Horizon Goodwill is a Hagerstown, MD charity that provides work and training opportunities to the community. Prior to 2020, Horizon’s health plan provided coverage to 150 employees using an independent third-party administrator (TPA) and a rented PPO network. The plan had been experiencing cost increases and so, with the strategic advice and operational know-how of their benefits advisor Ben Bohonowicz, Horizon Goodwill began implementing innovative strategies to reduce costs while preserving generous benefits for patients. First, Horizon moved from a status quo PPO network to an open-access network that allows patients to go to any doctor they choose, and pays health care providers on a Medicare-based rate. Horizon also moved to a fiduciary, pass-through PBM that only gets revenue from its employer clients and not by the drug industry. They also introduced international script sourcing and patient assistance programs to try to save patients money on their drug costs while simultaneously lowering costs for Horizon.
The next year, Horizon added the elite service of direct primary care to the plan. This benefited the chronically ill the most, because they had unlimited, 24-7 access to a doctor who knew them and coordinated their care. The following year, 2022, Horizon began directly contracting with community-based hospitals to obtain the best value and smooth access for patients. They also redesigned their pharmacy cost containment program for enhanced engagement and savings. This year in 2023, Horizon, acting as a prudent fiduciary and constantly competing out services to obtain best value, replaced the plan administrator and pharmacy benefit manager while overlaying a new advocacy and concierge service to members. It was important for Horizon to simplify the member experience by creating a single entry point to Horizon Goodwill’s health plan for any type of need.Horizon’s focus in the future is to build out a friendly provider network for critical specialties and strengthen its relationship with local hospitals with direct contracting.
While these plan changes have improved the plan’s fiduciary performance dramatically ($770 per-employee-per-month in 2020 to $565 PEPM in 2022 – a 26% reduction), Horizon was always equally committed to improving patient experience and lowering out-of-pocket costs. Members benefit from a very competitive plan design with low deductible ($250) and copays ($15/$30). Horizon Goodwill pays the direct primary care (DPC) membership fee on behalf of members who want to participate. Members also benefit from no cost-sharing for all DPC services – including ancillary services such as labs, medications, x-rays and others. If the DPC doctor coordinates downstream care such as diagnostic services and imaging for the patient, the patient receives those services at no cost. If patients need elective procedures, Horizon leverages bundled arrangements at local Centers of Excellence to waive all cost sharing for members. When patients need hospital-based care,Horizon coordinates with community based programs to waive the majority if not all of their member cost-sharing. For any patients taking multiple maintenance medications, our concierge pharmacy provides all medications at no cost. Furthermore, patients who participate with our concierge pharmacy program receive a one-time cash incentive up to $500.