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Industry: Auto Dealer
Number of Employees: 500
Headquarters: Parkserburg, WV

Matheny Motors is a family owned company of automotive and truck dealerships, headquartered in Parkersburg, WV with more than 300 employees in 12+ locations across 5 states. They were facing year over year double-digit rate hikes as high as 50% and 30% on their fully-insured carrier plan. Equally bad, the plan imposed thousands of dollars in cost-sharing on patients before the plan coverage kicked in.

Starting in January 2020, the company switched to an innovative benefit design that rewards patients who use a relationship-based nurse navigator program to help with provider selection, second opinions, scheduling, care management, specialty medications, clinical and psychosocial support. Patients who access care by partnering with the nurse navigator program have their cost-sharing reduced to zero in most cases. These vendors are managed by a transparent, unconflicted benefits advisor, who designed the plan around employer/employee goals and no other interests.

The plan uses independent, unconflicted, transparent and high-quality vendors for third-party administration, pharmaceutical benefit management, specialty drug sourcing, and a center of excellence program (for patients with more complex conditions).

By prioritizing highest-quality centers of excellence for free (to the patient) diagnosis and second opinions, the Mayo Clinic intercepted a misdiagnosed cancer and spared a patient years of anguish and inappropriate and dangerous treatments.

Plan Highlight

In the first two years of the plan, Matheny Motors saved $375,000 (37%) while simultaneously offering patients a re-humanized health plan that leapfrogs access barriers, handholds patients through complex care needs and high-cost drug sourcing, while eliminating or dramatically reducing their cost-sharing.  

Industry: Wholesale Plumbing Supplier
Number of Employees: 130
Headquarters: Nashville, TN

Kenny Pipe & Supply Inc. is a family-owned, 230-employee, wholesale plumbing, pipe, and valve distributor based in Nashville, Tennessee. The company had been on a carrier-controlled, self-funded plan for several years. However, with an aging population and growing company, the health plan began to see dramatic cost increases.  In 2016, the company was facing a 50% increase for employee costs if a change wasn’t made. Their three main goals were to 1) improve quality and appropriateness of care, 2) reduce costs for employees, and 3) reduce overall plan cost.

Starting in 2017, the company engaged benefits advisor David Johnson with the Alera Group. David helped Kenny Pipe & Supply transition to a risk sharing arrangement called an insurance captive.  Over the next three years, David and the company implemented the following programs:  1) a reference-based-pricing model based on paying health care prices as a percentage above Medicare rates. 2) a transparent pharmaceutical benefit manager, including an independent specialty drug sourcing solution, and 3)  an innovative benefit design that rewards patients who use a custom-built network of direct contracts with the local hospital systems. 

The plan saved 27% on the plan’s per-member-per-month costs in the first year. The prescription drug solutions implemented in year 2 reduced pharmacy spend by 22%. Overall, the transformation of the company’s health plan has saved $750,000 over three years. 

When it comes to patient cost-sharing for premiums and out-of-network benefits, the plan is a dramatic improvement over the company’s previous carrier offering. Employees enjoyed a $0 deductible and $500 max copay for certain high-value care and high-value providers. This contrasts with the previous deductible of $1,000 and a $3,000 max out-of-pocket cost for employees. With the savings from the health plan, Kenny Pipe & Supply was able to enhance its 401k match program, improve the benefits available to members, and reduce employee out-of-pocket costs.  

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Industry: Collision Repair
Number of Employees: 150
Headquarters: St. Louis, MO

Schaefer Autobody is a collision repair company operating in numerous locations in the St. Louis, MO metro area. With almost 250 employees, the company was paying an outrageous rate with Anthem BCBS of about $2M a year, including more than $13K per employee per year. Patients had to select between a dizzying 8 different plan offerings with significant cost-sharing in terms of deductibles and other out-of-pocket expenses.

Starting in March 2021, the company switched to an innovative benefit design that rewards patients who use a custom-built network of direct contracts with the local hospital systems. The plan uses independent, unconflicted, transparent and high-quality vendors for third-party administration, stoploss coverage, pharmaceutical benefit management, brand and specialty drug sourcing, surgery bundled contracts, and imaging procedures. Patients who access care, including more than 500 brand drugs, through these contracts pay zero in most cases. 

These vendors are managed by a transparent, unconflicted benefits advisory firm, who designed the plan around employer/employee goals and no other interests.

When it comes to patient cost-sharing for premiums and out-of-network benefits, the plan is a dramatic improvement over the company’s previous offerings from Anthem. Patients who seek care using the direct contracts have no cost-sharing, but even those who choose to go elsewhere have out-of-network cost-sharing that is lower than the best of the Anthem plans from the year prior. The concierge customer service approach is to personalize problem-solving so that the plan always does right by the patient. For example, a plan member needed a drug that was not on the plan’s formulary. The plan was able to override the formulary, get the member copay assistance and secure access for the member to the drug she needed to regulate her menstrual cycle.

In the first year of the plan, Schaefer Autobody has already saved almost one million dollars (50% less than under the old plan) that the company has reinvested into its workforce and core growth initiatives. At the same time, the plan has re-humanized health care, leapfrogging access barriers, and ensuring that patients with complex care and high-cost drugs have convenient solutions with no cost.