How This Houston Group Saw 40% Reduction In Claims Spent In Year 1
Achilles Group saved $300 per employee in claims spent in year 1
Who Is Achilles Group?
Achilles Group is a human resources management company based in Houston, Texas. They offer a unique approach to HR business solutions by designating an HR professional to manage the relationship, work directly with the leaders, and create custom solutions for organizations.
When evaluating their benefits strategy, they worked with an experienced broker at Higginbotham, to build a powerhouse health benefits strategy. As a fractional HR expertise provider emphasizing direct relationships, Achilles Group knew they wanted their health benefits to reflect that same value.
They strategically provided employees on the health plan with a First Primary Care membership to improve access to premium care, reduce claims, and help guide their people to the best outcomes for the lowest cost.
“Regardless of size, Direct Primary Care is foundational in designing a
High Performance Health Plan – Employer Built, Not Carrier Built.”
– Michael Avenevoli, Broker
Achilles Group
Employer-Built Plan
Value-Based Primary Care
- $0 Unlimited primary care visits
- $0 Unlimited virtual visits with primary care doctor
- $0 Annual labs
- No long waits
- Advocate for total health and wellness
Brand & Specialty Rx Program
- $0 Generics
- $0 Brand-name drugs available through international mail-order program
- Specialty Rx program designed to mitigate cost against the plan and allow for little or no out-of-pocket expense to member.
Pre-Planned Surgical Solution
Healthcare is one of the few industries where the consumer does not know the cost of service before receiving care. This surgical solution allows members to have surgeries performed for $0 out of pocket.
- Breast
- ENT
- Face
- General (including bariatric)
- GI Endoscopy
- GYN
- Orthopedics
- Pain Management
- Spine
Open Transparent Network
- Transparent pricing for all facilities
Diagnostic Imaging Solution
$0 Diagnostic Imaging
- MRI
- CT
- Ultrasound
- XRay
- PET
- Nuclear Medicine
- Mammography
- And more…
The Results
After Achilles Group decided to offer First Primary Care for primary care benefits, they selected an innovative third-party administrator who fully embraced the benefits of direct primary care to set up and manage a level self-funded group plan. The plan design incentivized First Primary Care usage over the traditional medical options included in the plan so that employees have great options all the way around.
After over a year with this strategy, Achilles Group came in almost $2,500 Per Employee Per Year under their projected spend amount in 2021. It greatly enhanced their benefits from their previous “Carrier Built Plan.”
First-Year Results
2020 Plan Year Claims Paid
Total Claims Paid = $103,000
$244.89 PMPM
| Health Plan Snapshot | Reporting Period (February 2021-March 2022) |
|
| Group | Benchmark | |
| Medical Claims Paid | $50,355 | – |
| Pharmacy Claims Paid | $11,744 | – |
| Total Health Claims Paid | $62,099 | – |
| Subscribers | 14 | – |
| Members | 36 | – |
| Member Months | 458 | – |
| Average Family Size | 2.57 | 1.95 |
| Inpatient PMPM | $45.65 | $113.89 |
| Outpatient PMPM | $25.03 | $169.56 |
| Office Visit PMPM | $39.27 | $71.46 |
| Medical Claims PMPM | $109.94 | $354.92 |
| Pharmacy Claims PMPM | $25.64 | $103.39 |
| Medical & Pharmacy Claims PMPM | $135.59 | $458.31 |
40% Reduction in Claims Spent Year One
First Primary Care can be the foundation of any customized health plan, fitting any unique workforce, goals, and budget.
Find out how much you could save in just one year with First Primary Care.