Health Plan Retains 5,000 Member Group with Carve-in Opportunity

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Life Health Plan
Self-funded Lives
  • Developed support structure for ​all renewals and new membership carve-in opportunities​
  • Engaged to assist with group retention strategy
Retained Client with Increased Profitability

AlignRx helped this health care plan retain a 5,000-member group with an interest in carving out prescription services. The client sought assistance in navigating the current prescription market and received a proposal from a coalition offering that would seemingly alleviate their concerns.

On behalf of the health plan, our pharmacy consultants collaborated with the client, providing additional insight into the offering to help them understand that the coalition would exclude several specialty drugs and, while the savings might appear great on the surface, those savings were inflated and not aligned with their interests.

AlignRx provided the health plan with the market context to rethink the carve-out option and helped enhance their internal capabilities around tiered pricing, formulary strategy, sales, and marketing options that would shine a light on their clinical savings guarantee. We leveraged our unique ASORx 360 solution to develop a dedicated support structure that would keep groups carved in and create a group-retention plan that encompassed all renewal and new carve-in membership opportunities.

We also provided underwriting support and creative ideas to make their RFP proposals compelling to new and existing businesses. Our team provided insight on how they should price their groups and offered marketing recommendations around different programs that they could provide, such as specialty co-payer solutions and clinical guarantees, that would add value and attraction to their RFP offerings.

AlignRx’s engagement resulted in the development of a comprehensive financial proposal with market competitive guarantees, increased client retention, and a significant increase in profitability.

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