Challenge

A manufacturer with cash flow concerns embarked on a companywide mandate to decrease expenses.

Understanding that its self-insured medical risk program represented a major cost, the organization partnered with Hylant Business Risk Consulting to uncover cost-saving opportunities.

Solution

The Hylant Business Risk Consulting team engaged in a unique holistic and collaborative analytical process that integrated contract and pricing analysis with financial decision-support modeling and stop loss risk transfer mechanisms.

Specifically, the analysis focused on the following qualitative and quantitative program improvement areas:

• Medical network(s) pricing models and savings
• Pharmacy benefits management pricing models and savings
• Stop loss risk transfer deductible/risk optimization

Hylant recommendations saved the manufacturer more than $3.5 million in annual program costs through new discounts, rebates, specialty drug spend and deductible optimization.

• The average medical network discount of 35% was increased to 40%+.
• A pass-through pricing model was implemented, requiring the pharmacy benefit manager to pass back 100% of rebates and prescription drug discounts.
• Specialty prescription alternative funding programs yielded savings of up to 70% on specialty drug spend.

Transition of eligible plan participants to Medicare reduced program costs and improved employee care.

Hylant Business Risk Consulting helps organizations recognize the sometimes hidden, costly risks to their operating performance and maximize opportunities for improving business performance.