Healthcare solutions built for the craft beer community H.O.P.S. Program Healthcare Optimization & Profit Strategy
Whether promoting local beer or advocating for favorable laws and lower excise tax rates, the collective voice of the craft beer industry speaks louder than that of individual brewers alone. Our association health program, called H.O.P.S. capitalizes on the exceptional risk and claims predictability that the craft beer industry has to offer, and our block renewals all but eliminate shock renewals.
This aligns with Sterling Seacrest Pritchard’s core philosophy that we’re StrongerTogether. Our purpose is to serve the craft beer community by providing clients with the ability to build culture, foster collaboration & inclusion, while protecting their most valuable asset - their people.
Our proprietary H.O.P.S. program is the result of years of discipline, research, collaboration and learning and was developed specifically for the craft beer industry.
We don’t see healthcare for what it is . We see it for what it can be .
Stronger Together
CRAFT BEER INDUSTRY BY THE NUMBERS…
+ Demographics & Risk Profile
70% = male
45% = 20s
35% = 30s
< 2% = 50yrs+
_ Average size of craft brewery
< 50 employees (small group market)
_ Average number enrolled in health insurance
15 - 25 employees
_ Number of major medical carriers
5 traditional carrier / networks
_ Types of small group insurance plans
2 Fully-insured or Level-Funded (most competitive)
_ Available cost-containment programs
0 (Carriers retain 100% control & profits)
H.O.P.S. Program
Medical Plans with cost containment
Designed to reduce costs while boosting employee satisfaction
The Difference Is In The Details
Our H.O.P.S. program includes medical plans engineered to reduce copays and out of pocket costs for employees, while providing national network coverage options and rich pharmacy coverages.
Network Advantages
o Breweries can leverage national PPO networks and RBP (Reference Based Pricing) options
o Fixed premiums provide breweries with the look and feel of a fully-insured plan for simplicity
Integrated Pharmacy Savings Program
o Our Rx program allows employees to obtain high-cost brand & specialty medications with $0 copays
o Reducing pharmacy costs creates healthier budgets for medical claims – improving plan performance
o PBM rebates traditionally paid to the insurance carrier, are paid directly to you on a quarterly basis
Plan Administration & Employee Steerage
o Better oversight reduces the net amounts paid per claim, delivering plan savings of 15%-20%
o Our TPA partner optimizes the program behind the scenes, leveraging multiple cost saving programs
o Fully transparent costs and real-time data and analytics eliminate surprises at renewal
Shared Risk Pool & Block Renewals
o Breweries join a fully-credible risk pool, protecting your brewery if you have a bad claims year
o Block renewals provide the most predictable and balanced year-to-year costs
o On average, groups save enough in their first 4 years, to fully fund their 5th year
o H.O.P.S. provides a path to carve out craft brewers as their individualized risk pool
Understanding the healthcare landscape
Evaluating the pros and cons of health insurance funding
Fully-insured
Fixed Premium Invoice
o Risk exposure tied to individual employer
o Insurance carrier covers claims liability
o Insurance company retains 100% of claims surplus
o Monthly insurance premiums cover everything
o No access to claims / population health data
o No cost containment opportunities
o Medical renewal based off employer’s experience
Self-funding
Fixed Premium & Administration Invoice
o Risk exposure tied to individual employer
o Employer/Stop Loss covers claims liability
o Employer retains 100% of unused claims
o Multiple invoices for TPA, admin fees, stop loss premiums, network access fees, broker fees, and claims below the up to the stop loss deductible
o Full claims / population health data & reporting
o Multiple cost-containment programs available
o Specialty Rx carve outs reduce claims and costs
o Employers receive 100% of pharmacy rebates
o Medical renewal based off employer’s experience
Level-funding
Fixed Premium & Administration Invoice
o Risk exposure tied to individual employer
o Insurance carrier covers claims liability
o Limited share of claims surplus from carrier
o Monthly insurance premiums cover everything
o Limited access to claims / population health data
o No cost containment opportunities
o Medical renewal based off employer’s experience
HOPS. . . .
Healthcare Optimization & Profit Strategy
Fixed Premium & Administration Invoice
o Risk exposure is shared across 192 employers
o TPA/Stop Loss covers variable (claims) costs
o Employers retain 100% of unused claims funding
o Monthly premium equivalent covers everything
o $0 Virtual care + $0 Mental & Behavioral Health
o Full claims / population health data & reporting
o Integrated cost-containment lowers your cost
o Pharmacy carve outs reduce employer claims
o Block renewals based off experience of the pool
o Employer receives 100% of PBM rebates
o Accelerated & block underwriting – without apps!
o Ability to isolate brewery risk pool (SIC 2082)
NOT YOUR TRADITIONAL ASSOCIATION PROGRAM
H.O.P.S. provides a better alternative for businesses that feel trapped by the rising cost of health insurance. Leveraging our private brewery risk pool, we are transforming insurance from a cost center to a profit center, delivering multiple revenue opportunities back to our brewery clients bottom line, year-over-year.
