RFP Response

Page 7

Health Plan Cost Management

38. Describe your experience assessing and implementing self-insured options.

We have many years of experience in assessing and implementing many types of self-insured options. To see the full spectrum of options that we offer clients, click the link below. While there may be some opportunities for you in this spectrum, also keep in mind the above discussion on the New York regulation of stop loss insurance and its impact on small group self-funded plan availability in New York.


39. Does your firm have underwriters on staff or experience underwriting medical plans?

Yes, our staff has extensive experience creating working rates, analyzing claims, and we have a former insurance carrier underwriter on our local team. Plus, we have extensive additional resources through our relationship with NFP.


40. What claim analytics technology or processes do you utilize?

We adhere to a formal data-driven process. To negotiate renewals in our clients’ favor, to develop wellness goals, to explore funding options, to manage budgets – it all starts with data. At the most elemental level, each month our clients receive a one-stop overview where they can see claims, premium (where applicable), headcount, large loss info, and other related data on their own Claims Dashboard.

This snapshot gives actionable insight of the plan’s success in numbers and graphs, both on plan year and rolling 12 basis, comparing to prior periods. And we’re always looking to spot areas for improvement.

In addition, we pull and analyze claims utilization reports as frequently as makes most sense for our clients, whether it be quarterly, annually or somewhere in between. Together, we look at underlying claims utilization trends, comparing to benchmarks, identifying outliers and using real-world data to help drive plan design decisions, wellness program decisions and overall employee education.

For example, if we find that a group’s ER claims are running higher than average, we can look closer at the diagnoses, the amounts paid per visit, etc. We can then make decisions on ER copays (depending on benchmarking) and focus on employee education to encourage alternatives such as urgent care centers and telemedicine. Similarly, when reviewing or developing a wellness program, we can find efficiencies by identifying the areas of concern for your group and develop programs around those. Prescription drug utilization can often be a significant driver of costs, particularly with specialty drug increases. By identifying trends with reliable data, you can begin to explore alternative funding options.

Through our NFP alliance, you would have access to some of the leading medical data reporting and analytics solutions in the industry. Using these tools, we can rapidly integrate all of a population’s eligibility, medical claims, pharmacy claims, health risk assessment and case management data. Then we would apply a wide range of medical rules to predict individual and aggregate risk in that population.

Through the use of intensive data mining and predictive modeling techniques, Benefits Partners’ claims analysis tool automates the analytical process, enabling clients to make more effective and timely medical management and financial decisions.


41. Please provide examples of how you have helped your customers manage and/or reduce healthcare costs.

See here for a description of our process and some case studies.


42. What is your approach to process for managing prescription drug costs?

Innovo, through NFP, provides access to best-in-class coalition-based Rx pricing with hundreds of thousands of lives, plus contracting with several major pharmacy benefits management companies. We can also offer NFP Rx Solutions. With NFP Rx Solutions and Express Scripts, you receive access to technology, clinical oversight and innovative strategies to assist you in controlling prescription drug costs. NFP Rx Solutions brings a wealth of knowledge, expertise and solutions to the table, including:

  • Contract management, with best-in-class coalition pricing, totaling hundreds of thousands of lives
  • A team of clinical pharmacists and dedicated account management teams
  • PBM contract analysis and negotiation expertise
  • Clinical cost-savings analysis and programs
  • Targeted employee communications
  • Auditing capabilities to ensure contract compliance
  • High-cost drug management for specialty and compound drugs
  • Manufacturer coupon programs

Data-based Insights

Evidence-based decision-making, including quantitative analyses of clinical and financial outcomes whenever possible, remains your most important tool in effective prescription drug benefit management. NFP Rx Solutions’ clinical and consulting expertise can help you achieve your prescription drug management goals.


43. What is your level of expertise with respect to self-insurance and stoploss?

We participate in the NFP stop loss center of excellence. This allows us access to better contract provisions on our clients’ behalf. We use that as one set of options, as well as looking outside to ensure you receive the fullest options. However, remember that New York state law restricts the purchase of stop loss insurance for groups under 100, and its impact on small group self-funded plan availability in New York.


44. Do you have actuaries and or underwriters on staff and are they included?

Yes, our staff has extensive experience creating working rates, analyzing claims, and we have a former insurance carrier underwriter on our local team as well as extensive additional resources through our relationship with NFP.


45. What cost projections and analysis can you provide to support our fiscal goals?

While we do not know Orbis International well yet, there are certain challenges that you likely face given your particular circumstances, and based on our experience with similar organizations. For example, as a social services organization, it’s likely that many of your employees do not receive large salaries and employee benefits become a critical part of the overall compensation package. Therefore, it will be an ongoing challenge to provide reasonably rich benefits at an affordable cost to employees and your organization.

Opportunity: benchmarking

We will begin by first benchmarking all plans against others in your industry, drawing on proprietary national NFP data. We will then fully explore all plan carrier, design and plan funding options, in an unbiased way, to generate the ideal balance of plan richness and cost. While results can vary from client to client, our independent approach has led to an average renewal increase of just 2.2% across our clients with 50+ employees.

Opportunity: utilization analysis

As your organization expands and benefits claims utilization becomes more predictable, there will be increased opportunity for alternative funding options on the medical plan, as well as other plans such as dental and short-term disability. However, you will need to also closely analyze your particular claims risks. We at Innovo have deep experience in analyzing claims data and trends to advise you to make the best decisions possible when evaluating options. In addition to traditional self-funding options, we are also able to offer you captive solutions through our affiliation with NFP, as well as explore participating insured contracts.

Opportunity: administrative efficiencies

Innovo specializes in offering additional HR administrative help to support through our Total HR solution. We routinely work on-site for employee education, and in addition, offer a special AI-powered tool called ALEX that “does the math” for employees when deciding benefits to choose. Total HR resources and this important tool can help your HR team efficiently meet the needs of a growing organization.

Finally, should you be interested in a fully dedicated call center for all employee inquiries, we can provide you with local resources out of our Massachusetts office, or even a larger resource through a dedicated call center to address coverage questions. This call center, staffed with NFP employees in our Austin, TX, service center, gives your team access to experienced, courteous and knowledgeable staff members to answer questions accurately and quickly.

46. What specialized resources do you have for pharmacy cost control?

See previous reply.