Case Studies

Case Studies

Consider what CME has done for others

CME was asked to assist a group of 35,000 lives with an overhaul of its health and welfare plans in order for the group to remain competitive and cost-effective in the marketplace. CME analyzed the plans and suggested several changes that resulted in savings of almost $80 million over a 10-year period for dental, vision, and prescription drug alone. CME also helped the group revamp its workers compensation program, while saving in excess of $100 million over that same period and turning the group’s program into one of the nation’s finest and most emulated.

A group with 8,000 lives was concerned about the impending increases in its prescription drug plans. CME analyzed those plans and undertook a comprehensive RFP process to obtain competitive bids for the group’s renewal. Without changing the group’s plan design, the resulting renewal cost savings were over $1.7 million when compared to the prior year.

A local company was growing nationally through internal growth and acquisitions. As the number of their locations increased, CME was able to identify the most appropriate networks for the company to utilize. CME completed analyses that enabled the client to consolidate several plans into one plan; thus, standardizing the benefit coverage for all employees as well as generate significant administrative savings for the client. This ensured a seamless implementation for the client and has resulted in the best possible coverage for employees, who are spread across the country.

With another large municipal employer, CME was asked to review the group’s existing self-insured prescription drug plan. CME initiated a comprehensive RFP process that required each vendor to unbundle all elements of its pricing. In addition, CME required each vendor to actually re-price every prescription drug claim that the client had incurred in the prior year, using the pricing they were proposing. As a result of this RFP process by CME, the client saved nearly $2 million per year.

A CME client was involved in a billing dispute with a large insurance carrier. By the time CME was notified, the dispute had grown in excess of $917,000. This amount had been developing over years and CME determined that it would be both difficult and time consuming to reconcile accurately. After working with both parties to identify the full scope of the problem, as well as possible solutions, CME arranged a meeting with the carrier and the client. As a result of CME’s research, recommendations, and ongoing business relationship with the carrier, the disputed difference was reduced by over $433,000. This not only saved the client $433,000, but also the countless hours they would have needed to reconcile the accounts if CME had not been able to broker this agreement. As part of the agreement, CME also negotiated for the carrier to both accept a monthly electronic file from the client and reconcile that data with their own system, so that any discrepancies could be handled immediately. Accordingly, the client and the carrier’s eligibility and billing are now in sync and future discrepancies will be better resolved with ease and efficiency.