EVHC creates a financially sustainable future for a mid-market employer running out of options.
The Challenge
The Challenge
Rising Costs, A Looming Deadline, and a Labyrinth of Choices

Facing an annual average health insurance premium increase of 23.5% with their current carrier, Anthem, after enduring increases for the past three years, a New York-based employer with 800 employees was teetering on the edge of eliminating medical benefits entirely—a drastic measure that could profoundly impact employee welfare and significantly damage the employer's ability to attract and retain talent. This dire financial situation jeopardized the brokers' two-decade-long relationship with the client. It underscored a critical need for innovative ideas and a transformative approach, not just to revitalize the renewal conversation but also to salvage the relationship and stabilize the client’s healthcare spending.

To understand the depth of the crisis, consider the immediate challenges facing the client:

  • Escalating Annual Premiums: A relentless climb in premiums, exacerbated by high claim years and costly pharmaceutical benefits, strained the employer’s budget beyond sustainability.
  • Recent Insurance Volatility: A tumultuous history of switching carriers each year for the past three years complicated the task of obtaining competitive quotes.
  • At-Risk Benefits: The soaring costs pushed the employer to consider cutting medical benefits for their 800-life group altogether.

The broker faced their own set of challenges, particularly their need to not only assemble but also persuasively pitch a self-funding proposal to a client who had previously been led to believe that self-funding was not a viable option:

  • Need for a Strategic Partner: The situation's complexity underscored the necessity for a strategic partner capable of introducing innovative perspectives and tangible tools for better control and transparency in managing healthcare costs.
  • Limited Expertise and Resources: The broker, though experienced, lacked the specific knowledge and resources essential for navigating the self-funded insurance landscape effectively. They needed a partner who could provide:
    • A purpose-driven approach to crafting insurance solutions
    • Strong relationships within the insurance markets
    • A meticulous and strategic review of claims data to facilitate informed negotiations
    • Expert underwriters skilled in customizing solutions for complex needs
    • A comprehensive panel of stop-loss insurers

The pressure was intense with only a few months remaining to secure a viable solution for an effective date that was just over a month away. The broker needed to quickly align with a new partner who could deliver immediate results and long-term stability, making the case for EVHC’s expertise and resources all the more critical.

The Solution
The Solution
Swift & Strategic Self-Funding Proposal from EVHC

In partnership with EVHC, the broker team leveraged the potential of partially self-funded insurance, delivering significant cost savings and enhanced coverage options:

  • Prescription Plan Overhaul: Revamped the prescription benefits plan, which anticipated annual savings of $276,266.
  • Comprehensive Market Relationships and Claims Analysis: Utilized EVHC's extensive industry connections and data-driven claims analysis to refine the client’s insurance strategy, emphasizing sustainable cost-saving strategies and long-term coverage options.

Extensive education on self-funding culminated in a significant "Ah-ha" moment for the client during the proposal presentation:

  • Breaking Down Costs: The proposal clearly differentiated between fixed costs and claims liability, demonstrating how self-funding allows for better budget control than their current fully insured model.
  • Visibility and Control: The presentation showed that with a self-funded model, the company would save on fixed costs and have clear insight and control over spending. This clarity revealed potential savings on variable costs based on actual claims data.
  • Budget Maximization: The presentation highlighted that any money set aside for maximum potential claims stays in the company’s bank accounts, meaning any unused funds can be kept by the company instead of paid out to the insurer—a key advantage of the self-funding model.
  • Operational Control: Detailed how claims management under self-funding works and the various opportunities to optimize for both comprehensive coverage and overall savings, leading to the realization: “Why haven't we done this before? EVHC is a well-oiled machine."

 

Chart Icon
The Results
A Victory for Cost-Efficiency and Coverage Integrity

The switch to EVHC's tailored self-funded insurance plan resulted in an anticipated total savings of $2,332,602 in the first plan year.

EVHC was able to accomplish this by:

  • Plan Design & Carrier Relations - The new plan, enhanced by strategic benefit changes, projected an expected increase of just +2.74%—a considerable improvement over the potential maximum increase, highlighting substantial savings and effective cost management.
  • Pharmacy - With guidance from EVHC, the broker team managed to cut the client's prescription drug expenses, yielding an additional annual savings of about $276,266.
  • Proactive Case Management - As the year progresses and claims are processed, EVHC will continue to assist the broker and client in realizing additional savings through the comprehensive '3T approach.’
  • The integrated approach - including proactive cost control and dedicated case management—helped the broker team present a convincing proposal that won them the business and positioned the client for a more financially sustainable future. The broker, now equipped with a compelling, cost-effective solution, solidified their position as strategic advisors in their client's eyes.

