At ClearPath Benefit Advisors in Columbus, Ohio, the goal is to help clients take control of their healthcare spend with a layered approach to benefits that is designed to disrupt industry norms and put employers in charge of their own data. It starts with moving clients to partially self-funded plans, where they can take advantage of ClearPath’s propriety stop-loss relationships, says Thomas Rubino, partner.
ClearPath works with a variety of stop-loss providers, including Symetra and Sun Life, and also participates in a purchasing coalition that has a captive arrangement using QBE as its stop-loss carrier. That coalition, run by EBA’s 2017 Adviser of the Year Mick Rodgers of Axial Benefits Group, historically returns 30 cents on the dollar for favorable underwriting gains in the pool, Rubio explains.
“We source the stop-loss outside of the ‘BUCA’ stop-loss arrangements, replace that with one of these proprietary options, which then provides the employer the ability to participate directly in favorable underwriting gains,” he says, referring to Blue Cross, United Healthcare, Cigna and Aetna. “Which means that they can get money back, if their loss ratio runs well on the stop-loss.”
Moving clients to such stop-loss arrangements not only gives them the opportunity to participate in potential underwriting savings, but it also opens the door to other cost-saving elements that come with taking more control of a health plan. For example, not all employers in the central-Ohio market are comfortable with reference-based pricing, Rubino admits, but for those that are ready to make the move, ClearPath also works with a boutique third-party administrator that specializes in it.
He recently moved one client who had been with a national carrier for the last 11 years to just such an arrangement. Part of the impetus behind the move was the employer’s background in the pharmacy business. Because of his experience as a pharmacist, he knew he was missing out on valuable rebates through his BUCA’s PBM. Rubino moved him to a fully transparent PBM, where he now receives 100% of the rebates.
Taking it a step further, the company, Health Care Logistics, carved out some of its pharmacy benefits with a select local pharmacy that includes a wellness component. Employees who participate receive their prescriptions directly from the pharmacy and have occasional one-one-one consultations with pharmacy staff to ensure they’re adhering to their prescriptions.
“So far, so good”
Bethany Reid was interim vice president of human resources and administration at the time Health Care Logistics implemented the change. They switched the Rx plan about nine months ago, gradually bringing all 275 employees at several different locations on board. “We have transparent costs involved there instead of all this hiding amongst the PBM,” she says. “So far, so good.”
It’s about creating a better experience for employees, says Rubino, who has been working with proprietary stop-loss arrangements for the last five years and helping clients transition to self-funding “forever.” “It’s a layered approach to try to disrupt the norm,” he says.
Other layers include bringing in medical management services to help with pre-certifications and other plan issues and having a robust internal team at ClearPath who are always available to help clients.
Stephanie Boehm is Rubino’s lead account manager. She recalls an experience about a year ago where she spoke daily with an insurance company on a client’s employee’s behalf, working to get approval for multiple surgeries the client needed to fit in before her plan year ended. After a month of calls, she was able to get approval two weeks before the client’s deductible reset.
“Our priority first and foremost is the client,” says Boehm. “We want to provide the highest level of service. … That’s really important to me to be really thorough and do the best I can to help our clients.”
ClearPath also has a data analytics system, Advanced Plan for Health, so that as clients leave their existing carrier and/or TPA they’re not losing access to data.
Not all clients are comfortable with leaving the BUCA system, but Rubino says going partially self-funded has been a positive step for those who are curious. “The way we're looking at it is this is something that's we can replicate fairly easily with other clients,” he says, “but if they're not there on the continuum, ultimately, by retaining us, we can get them there.”
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