Three contenders packed the room for this year's Solutions Showdown.
Since its inception, the Solution Showdown session has become a behemoth at BenefitsPRO Broker Expo, as evidenced by the standing-room-only crowd at this year's event. Though regular hosts David Contorno and Emma Fox of E Powered Benefits were unable to be there in person, they once again assembled a top-notch trio of industry innovators to share their cost-saving solutions.
"There are a lot of other things we're trying to solve for, so there's going to be some nuance in that, but at the end of the day, it's about delivering the best cost management solution," stand-in referee Ryan Miller told the audience.
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Patient-centered medical management
First up was Aaron Ault of Ault International Medical Management, a "carve-out, concierge, patient advocacy based medical management organization," if you want to get bogged down in jargon. More simply, they work with patients to steer them to the right medical care for their needs.
"We focus on connecting to the right patients, at the right time, to the right care in the right places from the right doctors," Ault said.
Ault presented the case study of an employer with 350 employees out of Washington state who had implemented AIMM's P3CM Platinum Program. The goal was to engage employees "at the point of sickness" and start the process of directing them to the right care from the right providers.
"If a patient called into our medical team and followed that advice, then their out-of-pocket cost was waived," Ault noted. "This enables us to do a few different things: it lets us send them to high-quality providers, increases the likelihood for positive clinical outcomes and decreases their chances for negative issues like complications and readmissions."
Reference-based pricing
Omar Arif, senior vice president of growth for ClaimDOC, presented a case study on a familiar but still underutilized strategy: reference-based pricing. One need look no further than the most recent data out of the RAND Corporation to know how much more commercial payers are spending compared to Medicare counterparts.
"There's no buying power in this space unless you completely remove the network," Arif said. "It's incrementally gone up."
ClaimDOC negotiates on behalf of its clients to bring those rates down to somewhere close to 150% of Medicare rates, a significant savings to the employer in and of itself. But the case study Arif presented also included another valuable service: audits. "We audit the bills before we reprice them," he said. "We deny pieces of the bill that shouldn't be in there."
Through reference-based pricing and the claim review process, ClaimDOC helped an employer in Connecticut and its 900 employees cut their health care spend.
Prescription drug management
The final contender in this year's showdown was Bill Hepscher of RxManage USA, taking aim at a well-known source of health care spending for employers: prescription drugs.
"We all know that 5%, 10%, 15% of the population is driving 90% of the overall costs," Hepscher said. "Even though they have great generic utilization, a small percentage of the population is driving the overall costs."
It's not consumers buying generic drugs at Costco that Hepscher and his company worry about, but those taking high-cost, brand name drugs. "If it's advertised on TV, those are the drugs we're going to help you with," he said.
For those, RxManage facilitates the purchase of medications from Canada, where the cost is significantly less. For his case study, Hepscher presented a public sector employer out of South Carolina with 2000 lives. "The percentage of brand name fills was only 10%, and generics were more than 80%," he noted, but it was the brand name drugs driving costs.
Winning ideas
As usual, the audience was invited to vote for the solution they thought would provide the most cost sayings, and with 48% of the vote, Arif's RBP solution was the clear winner. The data backed it up: between RBP and billing audits, the employer in Arif's case study saved $2 million.
Despite coming in second, the savings from Ault's medical management solution were impressive: $1.2 million for the employer in the case study. And Hepscher's prescription drug solution cut the employer's costs by 9%. "Our prediction is just by impacting less than 10% of the population taking high cost-drugs, we'll save 25% of health care costs," he noted.
Emily Payne
Emily Payne is director, content analytics for ALM's Business & Finance Markets and former managing editor for BenefitsPRO. A Wisconsin native, she has spent the past decade writing and editing for various athletic and fitness publications. She holds an English degree and Business certificate from the University of Wisconsin.
