A mid-size employer identified & drove cost saving opportunities to the tune of $400k+ within 4 months ($1M yearly) of solution implementation with D Cube

Client Situation

Client description
  • The customer was a mid-size organization who were working with a TPA to manage the health insurance for their sizeable population of employees and dependent members.
Challenge
  • There healthcare cost was increasing significantly year over year and there PEPM cost was almost 20% higher than other employers of same size.
Objectives
  • Client approached us to help them identify the drivers of high healthcare cost and develop a sustainable solution to manage and monitor it effectively in future.

D Cube Approach

Implementation of the Prudence platform
  • Step 1: Integrated multiple sources of claims data, internal HRA files, Rx Data, Direct Contract and Direct contract aggregator data
  • Step 2: Identified the high cost items and evaluated the potential options to bring the cost down
  • Step 3: Deployed a series of executive & business user level dashboards from our Prudence platform & included composite models to monitor current costs as well as provide actionable insights for keeping the healthcare cost down in future

Client Impact

  • Avoidable ER Visits – We noticed that 40% of ER visits were for the disease conditions that does not require ER resulting in approximately US$60K of unnecessary expenditure. We recommended to educate the employees about ER usage and increase Copay for ER visits as a negative incentive
  • Generic Utilization – We noticed that 25% of chronic medication can be replaced by Generic medicine that will result in approximately US$100K of savings
  • Low Utilization of Low Cost healthcare providers – We identified low cost healthcare providers for top medical procedures (Orthopedic & Spine related procedures & Respiratory conditions) and asked employer to guide the employees to utilize them. This had a potential of saving more than US$300K over a 12 month period