23% Claims Reduction, 40% Fewer ER Visits

The Challenge

The irony wasn't lost on anyone. This regional healthcare network — spanning 2 hospitals and 6 outpatient clinics — spent its days helping patients get healthier while its own employees struggled with:

• High-deductible plans that discouraged preventive care — nurses and support staff skipping their own prescriptions because of out-of-pocket costs
• ER overuse for non-emergencies — staff and their families using the ER for issues that could've been handled by a telehealth visit or urgent care
• Rising claims year over year — a pattern of reactive care creating a compounding cost problem
• Burnout-driven turnover — healthcare workers leaving for employers with better total compensation packages

The Solution

Optiv Health layered a Section 125 supplemental plan on top of their existing coverage. The plan was specifically designed for healthcare organizations where employees understand the value of preventive care but can't always afford it under their own deductibles.

• $0 copay prescriptions — covering chronic condition medications that nurses, aides, and administrative staff were rationing or skipping entirely
• 24/7 telehealth for employees and dependents — reducing the instinct to "just go to the ER" for after-hours issues
• Pre-tax deductions generating immediate FICA savings for the organization
• Preventive care emphasis — annual wellness visits, screenings, and chronic disease management included at no cost

The Results

Claims Impact

Metric	Before	After (12 Mo.)	Change
Total Claims	$2.1M	$1.62M	-23%
ER Visits (non-emergency)	312/yr	187/yr	-40%
FICA Tax Savings	—	$41,310/yr	New
Total Annual Savings	—	—	$289,000

Operational Impact

• Medication adherence among staff up 71% — when the people dispensing medication can actually afford their own, outcomes improve dramatically
• Sick call-outs down 28% — healthier employees showing up reliably, reducing the scramble for shift coverage
• Telehealth adoption at 89% — employees and dependents using virtual care instead of defaulting to the ER
• Turnover reduced 15% — improved total compensation package helped retain experienced nursing staff

"Emergency room visits dropped by 40% and our overall claims costs are down 23%. This program pays for itself several times over. Our nurses finally have access to the same quality of preventive care they provide our patients every day."

— Chief Administrative Officer