Episode 30 – The Client Solutions Difference

Mike Stull (0:00) 

Hi, and welcome to this month’s episode of the Employers Health HR Benecast, your source for expert commentary and insights on current health benefits-related news and strategies. This is your host, Mike Stull.  

We just had our first in-person event in more than two years, and it was so great to see so many of you there. If you couldn’t join us, we’ll have a virtual option available beginning April 6th. Be sure to register to hear about all things affecting pharmacy benefits management, including biosimilars, regulatory actions, gene therapy, and more. We also had an employer panel at the end of the day that received fantastic feedback from our audience, and I really thank all three employers who participated on that panel. 

And if you’d like to join us in person, the 22nd Annual Innovations in Benefits Conference will be May 18th in Canton, Ohio. We’ve got a fantastic lineup of speakers covering the value of virtual care, meaningful mental health benefits, and the importance of world-class communication during a time of change. Visit employershealthco.com/benefitsconference to learn more and to register. 

If you haven’t already, I encourage you to listen to the last episode of HR Benecast, where I answer some of the questions we frequently receive from clients and consultants. We had a number of entries into our drawing from that episode, and I’m happy to announce that Allison Franklin at Intuitive Surgical was our winner. Allison submitted the correct keyword and will receive a $50 Amazon gift card. Congratulations, Allison. If you have questions you’d like answered on a future Ask Mike Anything episode, please submit them on the Employers Health Podcast landing page or email them to Emily Clevenger at eclevenger@ employershealthco.com, again, [email protected]. Be sure to listen for the keyword in this episode and enter for your chance to win. I’ll share the keyword later in the show or even during the interview, so be sure to listen closely. 

On today’s episode, I’m talking with Zach Hostetler, Senior Vice President of Client Solutions here at Employers Health. Zach leads the EH Client Solutions team in their work managing vendor relationships and providing strategic and tactical support to clients as they work to provide high-quality health benefits at a sustainable cost. He’s here to share what the team’s growth means for Employers Health clients and their consultants, the challenges we’re seeing, and some of the innovative approaches employers are taking to combat rising health care spend. 

All right, well, welcome, Zach. Could you start by just giving a quick introduction of yourself? 

Zach Hostetler (3:00) 

 Yeah. So, Zach Hostetler, Senior Vice President of Client Solutions. I’ve been with the coalition for almost eight years now, based out of our Canton headquarters, and very excited to be here with you today, Mike.  

Mike Stull (3:17) 

Great. So, let’s get started. 

The Client Solutions team, a lot of growth on this team, 20 team members by the end of next month. What does this all mean for Employers Health clients? 

Zach Hostetler (3:26) 

 Sure. Before I talk about that from a service standpoint, I just want to talk about the overall growth of the coalition that’s causing that growth for the team. 

So, the organization has, year over year for the last three years, had record sales years. And, you know, I’ve heard before that people think that we’re being boastful when we’re telling them about our growth and how successful we’ve been despite the pandemic. And I always have to remind people that we’re not doing that to pat ourselves on the back. But the reason we do that is because we are a group purchasing organization, and the leverage that we’re able to achieve by our continued growth is really beneficial to the coalition and then each individual employer that participates in our program. So, it’s really that continued growth that’s pushing us to add more team members, because as the book continues to get larger, we need to add additional team members to support those clients.  And, you know, it was kind of easy during COVID when we weren’t getting out there and meeting with groups in person, because you could have meetings on opposite sides of the country before lunchtime on the same day. And now we’re back to meeting with groups in person, which we absolutely love doing, and we’re very excited to get back out there again. But as a result of that, we, you know, are spending a lot more time on the road, and that’s not the most efficient use of time to be able to do the work that’s required for our clients. 

So, this is going to lead to, you know, better engagement with the Client Solutions team, and it’s going to free up some of the capacity of some of our more senior team members so that instead of them being or working on clients on a direct basis, as they maybe have previously, it’s going to free them up to work with some of our large consulting firms that we work with very closely, work with a lot of the clients that fall under their individual team members’ books of business. So, we’re able to do a lot of things with that. 

