Despite bringing us inflation and supply chain issues, and the start of the Russia-Ukraine conflict, 2022 was a year filled with great optimism as the world rebounded from the COVID-19 pandemic.
For starters, in February, scientists decoded the entire human genome! Filling in millions of missing pieces of DNA could potentially unlock future medical breakthroughs. In May, scientists were able to grow plants in lunar soil, which could make longer stays on the moon a reality. Then in June, a drug trial from Memorial Sloan Kettering eliminated cancer for more than a dozen US rectal cancer patients!
In the world of student health at Wellfleet Student there was also plenty to celebrate. Here are some of the highlights from 2022.
Continued formulary enhancements
The Wellfleet clinical team continuously evaluates the pharmaceutical landscape for the benefit of our clients and student members. Further, we consider the latest clinical and financial information to identify impacts on our Student Formulary to ensure we’re providing student members with the best options to meet their prescription drug needs.
Here are the updates we made to our student formulary in 2022.1
Improving efficacy and options
Noting the impacts on student mental health we revisited our formulary options and found we could add and update to help provide medications that showed better efficacy and lower side effects in the age group we serve. This included fluoxetine, Lithium, Quetiapine, Sertraline, and more.
Also, in reviewing our dermatology class of medications, we found that Clindamycin Phosphate Benzoyl Peroxide Gel (1.2-5%) is clinically proven to work as well as other high-cost topical or oral agents.2 Further, studies show it has a high level of patient satisfaction, including significant improvements in factors that affect the quality of life for those young adults dealing with acne.3 So, we’ve added it to the $0 copay drug list to incentivize its use.
Further, we added the generic Proton Pump Inhibitor (PPI) form of Dexilant®, dexlansoprazole to the formulary. This was done to provide an effective gastroesophageal reflux disease (GERD) treatment for student members that is not yet available over the counter, that can also save plans 15-20% per fill, when compared to the name brand equivalent.3
Cost-saving formulary updates
Additionally, after reviewing our clinical data, we found a subsection of student members who received medication dosage increases to improve their treatment, which unfortunately caused their copay to increase. This didn’t sit well with us. So, we updated our formulary policy to include additional strengths of certain medications, so that members don’t have the burden of extra out-of-pocket expenses to get the relief they need.
We also made a move to add Apretude an injectable HIV PrEP medication to our formulary with a $0 copay, helping improve care and reduce out-of-pocket costs.
Furthermore, we replaced brand Narcan® with the lower-cost generic naloxone nasal spray on the $0 copay drug list. According to the FDA, the generic version of naloxone includes the same active ingredients as Narcan® and is shown to have the same therapeutic effect.4
Lastly, we have efforts in place that help guide members toward lower-cost and preferred alternatives through the formulary design. An example of this is our formulary tiering which sets some high-cost generics at a higher copay tier to help incentivize the use of lower-cost generics, which are placed at a lower copay tier. This encourages lower copays for the student member and lower expenses to the school plan.
When we look at the avoided drug costs for our participating school partners over the 2021-2022 plan year, $2.5 million could be attributed to the utilization of formulary preferred options over their higher-cost alternatives.5
Find out what changes and updates were made in January and July of 2022. Learn more about the Wellfleet Student formulary and the 40+ $0 copay drugs that are included.
Plan and member savings from claims review
At Wellfleet customer centricity and operational excellence are key tenets that guide us. Our Payment Integrity Program is one born out of those key beliefs and upholds our commitment to the Triple Aim – the right care, at the right price, to the members’ satisfaction.
With a sharp focus on the Triple Aim, our Payment Integrity Team is actively involved in verifying all claims received are for eligible members, from legitimate providers, and that Wellfleet is the carrier responsible for payment. This includes ensuring billing adheres to payment policies, is in line with standard medical protocol guidelines, and is not wasteful or abusive.
Our main areas of focus are on claims Pre-payment analysis, post-claim analysis, out-of-network claims, and waste and abuse. This helps ensure student members are receiving the best pricing for the services they received while assuring providers are being paid appropriately for services rendered.
In 2022, our payment integrity program helped save school plans more than $21 million! This includes savings derived from claims pre-payment auditing ($7,280,278), Out-of-Network discounts ($13,814,833), and adjustments from waste and abuse ($180,823).8
In fact, over the last 5 years, our payment integrity program has helped save school plans almost $77 Million!8
In addition to pre- and post-claims analysis, we take a deeper dive into claims. Of note, this year’s largest savings came from incorrect bill coding for the birth of a child. The school plan saved more than $83k, while the member saved almost $5,000 in out-of-pocket fees.
Learn more about the payment integrity team and the great work they do to help our clients and students save.
Supporting student mental health needs
We poured over internal and external data, and we found that overwhelmingly students continue to demonstrate the need for mental health resources.
In fact, in the last year, we’ve seen a nearly 40 percent increase in prescriptions for behavioral health indications, including depression, attention disorders, and anxiety.
Unfortunately, with this increase, there is still a large population of students who are not seeking the care they need. A major reason is education. When it comes to behavioral healthcare for students, there is a lack of awareness of providers’ roles and confusion about what to consider when selecting a provider.
