01 Strategic Service Model Strategic Consulting, Creative Cost-Containment Solutions, and Hands-On White Glove Service
Alec Jenkins EVP, Employee Benefits
Ryan Campbell Managing Director, Employee Benefits
Shawna Johnson Strategic Account Executive
Binni Carter Sr. Account Executive, Employee Benefits
02
What We’ve Uncovered Pain Points & Challenges
Senior Leadership Human Resources Employees
• Lack of stop loss and self-funded education for key stakeholders
• Minimal education on contract provisions and protection features
• No long-term planning using KPIs and data analytics
• Lack of strategic consulting
• Lack of HR resource support
• HR team bogged down with administrative tasks
• Current broker is focused on key accounts – neglecting the needs of GOAT as a noteworthy organization.
03 Implications of No Change What Happens if Nothing Changes?
• Lack of employee education, strategic communication campaigns
• Employees do not understand the value of their benefits
• Lack of oversight into contract language and SL protections will result in increased liabilities and unnecessary exposure.
• Lack of data-driven decisions will put employees’ health plan dollars at risk.
• Growing uncertainty about the stewardship of health plans means unilateral decision making and negative ROI.
• Without resources and service support, the HR team will continue to feel overwhelmed and burned out.
• If Priscilla has to keep doing the job of the broker as well, GOAT will be forced to spend money hiring another HR employee.
• Employees will not see the value of their total compensation package.
• Missed admin and vendor fees resulting in long-term profit leak.
Your Extended Core & Day Two Service Team
o Human Capital Management, Technology, Finance, and Employee Benefits has become a more broad and complex area of exposure. Our team of subject matter experts is here to support you through every component of talent management.
o Professional In-House Marketing & Communications Team – Consistent and comprehensive education materials create brand recognition and improved understanding of benefits.
o Educational Communication Campaigns – Drive engagement and create a cohesive culture, with on-brand communication and wellness materials.
o Multi-Pronged Educational Approach – Benefit Guides, bi-lingual Open Enrollment materials, customized videos, GOAT branded micro-site, and more.
o Samples
• Reallocate Your Time & Gain Peace of Mind
o Employee Resource Center (ERC) – A designated call center with licensed Higginbotham employees to take employee service calls surrounding all employee benefits.
o Enrollment Support / OE Education – We provide white-glove support throughout enrollment season and during Open Enrollment.
o Compliance – As part of the Higginbotham Day Two Services, we have robust technology resources, compliance communications, and an in-house ERISA attorney with extensive employee benefits expertise.
o In-house HR support – Leveraging resources and technology for a multitude of HR related tasks – Eligibility Management, COBRA, NDT, ACA Reporting, Tax-Advantaged Plans, Compliance, and Population Health Management.
• Leveraging Partnerships & Goodwill
o Negotiate from a Position of Strength – Our long-standing and reputable partnership with carriers and point solution vendors puts us in a position to facilitate top-tier benefits, holding a high standard of accountability on behalf of our clients.
o A True Partner– Real partners that understand and care about your business.
07 Health Plan Strategies & Data Driven Consulting Better
Cost-Control & Benefit Enrichment
Active Plan Management
• Access to medical, Rx, eligibility, network, and pricing data all in one place.
• Self-service dashboards for trending and forecasting high-cost claimants and chronic conditions.
• Executive-level summaries with drill-downs fordeeper actuarial orclinical dives.
Network & Steerage Modeling
• Ability to pin-point network disruption before a carrier/TPA change.
• Steerage opportunities based on quality, cost, and access data per provider/facility.
• TPA - evaluating best service, integrations and adjudication of claims.
• Stop-loss - best pricing, rating.
• PBM - transparent rebates, drug sourcing and bio-similar alternatives.
• Network - constant evaluation of member distribution/access to care, negotiated rates and flexibility on slice/carve-outs.
• Point Solutions - disease management, chronic conditions, direct contracting/centers of excellence, care navigation, patient advocacy, medical bill reviews, virtual care.
08 Case Studies Stewardship Unlocked
Jcode/Infusion Therapy Redirect Program
Saved $485K in Rx claims – Allowing a very sick member to get treatment in the comfort of her home
Group Size: 900 | Funding Type: Self-Funded
• Challenge: The client had a member getting infusion therapies administered in the hospital – The markup with over 400% when compared to the same therapy accessed through the pharmacy.
• Solution: We reached out the carrier to implement a Jcode/Infusion Therapy Redirect program. Just by sourcing the treatment from a pharmacy rather than through the hospital, we were able to save the plan nearly a half million dollars and allowed the member to get treatment from home, giving her a better chance of recovery.
Alternate Funding & Care Navigation Cost-Containment Strategy
Saved 39% on both Medical and Rx claims
Group Size: 350 | Funding Type: Self-Funded
• Challenge: The client had high-cost premium and low value benefit plan with Cigna (Level-Funded).
• Solution: We moved them to a self-funded captive arrangement, implemented cost-containment solutions including:
o Case management for cancer
o Alternate sourcing for high-cost medications
o $0 imaging/$0 surgery benefits
o Mobile app housing all benefits and care navigators
o Saved 39% in total costs in 24 months
09 Annual Timeline Service & Renewals
Onboarding Q2 Q3 Q4 Q1- 2027
• Broker of Record Letter Executed
• Kickoff Call with Higg Team
• Full Plan Analysis –Internal Systems Update
Communications
• Payroll HRIS / EDI Feeds – Capabilities and Needs Assessment Communications
