2019 Financial Highlights
- Majority of funding comes from membership fees
- Membership fees:
- Based on the number of health plan eligible employees and early retirees
- 2019 - $15 per health plan eligible employee and early retiree per year in the 22 counties of eastern Wisconsin (sixth year in a row with no increase)
- Vendor Sponsorships at BHCG events
Membership Growth and Opportunities Expand
Employers large and small – both self-funded and fully insured – participate in BHCG to positively impact the cost and quality of health care delivered in our community. We lead change and create value.
BHCG membership exceeds 250,000 covered lives in the 22-county region of eastern Wisconsin and nationwide through standalone memberships for employers accessing BHCG best in class strategic partners.
Cost Results – Positively Impacting Trend
Leveraging our purchasing power and the collective experience and knowledge of leading member employers and best in class strategic partners, we have made remarkable progress in slowing health care cost trend – for our member employers, their employees and the community.
Over the past 14 years:
- The annual allowed per member per month trend increase for BHCG self-funded member employers has averaged 1.2 percent annually
- Increases in the southeast Wisconsin region have ranged between five and 10 percent annually
Virtual Health Plan Results – Identifying opportunities to improve
UnitedHealthcare’s continuous health care cost action plan uses a reporting and analysis tool to monitor health plan performance across BHCG member employers, identify cost drivers and develop solutions.
The Virtual Health Plan – directed by a senior health care executive team consisting of a chief medical officer, a chief operating officer and an analytics team – is an advanced analytic process that focuses on BHCG’s collective benefit plan performance. The Virtual Health Plan process:
- Develops clinical strategies
- Assures clinical operating integrity
- Identifies emerging trends and cost drivers
* Dates of Service 1/1/2019-12/31/2019. Paid through 02/29.
Risk adjusted PMPM is 19 percent lower for employees and spouses of all BHCG employers that are highly engaged with Premium providers in consecutive years vs. adults with low utilization of Premium providers in consecutive years.*
Best Doctors Results – Empowering Health Care Consumers
Best Doctors, Inc.®, BHCG’s informed decision-making vendor since 2012, offers a real solution for the problem of medical uncertainty for the most complex, critical and costly cases. Best Doctors connects employees and dependents facing medical uncertainty with more than 50,000 world-renowned medical experts across 450 specialties and sub-specialties.
BHCG member employers have access to an ever-growing portfolio of core and optional services at significantly reduced rates.
Key BHCG case statistics for 2019 included:
- 90 percent of respondents gave Best Doctors the highest customer satisfaction rating possible
- The program’s expert medical consultation services indicated diagnosis changes or clarifications were recommended in 48 percent of cases and treatment changes or clarifications were recommended in 77 percent of cases
- BHCG employers realized a return-on-investment (ROI) of 3.2:1
"Best Doctors provides peace of mind for our associates when navigating a complex health care marketplace.”
- Lisa Mrozinski, Director of Total Rewards, Baird
Navitus Health Solutions – Outstanding Cost Results for Member Employers
Navitus Health Solutions’ unique approach to pharmacy benefit management combines financial performance, demonstrated service and clinical excellence with a 100 percent pass-through business model that aligns incentives with the best interests of our member employers.
Navitus Health Solutions proved to be a game changer for four member employers who implemented Navitus in 2019. Using its administrative fee only model featuring complete transparency and lowest net cost, Navitus has produced outstanding cost savings. Several other BHCG member employers made the transition to Navitus as of January 1, 2020. Their results will be reported in the upcoming months.
Pharmacy Spend - 2019 vs. 2018
City of Kenosha:
Savings of $649,389 for the year
Masters Gallery Foods
Savings of $443,428 for the year
Paragon Development Systems
Savings of $142,472 for the year
Savings of $396,657
* Represents 2nd half of 2019 savings only