We’re also, I guess, maybe a month or two ago, we had someone come in and do some client centric training for the team. So, some active listening and how to understand the individual client goals. So, when we’re out there during your annual reviews and asking you what are your goals for this year? What’s bothering you? What’s keeping you up at night? And, you know, oh, the answer is always, oh, we want to cut costs. And we are sitting there trying to, like, really pull some more out of you because we want to really understand how you are evaluated in your individual role and what we can do to help you be successful over the next year. We’re not doing that just to be nosy or not doing that just simply to fill time at the beginning of the meeting. I mean, we genuinely want to know what those items are so that we can be that better vendor than what you’re used to working with on a day in and day out basis. 

Mike Stull (6:35) 

Yeah, definitely. When we understand what’s important to each of our clients, it helps us to make more efficient use of their time by prioritizing the things that we think and know are important because they’ve told us that they’re important.  

So, when you look at the clients your team serves, speaking of client priorities, when you look at the clients that the team serves throughout the country, is there a common issue that you see or that the team sees that these clients are encountering?  

Zach Hostetler (7:08) 

Well, I don’t think that this one’s going to come as a surprise to you or certainly to the listeners, but specialty is the one that is kind of the obvious answer. 

Mike Stull (7:18) 

I was going to guess specialty.  

Zach Hostetler (7:21) 

Yeah. So, nothing groundbreaking here, but we can’t have a review without that being the main focus of the conversation. And some groups are continuing to be very lucky, I’ll say, and maybe their specialty spend as a percentage of their overall spend continues to be relatively low. Some are seeing higher trends, but they’re just now getting up to, the kind of, the benchmark where the rest of the book of business is. But that tends to, you know, all of our conversations tend to center around specialty. 

And then groups are always very interested in what they can do to help curb the cost of specialty medications and whether that’s looking at the options within their current vendor, whether they’re looking externally at different vendors, trying to find ones that will integrate within the current vendors, I mean, they’re looking at all of those different things. So that’s kind of the easy answer. 

I’ll say anecdotally, because this comes from a meeting that I was just in on Monday, but I really appreciated this employer’s perspective, was, so this one mentioned that they struggle to always remember what all of the options are that are available through their current vendors. So, they’re very happy with their medical vendor, they’re very happy with us on the pharmacy side, but they said that, you know, after they’ve been with these vendors for a very long time, sometimes it’s a challenge to remember what options are available through their vendors. So they hear these grand and wonderful things that other vendors can do, but they always want to take a step back and ask and try to understand what options are available through their current suppliers, because perhaps this was something that they completely dismissed three years ago, and it just has never been brought up again, but they want to be aware of those things. And that was a perfect segue into our continuum slide that we always bring out to reviews to just kind of go over at the highest level what all of the options are that are available to our clients, because it is easy to hear a great new story from a new vendor of what they’re doing, but in a lot of instances, some of those are things that are already available through your current vendors. So, making sure that we’re doing an effective job of keeping that stuff front and center for our clients is going to be something that we need to continue to focus on. 

Mike Stull (10:02) 

Yeah, the bright new shiny object tends to get a lot of attention, and sometimes you don’t realize that you have one of those in your toolbox already. So, it’s good to continually remind people. I know a lot of the carve-out versions that we’ve seen, particularly a specialty carve-out, a lot of the savings come from copay coupons, and all of the PBMs have copay coupon programs now, and variable copay or copay maximizer programs. Some comes from specialty PA, but there’s only so much denying of medication that you can do, and so making sure that you understand what the specialty PA looks like, what the criteria look like, what the approval rates look like, and what the opportunity looks like to improve, you need to understand that first with your current vendor before you decide to carve out. Any other ways that Client Solutions is working with these clients on these issues around specialty or around cost?  

Zach Hostetler (11:12) 

Yeah, I think at the most basic level, one of the things that we do for all of our clients is that high-cost claims reporting that we run on a weekly basis, and hopefully you’re not getting that report on Friday from your Client Solutions team member, but if you are, that’s one of those ways that we are just trying to keep that information at the forefront, make sure that our clients stay informed so that if they get a question internally that they are prepared to answer it, they understand what that is, why they’re seeing that on their plan, and if it’s something that can be managed or if it’s just one of those unfortunate realities of offering a drug program to your employees. So, that’s kind of at the most basic level of just keeping our groups informed so that there are no surprises. 