To aid in helping students we developed some tips that colleges can incorporate to help their student population feel comfortable seeking behavioral health care. Check out tips for both domestic and international students.
We also revamped our plan design to ensure our student members have access to behavioral health care where, when, and how they need it. The Student Behavioral Health Solution goes beyond the traditional network with eight distinct features designed to improve access to care, quality of care, and outcomes.
They include the following benefits:
- College Counseling Coordination
- A National Behavioral Health Network
- A Virtual Telehealth Network
- Out-of-Network Discounts
- Wellfleet Rx Student Formulary
- CareConnect 24/7 Behavioral Health Hotline
- Provider Recruitment
- Behavioral Case Management
Learn more about the Wellfleet Student Behavioral Health Solution.
Utilization management strategies save school plans $4.7 million
Core to Wellfleet’s mission is the Triple Aim – providing the right care, at the right price to the members’ satisfaction. So, we’re continuously reviewing the safety, efficacy, and cost of our formulary medications. Part of the review process includes an analysis of our utilization management strategies.
Utilization management strategies are procedures developed to help ensure student members are receiving the most appropriate medications while helping to lower the overall cost of health care. The utilization management strategies we have in place include step therapy, quantity limits, and prior authorizations; learn more about them here.
To identify the impacts of each strategy, an analysis was completed for claims processed from January-December, 2021 under Wellfleet Rx plans.
The potential cost of denied claims for products that have a utilization management strategy was compared to the actual cost of the approved claim that was subsequently submitted (if any), either for a different product, a different quantity, or the same product after review and approval.
When reviewing the impacts of our strategies in 2021, we helped save school plans $4.7 million dollars!8
Next-level student healthcare
Navigating the U.S. healthcare system can be a challenge for both domestic and international students. It can be even more challenging for a family when their student endures a traumatic injury and is thousands of miles from home.
That’s why all Wellfleet Student plans come with travel assistance from Travel Guard.
With decades of experience working with medical, travel, and government embassies across the globe, Travel Guard’s clinical and logistics team is second to none.
In 2022, Travel Guard and Wellfleet helped coordinate complex foreign medical care, overcame a travel ban, and formulated a multi-country flight plan — all in time to provide the critical care a student member needed prior to their student visa expiring.
“It was amazing to see how thorough Wellfleet and Travel Guard were,” said Chrissy St. Clair, Manager of Student Benefits at Johns Hopkins University. “Coordinating a medical evacuation flight is difficult enough, now add in four countries in three days and it feels impossible. But they were relentless. They kept everyone in the loop and got it done just in time.”
Check out the amazing full story here.
Providing solutions to help managers of student health care save
We looked at that data and found that among industry experts, in 2022, 76% of student health insurance plans had an increase of at least 5%.8
With the rise in the cost of student health care being a trend that is expected to continue, we developed a guide for those who manage student health plans with actionable steps fully- and self-funded colleges and universities can take to help lower their overall health care cost.
Some of the tips included how to collaborate with your payer or plan administrator to reduce the cost of claims, how to mitigate students’ use of costly ER visits as well as cost-saving considerations for out-of-network providers and more.
Managing student healthcare can be complicated. Check out our guide to discover simple ways to start implementing sustainable & cost-saving solutions.
Looking ahead to 2023
We’re so excited for 2023! We continue to have our sights set on improving the student healthcare experience through enhanced policies, coverage, access to care, and education.
If you’d like to learn more about Wellfleet’s Student Health Insurance products, services, and offerings directly from the Wellfleet Student Health team, check out our on-demand webinar.
To stay on top of Wellfleet Student happenings, sign up for our monthly clinical newsletter. We look forward to providing you with updates on the great things we’re working on throughout the year.
1 Zero Cost Drugs program may vary by school or may not be available to certain schools. See applicable Student Formulary for more details. If there is no “Zero Cost Drugs” section included in the Student Formulary applicable to your plan, this program is unavailable.
2 Gold, M., M.D. (2012, January). Clindamycin Phosphate 1.2% and Benzoyl Peroxide 2.5% Gel for the Treatment of Moderate-to-severe Acne. Retrieved on June 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277091/.
3 Savings can vary by plan design. Plan savings calculated from 20-21 plan data and prescription medication pricing available as of May 1, 2022.
4 Meyer. L. (2019, April 19). FDA approves first generic naloxone nasal spray to treat opioid overdose. Retrieved on June 28, 2022 from https://www.fda.gov/news-events/press-announcements/fda-approves-first-generic-naloxone-nasal-spray-treat-opioid-overdose.
5 Wellfleet (2022, August). Preferred alternatives savings. Retrieved November 8, 2022. Unpublished company document.
6 Wellfleet (2023, January). Payment Integrity Performance Review – December 2022. Retrieved January 18, 2023. Unpublished company document
7 Wellfleet (2022). 9331 & 9702 Member Level Detail & Savings Final_CY2021_WF. Retrieved June 20, 2022. Unpublished company document.
8 Risk Strategies (2021, December). Risk Strategies Benchmarking Survey Results Executive Summary 2021. Retrieved on December 30, 2022, from https://www.ahpcare.com/wp-content/uploads/2021/12/Risk-Strategies-Benchmarking-Survey-Results-Executive-Summary-2021-1.pdf.