case study library
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case studylibrary
Mercer
welcome to brighter
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Table of Contents
01/ Plan design, structure and innovation02/ Management of costs and risks03/ Compliance04/ Scalable solutions that grow with you
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01/ Plan design, structure and innovation
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Moving to self-insured without switching carriersCase study
• Lower paid employees with average benefits
• Reduce overall benefits budget without impacting employees
• Difficult to recruit and maintain employees, needed to minimize disruption
• Long-term relationship with vendors and hesitant to make move to new providers
Challenges
• Completed proprietary actuarial tools to assess the potential risk based on prior claims experience
• Completed in-depth analysis using NetPic, our discount network analysis tool
• Benchmarked plan design and ASO fees against our National Survey of Employer-Sponsored Health Plans
Actions
• Used tools, resources and our market leverage to negotiate new agreement with current carriers to move to self-funding with better terms and conditions
• Implemented carve-out Rx program, negotiating in rebates that were not previously offered
Results
Healthcare/nursing home client with 2,000 eligible employees
gross cost savings$1,900,000
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Benefit optimizationCase study
• When taking over a new client, Mercer performed a design review analysis of the groups current plan designs, looking for savings opportunities
• One area of immediate concern was the level of stop loss coverage
Challenges
• Mercer provided the client with an analysis on their current benefit plans
• Analysis demonstrated an immediate concern of the current stop loss level and the years of overpayment for that level of coverage
• Illustrated through benchmarking, financial analysis and claims history where there were savings to be had by moving closer to benchmark for Stop Loss coverage on a group their size
Actions
• Used Mercer’s negotiating leverage for additional fee concessions based on the years of overpayment
• Client agreed with the analysis presented by Mercer
• Increased Stop Loss Coverage by 1.5 times their current coverage
Results
Benefit administration industry with 700 eligible employees nationwide
estimated first year savings of $529,000
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02/ Management of costs and risks
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High number of large claimantsCase study
• Sample of claims based on combined financial/stratified sample
Actions
• Overpayment due to incorrect claim administrator pricing
• Overpaid maternity claims due to not applying coinsurance to physician’s billing
• Underpayments due to system setup issue of applying deductible to emergency room services
• Overpayments due to incorrect allowance for out-of-network claims
Results
• Client claims handled by a dedicated service unit
• Monthly audits of 20 claims per month
• Correction of system configuration for emergency room claims
Indirect ROI
Client with 500 employees seeing increasing claims costs due to large claimants
direct ROI of $99,000
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Negotiating to leverage savingsCase study
• Pharmacy coverage carved in
• Rx trend continuing to outpace medical trend at an alarming rate
Challenges
• Performed full marketing
• Analyzed Mercer’s Rx Options collective for preferred contract terms and pricing
Actions
• Utilized collective as leverage through negotiations with the carrier for more favorable contract terms and secured $300k in savings without having to change Pharmacy Benefit Managers
• Projected savings of over $400,000 annually
Results
Private equity client with 400 employees in NYC
estimated first year savings of $300,000
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Offset catastrophic claims experienceCase study
• Renewal from current carrier was unfavorable (40% increase)
• Increase was a result of poor catastrophic claims experience
Challenges
• Did a full marketing for the client, with six carriers
• Included three vendors from Mercer’s Stop Loss Coalition
• Negotiated a competitive rate and provisions for the client
Actions
• Client moved to a new provider that was part of the Mercer Stop Loss Coalition
• New coverage terms included a 40% renewal cap, with no new lasers at renewal protection
• By being part of the Mercer Coalition the client is eligible for the profit-sharing arrangement which could result in a dividend at no additional cost
Results
Market and consumer research client with 700 covered employees nationwide
estimated first year savings of $220,000
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03/ Compliance
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HIPAA privacy and security complianceCase study
• Renewal from current carrier was unfavorable (40% increase)
• Increase was a result of poor catastrophic claims experience
Challenges
• Did a full marketing for the client, with six carriers
• Included three vendors from Mercer’s Stop Loss Coalition
• Negotiated a competitive rate and provisions for the client
Actions
• Client moved to a new provider that was part of the Mercer Stop Loss Coalition
• New coverage terms included a 40% renewal cap, with no new lasers at renewal protection
• By being part of the Mercer Coalition the client is eligible for the profit-sharing arrangement which could result in a dividend at no additional cost
Results
Self-insured client
Need Review compliance with HIPAA regulations in light of the acquisition
Benefit Gap analysis completed to identify needs
Value Reduced risk to ensure go forward compliance
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ERISA ProsCase study
• Current wrap plan document was a combined Plan Document and SPD which did not provide an “easy to understand” employee summary of the benefits
• The current documents did not contain the most recent regulatory updates
Challenges
• Mercer partnered with ERISA Pro utilizing Wrap Tight to provide wrap plan documents and wrap SPDs for our client
• Worked with the client to complete a plan document questionnaire which enabled accuracy and review of plan details prior to production
• Mercer provided review by our Regulatory Resources Group (RRG) team for compliance check
Actions
• Mercer was able to provide a fully integrated Wrap Plan Document and separate SPD
• Provided client with a simple solution for their employees that was easy to produce and complied with all regulations
Results
Solar sales and installation client with 2,100 eligible employees nationwide
Need A compliant, administratively easy and cost effective solution
Benefit Simple solution driving compliance
Value Easy to produce compliant documents for employees
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04/ Scalable solutions that grow with you
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Communicating during COVID-19Case study
• Experiencing rapid growth
• Employees with limited access to computers
Challenges
• Implemented iNGAGED, a company branded and personalized app
• Downloading the app was optional for employees
• App housed all employer sponsored benefits and company information
Improving the experience
• CEO required all employees to download app once COVID-19 was diagnosed in the US
• Utilized push notifications to communicate location closures and impact
In times of crisis
Casual food restaurant with 30 locations over a large geography
Need Ability to quickly communicate changes regarding work status and company updates
Benefit App is a one-stop resource for all employee solutions and communications
Value Able to communicate and get information and updates to employees during this critical time