How Imagine360 Saved this Employer 19% Compared to Traditional Health Plans

After constantly experiencing double-digit annual will increase in healthcare prices with conventional medical health insurance, pest management firm Rollins knew it needed to do issues otherwise for its workers, in accordance with Jamie Benton, vp of human assets on the firm.

“We did plan design. We went to the Mercer Change. We did all that stuff. After which it simply would scale back prices for a yr, after which they might come proper again up,” he stated in a current interview on the Enterprise Group on Well being convention.

So in January 2023, the employer started working with Imagine360, an alternate well being plan for self-funded employers. And in accordance with an impartial evaluation launched final week, the corporate is getting outcomes for Rollins. The evaluation by Axene Well being Companions discovered that Imagine360 achieved 19% financial savings, or $7.7 million yearly, in comparison with conventional well being plans for Rollins. It additionally obtained a satisfaction rating of 90% and a 99% claims acceptance charge.

The report analyzed Rollins’ claims knowledge from 2023 and in contrast it to Axene Well being Companions’ benchmark knowledge, which incorporates practically $2 billion of healthcare claims throughout thousands and thousands of members enrolled in industrial well being plans.

How did Imagine360 obtain these outcomes? The corporate provides plan design help and administration. It contracts with prime suppliers and well being methods and supplies one-on-one member assist for care and billing points.

As well as, it makes use of a reference-based pricing mannequin to pay claims. On this mannequin, Imagine360 makes use of a benchmark like what Medicare pays for the service or the precise price of the process reported by the healthcare facility, after which provides revenue on prime of that reference worth. This compares to the standard Most popular Supplier Group pricing mannequin utilized by insurers, through which prices are typically inflated. The truth is, a current examine from RAND discovered that employers are paying 254% of what Medicare pays for a similar providers on the similar hospitals.

Rollins has about 20,000 workers throughout 47 states. The staff have a selection between Imagine360 or a conventional Most popular Supplier Group (PPO) plan. In 2023, 46% of its workers have been enrolled in Imagine360, and in 2024, that enrollment rose to 51%. With the financial savings it has obtained from Imagine360, the corporate has been in a position to reinvest in its workers’ well being, equivalent to by providing free major care.

Benton expects that enrollment in Imagine360 will proceed to extend sooner or later. Those who’ve been probably the most hesitant to maneuver away from conventional insurance coverage have been the extra high-cost claimants. Nevertheless, these are the members who would profit probably the most from Imagine360 due to the reference-based pricing mannequin, Benton declared.

“We now have not performed very well with our most cancers sufferers as a result of they worry altering docs,” he stated. “We’ve received to do a greater job of focusing on them, to have the dialog to say, ‘Look, your docs are going to be there. There’s going to be this low disruption. All it’s going to do is cost you much less cash, and in flip, cost us much less cash, and also you get to save lots of on the premiums.’”

The evaluation comes as employers are dealing with drastic will increase in healthcare prices. PwC predicted an 8% improve in 2025, the very best charge in 13 years.

Due to these price will increase, increasingly employers are pursuing various well being plans and pharmacy profit managers, stated Ellen Kelsay, president and CEO of Enterprise Group on Well being, in an interview on the convention. She listed Imagine360, Centivo, Surest, Capital Rx and Navitus as examples.

Imagine360 is noticing this shift. The corporate has practically 1,000 purchasers and hopes to see double-digit progress over the subsequent a number of years, in accordance with Chris Cigarran, chief industrial officer of Imagine360. He famous that some employers are desirous about transferring to an alternate well being plan, however wish to begin with an impartial third-party administrator and nonetheless use the standard service community, which Imagine360 provides as a transition interval.

“We’re actually attempting to make it easy for employers to make the change,” Cigarran stated in an interview. “Quite a lot of consultants and brokers have perpetuated a delusion that there’s not another choice. We’ve received an actual possibility.”

Image: Feodora Chiosea, Getty Pictures