Our unique self-funded solution mitigates risks, reduces claims volatility, controls costs, and returns savings back to your brewery.
From underwriting, to claims management and administration, H.O.P.S.’ holistic approach keeps it simple. Breweries have the benefit and protection of, multiple cost containment strategies, as well as powerful data & analytics for better and more predictable long-term decision making.
Our end-to-end support provides the flexibility and information you need to make fact-based decisions for happier, healthier employees, at the lowest cost.
2023 PROGRAM GAME CHANGERS
ONE-TIME BLOCK UNDERWRITING for any new members joining with a 7/1/23 effective date
Underwriting is simple, and only requires a member level census. Anyone joining after 7/1/23 can obtain a short or long contract to align with 7/1 going forward.
o Cost Efficiency offering 80-85% variable spend
o Best pooled risk/ROI model available
o Block renewals provide year-to-year stability
o Thorough, regular, and transparent reporting
o Turnkey solution enhances employee experience
50
310 STATES CITIES
192+
EMPLOYERS IN CURRENT RISK POOL
NUMBER OF LIVES COVERED
AVERAGE PROFIT DISTRIBUTIONS TO H.O.P.S. MEMBERS 10% $5.49M
PREMIUMS RETURNED TO COLLECTIVE PARTICIPANTS IN 2021
$1,000,000,000+
37,140+ MANAGED HEALTHCARE SPEN D
Pharmacy Benefit Management
H.O.P.S.’ integrated PBM partner provides your employees with great coverage and saves them money on high-cost and specialty drugs
PBM (Pharmacy Benefit Management)
H.O.P.S.’ pharmacy program specializes in Rx cost containment & member advocacy. Our customized solution reduces pharmacy costs while providing employees with a personalized member experience. As your pharmacy benefit management partner, your employees will have access to the following.
Drug Formulary Management
In-house formulary management provides greater flexibility and transparency of costs. Our program’s customer service department is staffed by certified pharmacy technicians.
PBM Rebates
H.O.P.S.’ pass-through PBM contract creates a revenue stream by re-directing quarterly PBM rebates from the insurance carriers, back to your brewery – reducing your healthcare spend.
Mail Service Delivery
Access to a self-owned and operated mail order pharmacy is convenient and delivers savings to your employees. Members have 24/7 access to consult with a pharmacist.
In-house Specialty Pharmacy
Allows the sourcing of high-cost brand and specialty medications, reducing claims costs and saving your employees money. In most cases, the member receives the medication at a $0 copay.
Variable Copay Program
Maximize specialty drug copay assistance programs and track member out-of-pocket costs with our specialty copay assistance & accumulator program. This proactively identifies available programs for your employees.
Diabetes Management
Diabetes affects one in 10 Americans and is the leading non-specialty drug cost driver. Our Diabetes solution is a comprehensive program strategically designed to improve member health education and outcomes.
$0 Copay Virtual Medical Care
Unlimited access to virtual medical care at no cost to your employees
$0 Copay Virtual Care At Your Fingertips
H.O.P.S.’ virtual care solution provides access to doctors and specialists available Nationwide and boast a 4.7 out of 5, average doctor visit rating. 24/7 Accessibility via the app, website or phone, with no pre-registration required. No matter what you’re facing, we’re available from wherever.
Common conditions managed through our virtual care service
o Abrasions / Lacerations
o Acne
o Allergies
o Asthma
o Bacterial Vaginosis
o Birth Control
o Bites and Stings
o Body Aches
o Bronchitis
o Cough & Fever
o Diarrhea
o Flu
o Frostbite
o Gout
o Headaches
o Hives
o Itchy Eyes
o Lice
o Medication Refills
o Migraines
o Nasal Congestion
o Nausea
o Pink Eye
o Respiratory Infections
o STD and STIs
o Sinus Infections
o Sinus Symptoms
o Skin Infections
o Sore Throat
o Sprains and Strains
o Travel Medications
o UTI
o Vomiting
How would you like to talk to a doctor? PHONE VIDEO Download the app today.
$0 Copay Virtual Mental & Behavioral Health
Unlimited access to virtual mental & behavioral health at no cost to your employees
Virtual Mental Health
When it comes to mental health, many people don’t know where to start to get the support and care they need. Our solution makes accessing mental healthcare easy. Available 24/7, Virtual Mental Health offers patients access to short-term, solution-focused counseling.
Our program’s licensed counselors hold master’s-level degree or above in counseling, social work, psychology or related mental health. Representatives assess patients’ concern and are available nationwide via app, web or phone to help with such mental health issues as stress, depression, anxiety, grief, marital, work and family issues, and alcohol and drug dependencies.
