Hero 2023

Midwest Carriers is a second-generation, family-owned trucking company headquartered in Kaukauna, Wisconsin. With 138 employees on the Health Plan and nearly 200 total eligible employees, Midwest Carriers has experienced a transformation in their Health Plan since late 2021. They have been a choice partner to many companies for their transportation needs from local and yard spotting services, dry truckloads, shipping brokerage, project management and freight and refrigeration services.

For the prior three years to hiring an independent, fee-based, transparent benefits advisor, they had struggled with a rollercoaster of expenses. Their spend in 2021 had eclipsed $1.8M annually on plans that had $3,000 and $4,000 per individual annual deductibles. Premiums had been skyrocketing and drivers, in particular, were struggling to keep up. While their culture had always drawn loyalty, the benefits had become an inhibitor to employee retention.

In mid-2021, their executive time sought a better way. They began the transformation by hiring a new independent advisor and implementing a nurse navigation program before the new plan year. In January 2022, they completed the transition to an independent TPA with a plan that offered a $1,000 deductible on major services and copays for office visits and prescription drugs. In addition, with projected savings, they were able to reduce premiums by 10%. By the end of the first plan year, they had seen $289,310 in medical and pharmacy savings through the nurse navigation program. That was a 17.6% savings to the company.

Through these advances, the Plan was able to fully remove its deductible and further reduce its premiums by over 20% in 2023. Today, members can access $0 specialty care and medications through the nurse navigation program. This has benefitted members like one driver and his spouse who had multiple knee surgeries done, all at no cost. The members received care navigation support to local outpatient surgery centers with high quality marks and fair, bundled pricing. The nurse navigation program has even coordinated cutting edge therapy services to expedite recovery that would otherwise be excluded from plan coverage.

Prior to these changes, Midwest struggled with consistent premium increases, high deductibles, no member support and guidance and a Health Plan that was misaligned to the company’s values. Multiple members have remarked to company leadership that this is the best plan they’ve ever had. The new benefits have even been cause for competitors to reach out to the advisor asking for help to fix their Plans.

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.

Cosmos Corporation is a mission-centered, family-owned and operated manufacturing company headquartered in St. Peters, Missouri. The company began as a beauty product distributorship in 1980 and has since grown into a global manufacturer of personal care, pet health and wellness, and household cleaning products. Cosmos has 137 employees currently using their health plan. Prior to transforming their health plan in 2022, they were fully insured and suffering 15%-20% increases year-over-year. Today, they have reduced their per-employee annual spend to $5,406 per employee – a savings of 45%.

In October 2022, the company transitioned to an innovative benefits design that rewards patients who use a network of direct contracts with the Local Health System based on a percentage of Medicare. Their health plan uses independent, high-quality vendors for third-party administration, pharmaceutical benefit management, specialty drug solutions, and healthcare navigation. They also utilize a hybrid direct primary care model through Rezilient Health, which provides their members with consistent convenient care. Patients who access care through these contracts pay zero in most cases. Cosmos Corporation employees have also been able to obtain their medications at significantly reduced rates. For example, a member was able to receive their Ozempic medication by international mail order for $0. 

Wentzville Fire Protection District is a public fire district in Wentzville, Missouri. They are one of the largest fire districts in their county, covering 88 square miles. The fire district has 64 employees currently using their health plan. Prior to transforming their health plan in 2022, they were fully insured and suffering 15%-20% increases year-over-year. Today, they have reduced their per-employee annual spend to $6,500 per employee – a savings of 20%.

In July 2022, the fire district transitioned to an innovative benefits design that rewards patients who use a custom-built network of direct contracts with the local hospital systems. Their health plan uses independent, high-quality vendors for third-party administration, pharmaceutical benefit management, specialty drug solutions, and healthcare navigation. Patients who access care through these contracts pay zero in most cases. For example, one member was able to use Connect DME to obtain a CPAP machine for $0. Another member is in need of knee surgery and their benefits advisors are working very closely to ensure that they are in-network, pre-authorizations are completed, and the entire process goes smoothly from start to finish. 

