amount of testing supplies), and will ultimately reduce larger, long-term costs that can arise with complications from diabetes.

Flexible Facilities

Group C is a current client. Roundstone’s claims department noticed a specialty drug being billed at five times the wholesale price for the drug, and notified the CSI team. Once it was confirmed that this particular drug was being provided at an inflated price, all worked to find a way to bring the cost in line with the market.

The patient alongside their physician was receptive to addressing the cost issue presented by this drug. The Third Party Administrator’s (TPA) case management team and Roundstone’s CSI team identified an outpatient setting to infuse and administer the drug. This simple change in the location where the drug was administered resulted in the employer saving over $170,000 annually.

The flexibility of self funding allows for creative solutions. Typically, 30% of a group’s prescription costs are specialty pharmacy drugs. The ability to administer some treatments in outpatient settings or at home can reduce costs significantly, and is just one of many options an employer has at their disposal when looking to contain costs under Roundstone’s funding solution.

Flexible Programs

Ahead of their renewal, Group D noticed their prescription drug spend was higher than expected, and brought these concerns to Roundstone. The CSI team once again dug into claims data and found that a handful of individuals accounted for 90% of the group’s pharmacy spend. By utilizing a prescription advocacy program, plan members and their employers can realize significant savings.

In this circumstance, the excessive drug costs dropped to zero for the employee. Group D now stands to save over $200,000 (and is moving forward with implementing this solution!)

The flexibility inherent in Roundstone’s benefit funding solution empowers employers to take advantage of opportunities to eliminate unnecessary costs. By using a variety of partners and discount programs, the same drugs and quality care can be accessed at much lower costs.

Even more important to note in this instance is the combination of transparency, control, and flexibility. The employer was able to capitalize on the transparency within its health plan, identify a rise in costs and take control with complete flexibility to implement an available cost containment solution.

With transparency, you have all the control you need to contain costs. Roundstone’s CSI team provides the turnkey expertise to offer solutions that deliver big savings to you.

Flexible Solutions

Let’s talk theoretical for a moment. We have an idea that can save you big. Imagine you’re a mid-size business with a self-funded healthcare plan in the midst of a worldwide pandemic (sometimes reality is stranger than fiction!). You’ve noticed that your claims for this year are very low, which makes sense because hospitals and providers have been prioritizing the very sick and emergency cases.

You know that few of your members have accessed care this year, and start thinking about after things open back up- when you’ll likely see an influx of claims to offset this time. But you have an ace up your sleeve. You know that your self-funded plan with Roundstone has the flexibility to add new programs at any point during the year, not just at renewal. So you looked into adding a telemedicine provider, and are implementing a new solution soon.

Now your members won’t have to wait for care, and minor conditions won’t become serious cases down the road. Telemedicine can help you realize big savings from the comfort of your home.

Will your group be the next savings success story thanks to the flexibility of a self-funded plan? There’s only one way to find out! Contact Roundstone to start your own proposal process!

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