Case Study #1: Health Fund Surplus
[PDF version of Health Fund Surplus Case Study here.]
Client:
A 8,200-employee organization.
The Challenge:
The Client had historically been running a modest health care fund surplus, and, in some years (with a competitor), an actual deficit in the health care fund.
Our challenge was to reduce claim costs to significantly increase the fund balance and lower the monthly cost of the program to the client.
Programs Utilized:
We initially implemented the following programs:
- LifeStyle Advantage (fitness center network at discounted rates)
- Using a $50,000 benchmark, identified 25 large cases totaling $3.0 million and utilized case management to optimize the plan performance
- Little Changes Big Results (didactic/classroom wellness and nutrition classes)
- Employee Assistance Program (family counseling resources)
- Healthy at Heart (cardiovascular disease management program)
- Member Education Programs based on the top ten diagnosis:
- “Know Your Numbers” Diabetes Education Program
- “Know Your Health Steps” Diabetes Education Program
- Free health screenings, preventive education, flu shots, free glucose meter upgrades
After successful launch of those programs, we proposed adding the following:
- Consumer online wellness service
- Disease Management Program options
Results:
- Health fund surplus increased by $5 million
- Established comprehensive employee benefit program at a cost of $150 less per month than similar groups in the area (in spite of double digit medical inflation throughout the healthcare industry)
- Assisted the client in achieving an overall savings of 68% in claim costs while achieving plan member satisfaction
- Employee Assistance Program (family counseling resources)
Going Beyond…
In addition to the positive results listed above, we also:
- Efficiently administered the group’s stop-loss reinsurance program and recouped $1.1 million
Foresight Case Studies include clients/results from various Access Plans USA, Inc. subsidiaries which utilize similar types of programs as Foresight TPA.
Foresight TPA
4929 W. Royal Lane
Irving, TX 75063
Phone: 1-800-854-2339