But then, you stole part of my answer there a second ago with some of those offerings that are available through the PBM programs that we work with. So, the true accumulation programs, the variable co-pay programs, or even a step further like a Prudent Rx, if you work with CVS, all of our PBMs offer some form of these types of programs, and we’ve seen a lot of success with those programs, and as you mentioned, a lot of the savings that come from some of the more aggressive vendors that are claiming to do a little bit more, a lot of it is coming from those co-pay dollars. So, effectively managing the co-pay value that’s being offered from the pharmaceutical manufacturers, I think, is really the first step. 

And, I mean, we have a client right now that was doing something a little bit more aggressive as far as managing specialty, and I think that they have not found that the disruption has been worth the savings that they’re seeing. So, they’re now evaluating whether or not it makes sense to drop that and continue with more of a traditional approach because they’re just seeing a lot of disruption, and the value was not there that they thought they would see at this point in the program. So, we’re more than a year in, and the savings just haven’t been there. And certainly, that’s an n of 1.  

So, there are certainly other instances out there. And if, you know, working with our Elixir program, I know that it works with some of those different advocacy vendors. So, you know, we do have the ability to offer some of those programs to date within the coalition. We don’t have anyone working with those programs yet, but those are offerings that continue to be on the table for our groups that want to continue to work with Employers Health, want to have a very managed contract on the back end. That’s something that is often sacrificed when groups are moving to one of those specialty programs is, you know, what type of program or what type of contract, excuse me, do you have that is supporting you on the back end for all of your non-specialty drugs or in the event that someone doesn’t qualify for those patient assistance dollars, you know, what contract is going to be used in that instance. And often, those are not nearly as tightly managed as the Employers Health contracts are. So, those programs that are available through ours are then, once again, backed up by a very tightly managed Employers Health contract. And then, you know, as I said, just keeping all of our recommendations and all of the different things that Employers Health has at its disposal, whether it’s a program through the PBM, whether it’s an ancillary vendor that we are offering to our clients, just keeping all of that top of mind.  

Mike Stull (15:11) 

Yeah, I think one of the most exciting things that we can share with clients today is that we really are developing a menu of options as it relates to specialty pharmacy. So, for those groups that are with CVS or Optum, we have, you know, standard programs through the PBMs in terms of prior authorization. We have concurrent prior authorization. We have the copay maximization programs, the true accumulation, all of those types of things. 

And then, the Elixir option offers us a couple additional features like a best-in-class specialty network, so that takes advantage of specialty pharmacies that specialize in a particular disease state. And also, as you said, Zach, the ability to carve out to alternative payment vendors, APVs, as Elixir likes to call them, the alternative payment vendors to tap into some of the foundation dollars or the needs-based assistance dollars that, you know, really, if you have a population that qualifies, I mean, groups are seeing some pretty big savings there. So, obviously, there isn’t a one-size-fits-all, and so creating a menu that allows groups to pick what’s right for them and what helps achieve their goals is something that we’ve spent a lot of time over the past year trying to develop. 

So, you talked a lot about, you know, seeing success with some of the programs. Do you have any specific results that you can share?  

Zach Hostetler (16:50) 

Yeah. So, with one of the programs in particular, I can share our updated savings numbers. So, with respect to specialty and managing to those co-pays and getting the full value in those instances where they’re available, our book of business has saved over $23 million from that program. So, that $23 million is spread across 44 clients right now, and that’s kind of a maximum timeframe of, I guess, about 18 months at this point. So, that’s a lot of money that has been saved. So, for those clients that had the program in 2021, they saw a decrease in their specialty trend of 3.9% and an average savings to their overall specialty of almost 20%.  

Mike Stull (17:48) 

So, let me just make sure we get this right. So, the trend, year-over-year trend for specialty for these clients was a negative 3.9%.  

Zach Hostetler (17:58) 

Yes. 

Mike Stull (18:00) 

That’s awesome.  

Zach Hostetler (18:02) 

Now that I think back, I didn’t say that appropriately, so thank you for clarifying that. Yes, a negative specialty trend for the groups that have implemented that program. 

Mike Stull (18:11) 

Yeah, that’s awesome.  