Waterford Union High School is a public high school located in Waterford, Wisconsin. The school has 99 employees currently using their health plan. Prior to transforming their health plan in 2023, they were fully insured and experiencing consistent rate increases.  They suffered an 11% increase in 2022 and a 15% increase in previous years. Since switching to a self-funded health plan, they have reduced their per-employee annual spend to $3,300 – a savings of 18.5%.

In January 2023, Waterford transitioned to an innovative benefits design that rewards patients who use a custom-built network of direct contracts with the local hospital systems. Their health plan uses independent, high-quality vendors for third-party administration, pharmaceutical benefit management, specialty drug solutions, and healthcare navigation. They utilize an employer-owned co-op called The Alliance for hospital and provider contracting that helps control costs and improve access to high-value care. Patients who access care through these contracts pay zero in most cases.

Tenax Corporation is a Baltimore, MD company specializing in netting and fencing, pipe protection, construction, agricultural and gardening solutions. They have funded their own health plan covering about 90 employees, for more than 20 years. In recent years, Tenax was experiencing significant increases in their health plan cost and asked their innovative benefits advisor Ben Bononowicz in 2021 to help them develop a plan for cost containment. Originally, Tenax’s health plan had an independent third party (TPA) administrator, a traditional rented PPO network and traditional PBM. In strategizing for the 2022 plan year, Ben conducted a full market competition for plan solutions on Tenax’s behalf. The company ended replacing the TPA, the PBM, and the stop loss carrier, resulting in a 6.4% reduction to total maximum liability. To further contain costs, Tenax introduced medical management, telemedicine, and a concierge pharmacy cost containment solution. When comparing Tenax’s total health plan cost in 2021 to 2022, they saved over $400,000.  

While these financial benefits have been impressive, they have not come at the cost of patients. Patients benefit from a generous plan design with low deductible ($500) and copays ($20/$30). For any members taking multiple maintenance medications, the concierge pharmacy provides all medications at no cost to the member. Furthermore, members who participate with the concierge pharmacy receive a one-time cash incentive up to $1,000.

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.

Once upon a time in the City of Ashtabula, there was a great concern about the rising healthcare costs burdening the city’s budget. The city officials and healthcare professionals were determined to find a solution that would save money without compromising the quality of patient care. Thus, they embarked on a journey to revolutionize their health plan.

The first step taken by the City of Ashtabula was to mirror that of the local city school district’s health plan.  This replication of health plans aimed to create a comprehensive and integrated healthcare model that would streamline processes and improve patient outcomes utilizing local doctors, pharmacists, and nurse patient navigators.  

Recognizing the importance of proper primary care, the City launched Direct Primary Care for a free offering to all employees and family members, the ability to have a Concierge Primary Care Physician on call 24/7/365 with all the time in the world to provide patients great care and personalized services. These types of programs focused on education, regular check-ups, and early detection of potential health issues. By prioritizing preventive measures, the City aimed to reduce the number of expensive hospital visits and chronic conditions in the long run.

These innovative strategies had the buy-in from all unions under the health plan.  This streamlined the care process, reduced errors, and eliminated the duplication of medical tests, resulting in cost savings.  The City of Ashtabula ensured that patients received high-quality care. This focus on continuous education and improvement led to better patient outcomes and reduced the need for expensive treatments or hospital readmissions.

As the first year completed, the City of Ashtabula began to see and hear of remarkable results from their efforts. The healthcare costs for the city started to decrease, allowing them to allocate more resources to other essential services and initiatives. Patient outcomes also improved, as residents benefited from timely access to care, better coordination between providers, and increased emphasis on preventive measures.

The success of the City of Ashtabula’s healthcare transformation story has spread far and wide, inspiring other municipalities to follow suit. Hoping the City of Ashtabula and their courage will help others with a national movement to transform healthcare delivery, reduced costs, and improved patient outcomes.

And so, the City of Ashtabula has become an example in their small community on how to bring healthcare back to Main Street and not controlled by the misaligned financial incentives of Wall Street.  We commend their management and union leaders for seeing it as the partnership it truly is. 

In the rust belt town of Ashtabula, Ohio, Ashtabula Area City Schools, an inner-city school district within Ohio’s 8^th poorest County, faced a daunting challenge. Year after year, they continued experiencing rising healthcare costs, and no real solutions to improving patient care while finding a way to lower costs.

