A regional insurance brokerage in Wisconsin was introduced to Point C through a recent client. The brokerage had multiple employers who were self-insured, but who whose plans were administered by other third-party administrators (TPAs) who did not have the same level of local expertise in the employers’ marketplace.

Some of the brokerage’s clients were facing significant cost increases due to a change in the care required for their member base. Multiple members had obtained MRIs with costs that ranged from $1,800 to $3,400 throughout Wisconsin. In addition, one client had a member requiring a monthly Rituximab injection, which treats an autoimmune disorder—pemphigus vulgaris—that causes the blistering and erosion of skin. The injection was being administered at a local clinic convenient to the member, but the cost was over $33k a month. Because of the high cost and recurring nature, the reinsurance carrier added a laser at triple the cost of the group-specific stop loss for that member.

After working with Point C for several months, the brokerage realized that Point C could help its other clients reduce their real healthcare costs while simultaneously cutting the cost of its stop loss premiums by eliminating member-specific lasers. Point C consulted with the employer groups, took over plan management, and conducted an audit of healthcare spend.

Point C immediately engaged local vendor partners throughout Wisconsin and negotiated MRI rates of $500-720, a 62-78% cost savings for the groups, which also reduced the out-of-pocket costs for the employers’ members. By utilizing a local specialty pharmacy, Point C was also able to arrange for an infusion nurse to administer home treatment for the Rituximab injection. The member preferred being treated at home and the cost of the treatment fell over 53%. Because of the cost savings, the reinsurance carrier dropped the laser at the client’s next renewal, driving premium savings for the employer.