CASE STUDY • INTERNATIONAL SCHOOL
By Bill Frack, Chief Development Officer
Client Establishes Control and Visibility Across Plan Performance
Hiring Wellnecity
A recognized international school with 400 employees and 800 enrolled plan members recently transitioned from fully insured to self-insured. They partnered with a broker team Wellnecity knew well, who recommended bundling benefits with a large insurance carrier—excluding only the stop-loss policy.
Soon after the transition, out-of-network mental health claims surged. While self-insured employers are typically able to access claims data for greater insight and control, the carrier—new to the self-insured market—declined repeated requests to provide it. Without this data, neither the broker nor the school could assess performance or determine why costs were exceeding budget.
Wellnecity was engaged to obtain the data and help resolve the issue.
Phase 1
Obtaining the Data
Wellnecity had a 3-month window to obtain the data from the carrier and deliver the insights the client and broker team needed to support informed decision-making during the renewal process. The timeline posed a challenge – it was tight for a carrier with limited self-insurance experience – and the stakes were high. The client was contemplating a return to a fully insured program due to the unexplained escalating costs.
Wellnecity’s data management team immediately established the connections to capture, clean, and structure the carrier’s data to conform with modern standards. Wellnecity delivered results within 2.5 months, before the window closed. Granular insights revealed the cause of the excess spending, and with Wellnecity’s support, redressing of the issues commenced.
Phase 2
Designing a New Vendor Stack
Given the negative experience with bundled benefits, Wellnecity suggested a different approach – designing an unbundled “best of breed” plan to improve performance, quality, and affordability.
Combining deep knowledge of health plan operations with the data-driven view of the client’s membership utilization and needs, Wellnecity worked with the broker team to define a set of five vendor configurations from loosely to tightly managed, informing the client of the pros and cons of each. Wellnecity also contributed substantially to educating the client on the limitations of traditional broad-access health plans that offer more choice, versus options that offer more control.
The client observed that Wellnecity’s “informed and objective perspective was important to developing confidence in (their) plan moving forward.”
Phase 3
Implementing New Vendor Stack and Point Solutions
When changing health plan vendors, it’s essential to establish data connections as soon as possible to avoid surprises. With the typical flow of information in healthcare, the broker might not see performance-to-budget problems until month 6 or 7 when it’s too late to rescue the current financial year.
The client’s new Third Party Administrator (TPA) offered access to another healthcare analytics tool kit as a solution. Their database, however, lacked historical detail, so the broker and client could not trend against the prior year to see if the issues were fixed. Wellnecity’s platform gave them the ability to measure the impact of plan changes year over year.
Continuous Improvement
Wellnecity stabilized operations in less than 3 months and is now leading the charge to integrate incremental point solutions. Wellnecity serves as the information and implementation hub the client and broker team rely on to proactively manage and measure plan performance.