Summit understands that it is not just about the size of the solution— it’s the precision of the approach.
THE CHALLENGE:
A large manufacturer with thousands of employees faced significant challenges in controlling healthcare costs. Their self-funded health plan, administered by a major insurer, offered little transparency, restricting access to claims data and preventing cost validation.
Without clear insights, the company struggled to identify savings opportunities or effectively manage their healthcare budget.
Seeking a transformative solution, they set out to eliminate the insurer as a middleman, taking full control by administering their plan in-house and leveraging their own clinical staff and expertise.
Summit Financial Group partnered with them to create a sustainable, innovative strategy to achieve their vision.
WHAT WE DID:
Summit developed a comprehensive strategy to enable a large energy manufacturer to take full control of their benefits administration. The plan was segmented into eight critical components, with a primary focus on implementing a flexible, real-time claims payment platform to support in-house management.
To achieve this, Summit crafted a customized RFP to evaluate claims payment software designed for direct administration, eliminating reliance on traditional insurers or third-party administrators.
Once selected, the platform was seamlessly integrated into the company’s IT framework, empowering their clinical team to manage claims in real time. This included negotiating pricing, addressing high-cost claims, and ensuring employee coverage with precision and efficiency. The result was a transformative shift in benefits management, providing transparency, cost control, and enhanced employee advocacy.
THE RESULT:
The real-time claims management system delivered $30 million in annual savings, with continued growth projected.
This transformation delivered unmatched transparency, enabling real-time insights and precise cost control. The firm reduced administrative delays while enhancing employee advocacy, raising the standard of care. These results demonstrate the impact of innovative healthcare solutions on savings and operational success.
