Collaboration Identifies Crafted Solutions for Client to Recoup Losses from State Regulations Medical Center, a public non-profit teaching medical center in Flint, Michigan with 5,500 members, was reeling from a sizeable financial loss caused by the implementation of new state regulations. While the medical center has been a client of Elixir since 2010, it was initially as part of a healthcare purchasing coalition with a set benefits structure. Once the coalition dissolved, Hurley Medical Center partnered directly with Elixir and discovered that their pharmacy benefit manager could provide a tailored solution to recoup some of those losses.

"Working directly with Elixir opened up a whole new opportunity to save. Prior to this partnership, we did not get the same attention, not even the transfer of knowledge of all our options." - Summer Jenkins, benefits, compensation and recruitment manager for Hurley Medical Center

Narrow Network Offers Unique Savings Solution

Utilizing a consultative approach, Elixir conducted a careful analysis of Hurley Medical Center’s claims and their dedicated Elixir account team suggested implementing a narrow pharmacy network as a way to save money with little member disruption. Pharmacies are generally willing to provide deeper discounts if they are part of a narrow network of providers, bringing significant savings for both the plan and the member.

The account team worked with Elixir’s Finance and Provider Relations departments to model narrow network options that would drive the greatest potential savings. They analyzed the plan’s current pharmacy mix and looked for the best network option to balance savings and member access. After this in-depth review of the plan’s current pharmacy utilization, it was decided to remove two national pharmacies and make Rite Aid the primary retail pharmacy chain. This narrowed the network by less than 30%, leaving 45-50K pharmacies for members to choose from. Rite Aid has a prominent presence in Michigan and, as the parent company of Elixir, was able to work with Hurley Medical Center to create a smooth transition for members and provide significant savings.

Custom communications were sent to members, alerting them of the transition. Additionally, Rite Aid associates reached out to affected Hurley Medical Center members directly to offer to transfer their prescriptions. In addition to aggressive rates on prescriptions, Rite Aid provided more savings opportunities to members through their Wellness+ program and gave welcome gift baskets to members when they came into a pharmacy to fill their first prescription. Signage welcoming Hurley Medical Center was also displayed in Rite Aid stores to further improve the member experience.

More than Money: Increased Member Engagement

Within the first nine months of implementation of the narrow network, Hurley Medical Center saved nearly $124K and members saved almost $54K on prescriptions.

Thanks to the assistance of Rite Aid in transferring prescriptions and providing other incentives, the switch to a narrow network was well received by members.

“Our expectation was that we were going to get high pushback because we have a strong union presence (nine different unions),” explained Jenkins. “But we did not see that push back because of the workarounds we came up with and the extras that Rite Aid provided.”

Jenkins went on to explain how word traveled quickly through Hurley Medical Center’s grapevine about what a positive experience it was. While one retired member living in Florida did have a concern, Elixir immediately stepped in and found a network pharmacy equal distance to the pharmacy the member had previously been using.

Savings Solution Leads to Increased Opportunities to Improve Care

With the success of the narrow network, Hurley Medical Center is now implementing Rite Aid’s Rite Care program. This community-based program empowers the Rite Aid pharmacist to provide one-on-one counseling to members affected by three common disease states with which members are having adherence issues. Lack of medication adherence has been another concern for Hurley Medical Center and this program is estimated to increase their adherence rates by 5% once implemented, which will improve overall care and costs.

“Working with Elixir, everything we’ve done has been easy for me,” Jenkins said. “Elixir provides all the necessary reporting, so I have all the information I need. When I want or need something, I just tell the Elixir team and it gets done. It’s exactly what any benefits manager wants.”

Through a consultative approach between Elixir, Rite Aid and Hurley Medical Center, the client was able to realize the savings they were looking for while still maintaining quality benefits for their members. In fact, the perks provided made it a positive experience for the members. And because of this strategic partnership, even more synergies are being pursued that can improve member care as well.