Employer success stories
Composite employer case studies based on real-world plan outcomes
These case studies reflect outcomes achieved by mid-market employers who took control of their health plan strategy — moving from passive cost-acceptance to active plan management.
$3.9M+
Illustrated outcomes across composite case examples
8
Composite case examples
5
Benefit strategy categories
160–650
Employee count range
Midwest manufacturer saves $1.4M in year one by moving off fully-insured
$1.4M
Net first-year savings vs. renewal
22%
PEPM cost reduction
8
Stop-loss carriers quoted
3 yrs
Claims data analyzed
A 340-life manufacturer had absorbed three consecutive 18–22% renewal increases from their fully-insured carrier. Their broker had never modeled self-funding, and the CFO assumed self-funding was only viable for employers over 500 lives. Stop-loss quotes had never been obtained.
Distribution company recovers $680K in PBM rebates through contract renegotiation
$680K
Annual rebates recovered to plan
31%
Pharmacy trend reversed to flat
5
PBMs included in competitive RFP
100%
Rebate pass-through achieved
A 520-life distribution company had been with the same PBM for seven years. Their contract had no audit rights, a spread pricing model, and rebates flowing to the broker rather than the plan. Annual pharmacy spend had grown 31% over three years despite flat enrollment.
Stop-loss restructure eliminates $290K laser and restores plan predictability
$290K
Laser eliminated at renewal
11
Stop-loss carriers quoted
3
Carriers offering no-laser coverage
$100K
Specific deductible maintained
A 210-life manufacturer had a $290,000 laser on a high-cost claimant at renewal — effectively removing stop-loss protection for their highest-risk member. Their incumbent carrier offered no alternatives. The CFO was considering returning to fully-insured.
Hospitality employer avoids $1.1M in ACA penalties through workforce classification audit
$1.1M
Estimated 4980H penalty exposure avoided
2 yrs
Prior filings corrected
480
Employees reclassified and tracked
0
IRS penalty assessments received
A 480-employee hospitality employer had never conducted a formal ALE analysis. Variable-hour workers were not being tracked for ACA measurement periods. The employer was offering coverage to full-time employees but had no documentation of affordability calculations or safe harbor elections. An IRS inquiry had been received.
Professional services firm cuts ER utilization 44% with direct primary care layer
44%
ER utilization reduction (year 1)
$65
PEPM DPC membership cost
3.2x
ROI on DPC investment
78%
Primary care utilization increase
A 190-life professional services firm had high ER utilization driven by lack of primary care access. Their plan had a $250 ER copay that wasn't deterring unnecessary visits. Primary care visit rates were low. The CFO wanted to reduce claims without shifting more cost to employees.
Healthcare employer reduces specialty drug spend 38% through biosimilar and site-of-care strategy
38%
Specialty drug spend reduction
52%→34%
Specialty as % of total Rx
3
Biologics converted to biosimilars
$420K
Annual specialty savings
A 650-life healthcare organization had specialty drug costs representing 52% of total pharmacy spend — well above the 40% benchmark. Three members were on biologics with no biosimilar conversion protocol. Specialty drugs were being dispensed at hospital outpatient pharmacies at inflated rates.
Arkansas nonprofit transitions to self-funding and redirects $380K to mission
$380K
Net savings redirected to mission
14%
Average annual renewal increase eliminated
$60K
Conservative specific deductible
115%
Aggregate protection level
A 275-life Arkansas nonprofit had been fully-insured for 14 years. Their board had concerns about the financial risk of self-funding, and their incumbent broker had never proposed it. Annual renewal increases averaged 14% over five years. The CFO estimated they were leaving significant money on the table.
Multi-state professional services firm builds high-performance network and cuts PEPM 19%
19%
PEPM reduction year over year
27%
Prior 3-year PEPM growth reversed
6
States covered by new network
82%
Navigation vendor engagement rate
A 160-life multi-state professional services firm had employees in six states with inconsistent network access and high out-of-network utilization. Their PPO network had no quality tiering, and employees were defaulting to high-cost facilities for routine procedures. PEPM costs had grown 27% over three years.
Disclaimer: All case studies on this page are composite case examples — constructed from patterns observed across multiple real employer engagements, with all identifying details changed to protect confidentiality. They are not verbatim accounts of a single employer. Results reflect specific plan designs, market conditions, and employer characteristics and are not guarantees of future performance.
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