Case Study:  Qosina Corp/Qosmedix
  • About the Client:

Qosina is a leading global supplier of more than 5,000 OEM single-use components to the medical and pharmaceutical industries. Their mission is to provide the best customer experience possible by helping their customers find, order, and receive quality medical components quickly and accurately. They support innovation by helping medical device engineers get their products to market faster and more efficiently. Qosmedix is a global, full-service provider of wholesale beauty supplies for the cosmetic, skin care and fragrance industries. Their vast inventory features high quality spa and salon products for beauty professionals.

Our relationship with Qosina Corp. began post-renewal in June 2019 after a series of 20%+ increases with limited ability to control costs.

Our focus was on obtaining claims information to identify the source of the unusually high medical and Rx claims. Our team experienced the typical resistance from the incumbent carrier, yet we were able to obtain the data needed to prepare analysis.

The HR team at Qosina and our advisors developed four main goals:

  1. Evaluate Member Contributions Strategy
  2. Minimize Member Disruption
  3. Take advantage of alternative underwriting protocols
  4. Reassess current plan designs

 

  • Approach:

Qosina and GPI evaluated the existing plan designs, contribution structure, member allocation and did a market evaluation of the existing fully

The incumbent carrier responded to market analysis with a projected 30%+ renewal due to claims trending at a 125% loss ratio.

  • Year One Results:

An early rewrite to an alternative carrier with favorable UW provisions for the applicable market segment helped the plan and members avoid a $600k+ increase and almost certain benefit and contribution disruption.

Plan options were reduced from three to two with clearer distinction between the High and Low plans.  Copays, Deductibles and Out-of-Pocket limits flowed more clearly, and members more easily distinguished the best plan option for themselves.

The favorable premium forecast allowed Qosina to enhance their benefit package with new benefit offerings including Short Term Disability.

To support Qosina’ s leave of absence management needs several lines of coverage were moved to Guardian including Statutory NY Disability, Short-Term and Long-Term Disability.

The first-year medical renewal of minus .07% reflected the advantageous underwriting methodology and re-supported the transfer of coverage mid-year.

No benefit or premium contribution change was necessitated at renewal.  This was especially rewarding in the midst of the current Coronavirus pandemic.

  • Group Details
  • Total Employees: 100+
  • Enrolled: 93
  • Covered Lives: 214

Fully Insured Rate History

(Pre-BrightPath) Initial Final
March 2018 Empire +55% Moved
March 2019 Cigna +36.9% +19.5%
(BritePath)
January 2020 Early Transfer -1.05%
January 2021 -.07 -.07

At the time of transfer from Cigna to Oxford, the plan was trending at 125% loss ratio.  An early change sheltered the account from a 30%+ increase and substantial benefit changes.

  • Year two and beyond:

The transformation of the plan from status quo to high-performance has been nothing short of remarkable.

Since our team approach started in 2019, the Qosina plan has had significant successes.  Gaining control of out-of-control premiums was easier than expected.  Enhanced benefits make recruiting and retaining talent easier which is especially important in the growth mindset of the organization.

  • Advanced Reporting & Analytics

The next phase will focus on the introduction of proprietary technology that allows our benefit team and Qosina’ s leadership to gain insights in to the medical and Rx claims and evaluate alternative cost control/benefit enhancement opportunities, as well as alternative funding options available to groups of their size.

Optional cash Price Rx option

A cash price alternative to the embedded Rx benefit can help members avoid unnecessary cost at the pharmacy.  Carrier embedded pharmacy benefits are plagued with spread prices and rebates that artificially inflate premiums and member OOP costs.  The BritePath Rx option helps control runaway claims.

On the Horizon:

Navigation tools so members are better equipped to make informed health care decisions, avoid unnecessary out-of-pocket costs and be better ambassadors of the organization.

Pharmacy Cost Analysis with true pass-through model projected to reduce the Rx spend by 30-40% leveraging enhanced capabilities such as copay assistance, lower ingredient cost, and securing rebates currently flowing to their PBM.

Partial Self-Insurance

When appropriate a shift from fully insured to self-insurance can help Qosina eliminate the artificially inflated costs and premiums associated with status quo fully insured plans.

  • About the Agency:

Group Planners Inc. d/b/a BritePath has been helping employers and their members optimize group health plans (and other ancillary insurance products) since 1997.

The agency is committed to benefit enhancement and education.  Too often employers and their brokers focus exclusively on insurance.  This is a flawed strategy that plays directly into the hand of a healthcare and insurance ecosystem that attempts to maximize profits off misinformed consumers. 

GPI helps employers refocus on healthcare costs and helps them develop high-performance health plans that outperform their counterparts by 20% or more. 

GPI follows the essential components of a BritePath health plan: Analytics, Insights, Elevate and Engage

  • Analytics:

The data belongs to the employer despite carrier resistance to share it.  GPI has the tools and strategy to obtain the data, so our clients are better equipped to make informed benefit decisions.

  • Insights:

Utilizing the newly obtained data our advisors can conduct true market analysis including PBM cost analysis, self-insured readiness, creative funding performance reports and make targeted benefit plan recommendations.

  • Elevate:

Plans are designed with an incentive-based methodology, so members are rewarded for making informed decisions.

  • Engage:

Members are contacted by a concierge team member when opportunities to enhance care and/or avoid unnecessary out-of-pocket costs are identified.

About the Agent: Louis C. Bernardi

Co-Founder & President

Health Rosetta Associate Advisor

lcbernardi@groupplannersinc.com

Direct: 516.590.0865

LinkedIn: www.linkedin.com/in/louisbernardi

Lou is a graduate of St. Johns University Class of 1989.  He is a resident of Massapequa Park, NY where he resides with his wife of 29 years, Jaki and their three children Louis, Andrew & Faith.

Lou has been exclusively focused on employee benefit since 1991 both as General Agent (1991 to 2017) and President of Group Planners Inc. (1997 to present).  Lou will soon be the author of his first book focused on the challenge’s employers, HR Directors and their members face in the managed care era of health care.  Lou believes it is imperative that stakeholders are conscious of the misaligned incentives that artificially inflate healthcare and as a result health insurance.  Lou is equality focused on helping grow awareness of the many tolls, resources and solution partners that exists that are already solving the cost and quality issues that most employers face.

Lou believes a BritePath focused high-performance health plan has the potential to forever change the trajectory of the cost and quality of most employer sponsored health plans.  In fact, quite often Lou finds that he is the first advisor that has sat down with a CFO or HR Director and changed the focus from insurance rates to health care costs.  Most employers are not aware of the significant rebates, spread prices and other hidden profit centers within most plans and perhaps more importantly the alternatives that exist to address these impropriates.

Lou always strives for maximum improvements with limited or no disruption.  The BritePath approach is a multi-year strategy that meets employers and their members where they currently are and takes them where they want to be.  Conversation is free, solutions are priceless.