Undeterred by these obstacles, Ashtabula Area City Schools set out on a transformative journey to redefine their health plan. In the Fall of 2019, they made a bold decision to embrace an innovative benefit design that would not only curtail costs but also prioritize patient care for their employees and families by use of independent providers such as a Community Pharmacist, a Direct Primary Care physician, and other independent provider groups.  

The cornerstone of their new plan was a relationship-based nurse navigator program, aimed at assisting employees in navigating the complex healthcare landscape. This program offered support with selecting providers, seeking second opinions, managing care, accessing specialty medications, and providing the concierge-style model of Advanced Primary Care. Employees and their family members who partnered with the nurse navigator program were rewarded with reduced or zero cost-sharing healthcare services, making healthcare free in many instances.  

To ensure the highest quality of care, autonomy, and transparency, Ashtabula Area City Schools selected unconflicted vendors for third-party administration, pharmaceutical benefit management, direct primary care, in addition to patient navigation. These vendors were chosen based on their commitment to excellence, transparent practices, and alignment with the employer and employee goals, free from any conflicting interests.

The results of Ashtabula Area City Schools’ innovative plan design were nothing short of astounding. In just the first year, the school district saved a staggering $2.4M, representing a remarkable 21% reduction in healthcare costs.  As we close out their 3^rd policy year, AACS expects to realize a full $10M+ in savings.   Simultaneously, employees were provided with a best-in-class health plan which eliminated or significantly reduced their out of pocket costs, breaking down access barriers and offering members the support they needed throughout their healthcare journeys.

Ashtabula Area City Schools’ playbook serves as a shining example of how a dedicated and forward-thinking public entity can revolutionize healthcare benefits while saving its community and employees’ much needed resources. As their story continues to inspire other organizations, Ashtabula Area City Schools stands as a beacon of hope to public school districts nationwide, proving that with determination and buy-in from teachers and unions, everybody wins.   

Allegheny Wood Products (AWP) is a privately held hardwood lumber company based in Petersburg, WV but located throughout West Virginia, Pennsylvania, and Virginia.  The company has over 700 employees working in 12 locations and employs an additional 500 people through logging and trucking contractors working exclusively for AWP.  AWP is a primary manufacturer and drier of hardwood lumber that markets its products to over 30 countries around the world.

AWP went from a “traditional” self-insured health plan utilizing one vendor for third party administration and medical network/processing and prescription benefits.  In January 2020, they determined that a change in direction towards healthcare was needed to help AWP’s employees and their families to obtain better health outcomes.  At this point, AWP began utilizing an independent third-party administrator, separate medical network, and a pharmacy benefit management service for utilizing and managing a pharmacy benefits vendor.  This change alone saw a significant increase in employees utilizing their healthcare.  AWP then began to look at innovative solutions to lower deductible and out-of-pocket costs to the employees while hoping to promote effective use of benefits to meet the employees and their family’s needs for a healthier life.

Some of these changes utilize a concierge approach to help employees find the most effective and high-quality providers and outcomes to better meet the employee’s healthcare needs.  When utilizing this service, the employees experience no or limited deductible and/or out of pocket costs.  These services can range from imaging to second opinions to surgeries.  Before these programs were introduced, many employees would delay procedures or medical care due to the out-of-pocket costs being unaffordable. Since adding this option, employees are working closely with our concierge system to be able to obtain these necessary procedures that are needed for a healthier and improved quality of life.  Not being able to afford medical treatment is not a barrier for employees any longer on AWP’s health plan.

Another program that AWP has instituted is having an independent physician on-site at the workplace.  This has provided an opportunity for employees who do not have a regular physician to be able to utilize one without the burden of having to take leave from work to have their healthcare needs met. The feedback from this program has been very positive as some of the employees are now receiving treatment for chronic disease states that before were left untreated.  Before this program, employees were receiving their care from an urgent care facility or the emergency room.  This program alone has improved healthcare outcomes and costs for the employee.

The company has over 475 employees utilizing the health care plan. After making some innovative changes, they experienced a reduction in spend of approximately $1M in savings (15.5%) for the 2022 plan year, compared to the prior year. These savings were a result of an innovative approach to health care utilization.