Recent Case Studies

EVHC Offers 24/7 Support
EVHC Offers 24/7 Support

Healthcare shouldn’t mean jumping through hoops, waiting on hold Waiting on Hold Instead of Getting Care An investment research company based in New York, needed an insurance company that would work with them—not against them. More specifically, the owner’s wife found herself constantly dealing with the burden of multiple phone transfers, being put on hold, and fighting to fill prescriptions and gather essentials for their diabetic son. With over 200 employees, it became clear that if the owners were seeing this amount of hassle just to maintain their basic healthcare needs, then their employees must be struggling as well. They needed a healthcare provider that would: - Eliminate the need for constant calls and follow-ups, freeing up personal time - Make employees feel heard, appreciated and respected - Maximize the cost-to-coverage balance, without dramatically upping prices - Find lasting solutions with flexible options “I can’t be the only one who is filled with dread when I hear hold music! Watching family members deal with health issues is stressful enough without having to jump through hoops to merely fill a prescription. It felt like my wife was constantly fighting with our insurance company, instead of them being on our team.” Partially Self-Funded Insurance, With a Personal Touch This financial investment company found their home with EVHC and our customized partially self-funded insurance plans. A key aspect of that customization is the fact that EVHC provides a one-on- one personal concierge-level service meant to make employees feel supported. EVHC provided: -24/7 concierge-level customer service, including member education programs -A personal EVHC account manager, who works tirelessly to ensure every item that employees, their families, and kids need is covered -Direct member engagement, where people’s needs and concerns are not just heard, but addressed -The ability to consolidate basic services into a mail order prescription offering, so essential supplies are received on a quarterly basis -Flexible plan designs, including home healthcare and diabetes treatment options “The whole point of health insurance is to make employees feel protected and supported. Insurance shouldn’t feel transactional or complicated. For the first time, our employees and families are getting the support they need—around the clock—instead of having to fight for it.” Peace of Mind and Saved Time In just the first year, this company experienced: -All their healthcare needs and services fulfilled without having to continuously call or wait on hold to ensure basic needs were met -Fewer headaches dealing with health insurance, more time to devote to the business -The peace of mind that comes with personalized service and support Partially self-funded insurance is already a paradigm shift, but EVHC is taking it to the next level by offering personalized coverage and support. For far too many, dealing with insurance providers has required speaking to a computer, constantly being put on hold, and having to jump through hoops for the most basic of care. Time that should be spent with loved ones and furthering business needs is instead spent stuck in frustrating customer service cycles.

READ MORE
EVHC Helps Top Financial Trading Firm Attract Talent, Gain Productivity, and Forget its Healthcare Hassles
EVHC Helps Top Financial Trading Firm Attract Talent, Gain Productivity, and Forget its Healthcare Hassles

Company Gains a Competitive Advantage Through Partially Self-funded Insurance Break down health insurance barriers A New York-based financial services firm that employs some of the world’s brightest young minds from the worlds of mathematics, computer science, statistics, physics, and more was looking to enhance employee productivity through better healthcare. The company competes with major corporations to recruit employees from some of the country’s top schools and has built an exemplary corporate culture onsite restaurants, gyms, and other amenities) that encourages productivity. The firm found that traditional fully funded healthcare plans didn’t fit with this culture. It needed solutions that were flexible, easy to use, and didn’t get in the way of employee productivity. Company management wanted their employees to focus on work, not overcoming the barriers (dealing with hard to work with carriers, navigating complicated networks and coverage plans, and more) typically associated with health insurance. The firm looked at partially self-funded insurance alternatives to help them: - Attract top-tier talent through health insurance benefits - Eliminate the number of hours employees waste talking to insurance carriers so they could focus on their jobs - Provide employees with great coverage options EVHC’s flexible partially self-funded plans The firm turned to EVHC, which offers highly customized and flexible partially self-funded insurance plans that allow employees to enjoy unparalleled coverage while providing companies with exceptional insurance benefits. EVHC provided the organization with: - A customizable plan that allows employees to use both in-network and out-of-network providers at little cost - Access to three of the nation’s four largest provider networks - 24/7 concierge-level customer service, including member education programs - Low individual deductibles - Greater price transparency - An easy-to-use HRIS platform for fast access to health insurance information, improving productivity and time savings - Insights into employee wellness across four categories (colorectal cancer screening, cervical cancer screening, flu vaccination, and breast cancer screening) Happier employees—and a competitive advantage The firm is now able to offer new and current employees with no hassle health insurance coverage that fits their culture and employees’ lifestyles. Many of the company’s employees are young, fresh out of college, and working hard at jobs they love. They don’t have time to worry about the hoops a fully funded provider will put them through. Now, they don’t have to. They can focus on being productive, driving business for the company, staying healthy, and enjoying the complimentary video games (and the firm’s many other great perks).

READ MORE

BACK TO CASE STUDIES

FAQ

Got more questions about EVHC or partially self-funded insurance?

EXPLORE OUR FAQS