Success Stories - Lafayette General Medical Center
Lafayette General Medical Center is a self-funded, Louisiana-based healthcare company with 2,500 (employees and dependents) lives. In 2003, prescriptions were still covered under the traditional major medical plan with a deductible and coinsurance and the hospital had never offered a pharmacy card program. Competition in the work force was the catalyst for driving the benefits team to consider a pharmacy card program. With no data available on member utilization, implementing a separate pharmacy card program was a major concern for the hospital. Members had to see the program as a benefit without exposing their plan to significant cost increases in the first year while data was being collected.
Ginger Campbell, BancorpSouth Insurance's pharmacy benefit consultant was hired to help them evaluate if they could implement a pharmacy card program given their cost and benefit constraints. By developing a predictive model to reflect typical utilization and costs for a group of this size in the healthcare industry, Ginger was able to illustrate the cost exposure of a claims fluctuation of +/-20% that gave the CFO the confidence to implement this new program.
This type of case can be difficult. It requires an ability to understand the employer's concerns and priorities. Ginger helped this client meet their goals of improving the benefit plan in the eyes of their employees and she did so without increasing their costs. Pharmacy costs were actually reduced by 30% in 2004, with no decrease in membership. In addition, Ginger provided the client in 2004 with over $66,000 in annual rebates from the pharmacy benefit provider she put in place.
To keep a close watch over costs, Ginger continues to use the client's data to formulate her own predictive plan modeling and trend analysis. She has been able to accurately predict future pharmacy benefit claim dollars each year to keep this group within their pharmacy benefit cost budget. For 2006, the actual claim dollars came within $1,000 of the predicted cost with an annual drug spend of just over $1 million. Lafayette General Hospital's pharmacy benefit cost increase for 2006 was only 3.8%, versus the double-digit increases most employers experienced.
