Transparency & Member Engagement

Transparency

We reach out proactively: Through proactive savings alerts, we have the ability to notify users of opportunities to save on their most common and recurring healthcare services and prescriptions.  This unique outreach model produces sustained engagement rates of nearly 60 percent and is the only solution on the market that pushes savings opportunities directly to users.

"Push" communications, such as Targeted Engagement Campaigns which deliver customized messages to specific populations, engage users over and over again to drive behavior change.  Cost Lookup enables users to search for a prescription, medical, dental, or vision service and determine the price they would pay at a specific provider based on their individual plan and network, as well as their personal preference for cost, quality and convenience.

While some cost transparency vendors tout high registration rates, sustained engagement is our goal.  We believe consumers must do more than just register to use a tool.  They must register and then engage in the process of shopping for care, again and again.  Our solution has been shown to drive sustained engagement to nearly 60 percent.

From the proactive delivery of savings alerts and targeted engagement campaigns, to the particular language, graphics and even order in which choices are presented, our solutions simplify the consumer decision making process and encourage ongoing engagement.

Member Engagement

Through its integrated service partners, HORIZON Health Ventures consistently delivers market-leading sustained engagement rates, quantifiable savings and clear ROI, all because our solutions are rooted in engagement science.  No other consumer engagement platform is as proactive, personalized, and perpetually strategic as those introduced by HORIZON.

WE MAKE IT PERSONAL.

Depending on the level of service required, our solutions are web-based, concierge driven, or both.  User Preference Management ensures users receive the information that's most valuable to them, however they want to receive it - via email, text, or through one-on-one interaction...and all savings opportunities can be identified for the individual down to certain dollar amount limits, service category, or even those within a certain driving distance. Finally, we enable users to see details of their personal health plan design, including their deductible status.

 

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Success Stories
Association Employer – New Jersey – HORIZON Solution: Employer Group Waiver Plan (EGWP)

Number of Retirees: 239
This Association had been managing their retiree pharmacy program and filing for the Retiree Drug Subsidy (RDS) since 2006 through its insurance carrier. After evaluation of current drug spend and projected RDS for 2014, the plan decided to move to a fully insured Employer Group Waiver Program (EGWP). Based on current enrollment, no change in plan design or drug plan, the group saved $430,000 or $1,800 PMPY. This was hard dollar savings and did not infer savings from the elimination of attestation, administration or from the elimination of OPEB liabilities.

Success Stories
Government Association - Washington, DC- HORIZON Solution: Employer Group Waiver Plan (EGWP)

Number of Retirees: 108
This Association had been managing their retiree pharmacy program and filing for the Retiree Drug Subsidy (RDS) since 2006 through its Pharmacy Benefit Manager (PBM). During the course of the relationship, the PBM never introduced the Employer Group Waiver Program (EGWP) to either the Association or their insurance broker. In May 2013, HORIZON Health Ventures introduced the concept of EGWP to the broker who immediately addressed the capability with the client. Keeping all pharmacy benefits the same, HHV was able to save this plan $189,000 or 28% of drug trend for 2014.

Success Stories
Municipal Employer –Michigan – HORIZON Solution: Employer Group Waiver Plan (EGWP)

Number of Retirees: 1,200
Managed for many years by the same carrier, this municipality moved their group retiree pharmacy program to HORIZON Health Ventures and its proposed Employer Group Waiver Program (EGWP) for a 13% savings to the plan. In addition, the group did so while improving their plan design on generic drugs. At the direction of HORIZON Health Ventures, the EGWP provider lowered copayments on generic products both at retail and mail thus resulting in greater steerage to lower cost products and thus a lower premium. In addition, based on this client’s plan year, (along with the new plan design adopted), the client was able to secure a rate cap for 2015 fixing their costs at a maximum liability until January 1, 2016.

Success Stories
Union – New Jersey – HORIZON Solution: RDS Reopening

Retirees Covered: 1,032
Reopening subsidy = $1,518,000
Additional subsidy = $280,000
18% additional subsidy recovered upon Reopening

Upon hiring HHV and RDS Reopening Services requested an audit of past Retiree Drug Subsidy filings from CMS. The request was approved and based on missed eligibility and inaccurate reconciliation of subsidy eligible claims, this client successfully Reopened their RDS filings from 2009-2012 recovering over $90,000 in additional subsidy. 

Success Stories
Municipality – New Jersey – HORIZON Solution: Pharmacy Benefit Management

Total Lives Covered – 2,900
Annual Drug Spend - $4,400,000
Issue – Adverse drug mix in the Proton Pump Inhibitor (PPI’s) category resulting in $297,000 in unnecessary drug spend.

Resolution – Plan design modification mandating PPI’s be purchased Over-the-Counter (OTC) along with full subsidy of a $0 copayment to the member.

Recommendation to eliminate member cost share for mandatory purchases of OTC PPI’s resulting in $177,000 net savings to the plan. Significant savings to both plan and member realized through slight modification of design and no member disruption.

Success Stories
Corporate Employer – Pennsylvania – HORIZON Solution: Medical Bill Review

Total Lives Covered – 400
Number of bills reviewed - 5
Total Amount of Hospital Bills Reviewed - $1,135,914
Negotiated Amount Paid by Plan Sponsor - $446,874

After hiring HHV for Cost Containment Services (Medical Bill Review), five out-of-network hospital bills (different patients with different health conditions) were reviewed for appropriateness and necessity. Due to the identification egregious billing practices, undocumented charges and reasonableness audit, successful negotiation was realized reducing the amount paid by $690,000.

The U.S. General Accounting Office has estimated that there are overcharges on 99% of all hospital bills.