A non-profit, community-directed Wisconsin health system partnered with Prism to optimize its employee health plan. At the time, the system owned and operated seven facilities with four distinct health plans. Multiple administrators and brokers provided services across those plans, and 85% of employees were under an HDHP. Underutilized preventative and primary services created an unusually high number of large claims.
Prism worked with the system to address the administrative challenges of multiple employee health plans and improve the overall health of the employee population. An RFP was conducted for Third Party Administrator (TPA) service with a focus on claims adjudication and reporting capabilities. The system and Prism chose a single administrator and formed a benefits committee with physician representation to manage plan performance. In concert with the organizational ACO strategy, the system standardized employee health plans to a single plan redesigned to fully support population health efforts. The system replaced all HDHP plans with PPO plans that highly incentivized employee engagement and encouraged primary preventative care and care management for certain manageable disease states, such as diabetes, heart disease, and obesity. The system’s physicians designed specific care criteria for those disease states. The system also implemented a robust outreach program and hired health coaches for plan members.
“Prism helped us reduce health plan costs by 11% while enhancing coverage for employees to fully support clinically based criteria for certain disease states.”
Vice President of Human Resources for Wisconsin Health System