Faulks Bros. Construction is a third-generation, family-owned company headquartered in Waupaca, Wisconsin. Their services vary in application and project scope aimed at supporting commercial and residential land improvement needs. From providing specialty sand and gravel mixes to excavation, they have been a community stalwart for decades. The company has around 70 employees using their Health Plan at any given point during the year. Prior to transforming their Health Plan, the company was approximately $455 per member per month for a fully insured program that had a $5,000 individual annual deductible on all non-preventive services.
In 2021, they transitioned to a self-funded program with an independent third party administrator, pharmacy benefits manager and nurse navigation program. This came after hiring an independent benefits advisor committed to full transparency of fees. They had worked from 2019 to 2021 to educate themselves on options with this advisor before making a change. Their new Plan provided full access to any provider and reduced the deductible on major services from $5,000 to $1,000 per year. In addition, it added affordable member copays for office visit services and prescription drugs. This was all done without increasing member premiums. While the first year’s per member per month reduced slightly to $432, this wasn’t without a couple of significant catastrophic diagnoses surfacing. Luckily, the Plan now included an Expert Medical Opinion program at no charge with a Nurse Navigator to support any care coordination needs.
Since 2021, the Plan has added 100% paid primary care at a regional independent clinic and a Type 2 Diabetes reversal program. On top of these plan enhancements, Faulks was able to completely remove its deductible in favor of straight copays in 2023. This was layered with the benefit of members receiving full out-of-pocket expenses when they utilized the nurse navigation program and selected the appropriate care option delivering the highest quality and the best cost. Through that program alone, Faulks saved $349,280 in medical and pharmacy claims. That was equivalent to a 37% differential in total cost savings to the company.
Prior to this move, the company was handcuffed with national or regional fully insured carrier options that consistently drove double digit premium increases, constant member plan deductible and out-of-pocket increases and overall uncertainty. This was on top of members not feeling supported in their journeys.
With the addition of the nurse concierge program, two member stories have been the tell-all of the transformation. In one story, a 52 year old male truck driver was unknowingly diabetic. His biometric markers were so poor that the attending physician would state he was “within days” of a major hospitalization. Through coordination with that primary care physician, a flexible benefit design and his nurse navigator, the member was able to get a continuous glucose monitor, begin treatment with insulation and expedite a path to stability. A short three months later, he had not only stabilized but self-regulated his diet to the point he was able to come off his medications. This entire episode of care was paid in full by the Plan with no member cost share because the member had coordinate through the nurse navigator.
In a separate story, a middle-aged male had struggled with shoulder pain for years, having had multiple surgeries, seen multiple physicians and was left with pain and uncertainty. He was faced with a difficult decision of having a joint replacement which would have lasting effects. Through his nurse navigator, a regenerative stem cell therapy treatment was sought out, with approval from the Plan to cover the expenses in full. The member has responded to the treatment so well that the shoulder replacement has been avoided, perhaps indefinitely, and the member has had mobility not experienced for years.