A Midwest Native American Tribe was facing an unsustainable increase in their health insurance costs.
Cottingham & Butler’s tribal nations team was invited to conduct our 3C’s analysis, where we benchmark coverage, cost, and consumption. This analysis leads to identifying areas of opportunity and developing targeted quantifiable recommendations.
Medicare Like Rates
We successfully implemented Medicare Like Rates (MLR) for all eligible claims for both facility and professional services. This strategy has hit $10M in savings in just the first 3 years.
Sponsorship
We implemented a marketplace program for short-term and ongoing high-cost claimants. This has led to $8M in savings within the first 3 years.
Out-of-Network Reference-Based Pricing
This pricing was implemented for large out-of-network spend and is primarily used for mental health and substance abuse. This addition has led to $1.2M in savings.
Pharmacy Benefits Optimization
A change in their Pharmacy Benefits Manager was recommended. The new Pharmacy Benefit Optimizer (PBO) was implemented with better pricing and traditional rebates on in-house claims leading to $600K in savings.