Accountable Care Organization

The Issue

One of our large clients had always focused their energy on providing their employees with a competitive benefit portfolio while maintaining control over costs. This worked until last year, when they experienced the first major increase in quite some time. They came to us looking for a way to combat the increase.

Our Solution

We immediately requested and received the utilization data to support the increase from their insurance carrier and plugged it into our data analytics program. We found that roughly 30% of their health care claim dollars were coming from just 1% of their employees. Digging deeper, we found out that many of these individuals were juggling multiple chronic conditions at once, often times with little coordination of care. As a result, we suggested working with an Accountable Care Organization (ACO), which correlates payments to quality metrics and works to improve care coordination between doctors, specialists, hospitals and private or public healthcare payers. They have demonstrated the ability to improve population health management and patient outcomes, benefiting both employer and employee.

The Result

Instead of focusing on changes in health plan design as a way to further control costs, we directed this client to focus instead on the inefficiencies of the health care delivery system. It has produced immediate dividends, as their first renewal since implementation of the ACO came in at 4%, saving them over $126,000. As an added bonus, the high-risk employees have found the management of care has resulted in less stress, less medications and more positive health outcomes.