Zach Hostetler (18:15) 

Yeah. As far as hard numbers go, those are the statistics I have. I can just say that we’ve had a lot of groups look at these programs and question, what’s the catch? How am I saving this much money? You’re claiming that there’s no disruption or that there’s going to be an actual financial benefit to the individual. The best thing I can say is, ask your client solutions representative from Employers Health to hook you up with someone that can serve as a reference that has already implemented this program. We have a lot of groups that have seen a lot of success with these, and they are the best advocates of the programs because it really is working better than anticipated, and they’re seeing higher levels of savings. It’s kind of funny that yesterday, I heard after a client meeting that we had a client that was actually complaining that the savings were higher than what was forecasted in the savings analysis before implementation. So, I’m not sure why he wasn’t happy about that, but he did have some words about the fact that the savings ended up being higher. So, I can’t promise that that’s going to happen to everybody, but in that one example, that was the case. 

Mike Stull (19:42) 

Very good. So, we talked a lot so far about what we’re working with clients on the PBM side. What else outside of PBM are our client solutions team members working with clients on? 

Zach Hostetler (19:56) 

 Yeah, so loosely tied to the PBM program, there still remains a lot of questions around the impact of COVID and the trends that we’re seeing, whether it’s related to vaccines or the filling of the tests that are now available. We do get a lot of questions about that. A lot of our touch bases with clients still focus on a lot of the metrics that I spoke of a second ago with respect to COVID. So that’s still very much a topic that is of concern to a lot of our employers. 

But as far as new solutions that we’re bringing to our clients, we started last year working very closely with Quantum and now have that as a preferred offering for our clients. So, I’m sure most of the people listening in are very familiar with Quantum. But for those of you who are not, Quantum is a healthcare navigation company. So, it works with your members to help them navigate the complex healthcare system. So when someone finds themselves in a position where they are needing to use the healthcare system or needing to use the health benefits that you offer them, Quantum is that one-stop shop for everything related to the benefits that you offer, whether it’s your medical plan, your pharmacy plan, any kind of point solutions that you’re offering. It is integrated with all of them and serves as the one phone call that you can make and have all of your questions answered and help people navigate a very complex system. So, a lot of our groups that are looking for a more integrated option, when they are carving out pharmacy and having that separate from the medical, that’s something that we continue to hear. This is a good landing place for those clients to evaluate whether a navigation service makes sense for their plan, because that gives them the best of both worlds. They can have that integrated feel of a carve-in while still take advantage of the cost savings and the plan management opportunities that are available for clients that carve out their pharmacy from their medical carrier. 

Mike Stull (22:25) 

Sounds exciting. All right. So, I think we’ve hit it all. Is there anything we missed?  

Zach Hostetler (22:32) 

I don’t think so. I think that’s all I came with today. Unless you want to talk about the new Star Wars show on Disney+, I think that that’s probably the only other topic I’m ready to talk about today. 

Mike Stull (22:44) 

We will save that for another episode. But it’s certainly an exciting time to be here at Employers Health, as you mentioned in the beginning. A lot of growth, a lot of new faces, a lot of changes. But at the end of the day, still trying to better outcomes, better experience, lower cost. And the Client Solutions team definitely plays a big role in helping our clients achieve all three of those goals. So, we really appreciate it. 

I hope you enjoyed hearing from Zach. It’s great to hear how our clients and team members are coming together to help achieve their goals while working to reduce health care costs. 

 Before we move on, I want to share the keyword for this episode. Today’s keyword is Innovations. So, if you’d like to be considered for the $50 gift card, please submit the code word Innovations, along with your name and email address using the link on the landing page. 

 For those who can’t make the trip to Ohio, we’ve got a great lineup of virtual events scheduled. As I mentioned before, the Virtual Pharmacy Benefit Conference will be released on April 6th. So be sure to check it out. On April 7th, join us for a webinar on the value of vaccines beyond the pandemic. And April 26th is the last in our three-part sightline series when I’ll be joined by Matt Harman as we discuss specialty management strategies. If you missed the first two webinars in the series on Contracting and PBM Fundamentals, the recordings can be accessed on the Resource Library section of our website. You can register for all upcoming events at employershealthco.com/events. 

Before we go, don’t forget to submit your questions regarding HR benefits and the value of group purchasing pharmacy benefits. You can do so by completing the field on the landing page or clicking the link titled Submit Your Questions Here. And then be sure to tune in to our next episode to hear the answers to your questions. 

There’s always something new at Employers Health, so be sure to follow us on our social media accounts, LinkedIn and Twitter to stay up to date.  

That concludes this month’s episode. Thank you for your insightful questions. Thank you again to Zach and thank you for taking the time to listen and for your continued membership, participation and interest in Employers Health.

Be well and we’ll see you soon.