How It Works
o Patients initiate consults using the app, web or phone
o Consults with an appropriate licensed counselor are scheduled, if indicated
o Counselor consultations occur via phone or video
o Additional care, if appropriate, can be referred and coordinated with mental health specialists in patients’ health plans for higher acuity, or longer-term issues
o No limit on the number of different issues for which a patient may be treated
o No pre-defined restrictions on the number of total consults
o Available in English, Spanish and other languages
o Zero cost for employees and their family members
A virtual care solution for mental health
Ancillary and Worksite Benefits
H.O.P.S.’ Association Health Plan provides a national network with unique offerings for your employees
Save money on ancillary & worksite benefits with H.O.P.S.’ Association offer H.O.P.S. worked with our carrier partner to develop the most affordable and robust association products for the brewery community. Your employees will have access to a broad range of unique coverages, allowing them to take care of themselves and their loved ones. These wholesale discounted products were designed to meet the unique needs and demographic of the craft beer industry and are available on a National network.
Dental Accident Critical Illness Vision Short-Term Disability Hospital Indemnity Life, AD&D Employee Assistance Program Long-Term Disability
MULTI-YEAR RATE GUARANTEE WITH NO UNDERWRITING ELIGIBILITY GOES DOWN TO (2) ENROLLED PER LINE OF COVERAGE COVERAGES CAN BE ISSUED ON A COMPANY PAID OR VOLUNTARY BASIS
Healthcare Navigation
Paving the way to lower costs and happier employees
Smarter guidance. Better care.
H.O.P.S. healthcare navigation tool dramatically improves employee health by pairing every member with a live, clinical guide who provides on-demand, tailored support throughout their care journey. The user-friendly app and clinical-first care team act as a single point of contact to H.O.P.S.’ offerings, delivering care decision support, education, steerage to high-quality providers, billing advocacy, and increased utilization of point solutions.
Educated, engaged members.
We actively educate and engage with members, driving them to utilize the service whenever a medical need arises.
A mobile-first front door to healthcare.
H.O.P.S.’ modern technology serves as a central hub for all healthcare and benefits information, making it easy for members to navigate.
Data-driven personalization.
Business rules route members to the appropriate care team member and turn robust data inputs into high-impact health guide intelligence.
Smarter clinical navigation.
Our clinician-driven delivery model combines dedicated human guidance with a proactive outreach informed by proprietary risk scoring.
Member realizes a medical need.
Members can access via an intuitive app.
Intelligent routing to the appropriate team member.
Clinician provides 1:1 support to member.
Best-In Class Data & Analytics
H.O.P.S. Data & Analytics provides actionable insight for your brewery, and for the craft beer industry as a whole.
H.O.P.S
Decisions .
Brewery program will not only provide you with the best data and analytics tool in the industry, but our brewery practice group will be able to pull analysis reports across the entire pool of participating breweries, allowing us to identify trends, and areas for program improvements year-over-year.
Success stories from our H.O.P.S clients
The impact of managing risks vs. managing rates
ISSUE EFFECT REMEDY
Brewery with 64 enrolled employees, received back to back renewals of 24% + due to a high-cost medication accounting for 52% of their monthly premium cost.
The member was hitting their out-of-pocket max in order to receive their prescription. The claims impact of the specialty drug was not leaving room to cover basic plan utilization.
The medication was sourced through a patient assistance program, eliminating the claims impact to the plan and providing the member their prescription at no cost.
ISSUE EFFECT REMEDY
Brewery with 20 enrolled employees had two high-cost claimants in their first year which led to a 65% increase at their renewal.
Competitive carriers declined to quote due to such a high renewal, so the brewery had to scale back the benefit plan to a high-deductible (HSA) plan.
Brewery moved into our program and was able to offer a much richer plan for their employees, at a significant cost reduction to the brewery.
HOW DO WE GET STARTED?
1) Provide a census for all benefit eligible employees: click here to download the H.O.P.S. census template Once completed, click here to securely upload your census
2) Underwriting Review / Quoting Process
Once submitted, the standard turnaround time is 3 -5 business days to receive a proposal. *Rates subject to change based on census changes and/or final enrollments.
3) Review available plans and make decisions
Our team will illustrate available plans and review the employer and employee costs - based on your contribution strategy.
4) Book employee open enrollment meeting
Our team will provide a customized Employee Benefits Guide, as well as an online enrollment system. Employee open enrollment meetings will either be conducted online or in-person, depending on location. We will review all available benefits in these meetings, so employees feel confident in their elections.
Implementation Timeframe & Process
The average time from submission (all completed employer paperwork), to your go-live date is approximately 10-15 business days.
The delivery of employee ID cards averages 7-10 days after a complete employer submission (all documents & signatures) has been received. Temporary cards available within a week.
Rodney Westbury, Jr. | Partner Brewery Practice Group Leader rwestbury@sspins.com
404-993-2188
Serve
Pamela Downs | Client Service Executive Brewery Practice Group Service Lead pdowns@sspins.com
678-832-8651
Debbie Fazzone | Employee Support Senior Client Service Assistant & Training Specialist dfazzone@sspins.com 404-995-1792
Sterling Seacrest Pritchard
Atlanta | Tampa | Savannah | Columbus | Birmingham | Little Rock
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Be StrongerTogether
Sterling Seacrest Pritchard’s Brewery Practice Group
Stronger. Together. sspins.com
