Summit creates innovative solutions that empower Native nations and large organizations to reduce costs and optimize benefits.
THE CHALLENGE:
Tribal nations face unique challenges in balancing sovereignty with federal and state healthcare regulations.
Rising medical costs threaten the sustainability of self- funded tribal health plans, with providers often charging far above Medicare rates.
Unequal access to benefits creates gaps between Native citizens with CDIB cards and non-Native employees. Pharmacy costs remain a major concern, limiting access to affordable medications. A solution was needed—one that honored sovereignty while ensuring cost savings and equitable care.
WHAT WE DID:
Summit worked closely with tribal leadership, insurers, and healthcare providers to create a tailored solution. Our strategy centered on bridging the gap between sovereign benefits and non-Native employee coverage while controlling rising healthcare costs.
To address high medical expenses, we developed a new provider network designed to significantly reduce claim costs without sacrificing quality of care. By leveraging innovative contracting, we secured lower reimbursement rates that aligned with the tribe’s financial goals.
No other firm had created a solution like this— Summit structured a first-of-its-kind network that balanced cost savings with the unique rights of tribal members.
We also collaborated with tribal health leaders to integrate their pharmacy system into a broader insurance network, allowing eligible members to access prescription medications at dramatically lower federal pricing. Through strategic partnerships and negotiation, we built a sustainable framework that honors tribal sovereignty, expands equitable benefits, and controls costs—positioning the tribe’s healthcare system for long-term success.
THE RESULT:
With our strategy, the tribe reduced healthcare claim costs by an average of 77%, cutting expenses from typical rates of 180– 225% of Medicare down to just 103%.
This innovative approach not only preserved financial resources but also ensured equitable access to benefits for both Native and non-Native employees. Additionally, by integrating the tribal pharmacy into the network, prescription costs dropped to VA federal pricing levels, generating substantial long- term savings for the entire health plan.
