This case study describes how a national multi-site healthcare provider was able to increase EBITDA by $3.38 million, free cash flow by $8 million, and exit value by $31.3 million through active management and minor tweaks to their benefits strategy over 5 years. This included aggregating multiple plans into a single plan, implementing new data and analytics tools, and ongoing minor changes to incentivize smart member decisions and remove unnecessary costs and waste while maintaining low employee premium increases and decreasing payroll contributions.

1. National, Multi-site Health Care Provider Case StudyMinus30
Active management paired with focused tweaks
increased EBITDA by $3.38M, free cash flow by
$8M, and exit value by $31.3 million, while also
reducing overall employee premiums.
Company
National, multi-site healthcare
provider
Company HQ
Chicago, IL
Employees
1,900 w/ 3,700 total plan members
Advisor Name
Brian Uhlig
Health Rosetta Score
2.2 with foundation set for 4.
1=status quo & 5=fully realized
Key Health Rosetta
Components
• Transparent Advisor
Relationships
• Patient Stewardship Tools &
Member Concierge
• Transparent Pharmacy Benefits
• Outlier Patients
• Enabling Technologies & Data
Analytics
Summary
The core takeaway of this case study is how basic
strategies like active management by the right
benefits advisor, refining the overall benefits
strategy, and ongoing minor tweaks to plan design
can sustainably lower costs. This strategy also
allows the client to incrementally embrace the
broader mindset shift necessary for larger changes
to capture major cost reductions and dramatically
improve quality in future years.
Key Accomplishments
1. Limited average employer spending increases to
1% per year from 2012 to 2016, as compared to
the average trend of 5.38% per year.
2. Decreased employee payroll contributions over
the same period
3. Strategies implemented increased EBITDA by
~$3.38 million in 2016, ~5% higher than if the
client’s spending had increased at average trend
rates. This translated into a ~$31.3 million of
enterprise value in a 2017 exit.
4. Access to senior mgmt. (CEO, COO) enabled
strategy that enhanced company initiatives

2. National, Multi-site Health Care Provider Case StudyMinus30
Details & Financial Results
The Health Rosetta advisor started by cleaning up the client’s overall strategy. The
company originally had a combination of fully-insured and self-funded plans across multiple
states. The first step was to aggregate these into a single plan with a single administrator.
This, combined with implementing new data management and analysis tools and processes,
opened the door for ongoing active management.
With this foundation, the strategy focused on multiple smaller tweaks to create initial
wins while minimizing changes to the member experience. Over time, the advisor
implemented changes focused on incentivizing smart member decisions and removing
common sources of unnecessary waste. A primary goal of this approach was to increase
member attention to where and how they spend plan assets, setting the stage for the
advisor’s longer-term strategies in 2019 and beyond, such as direct contracts for surgical
procedures and high-value primary care. The advisor also optimized various levers for
managing costs, such as network limitations for high-cost areas like dialysis, PBM carve outs,
dependent audits, spousal surcharges/exclusions, 5 tier rates, and ongoing data analysis to
regularly identify opportunities. The client’s satisfaction with the strategy was also very high.
Together these strategies drove significantly lower costs, resulting in higher EBITDA,
free cash flow, and, ultimately, higher enterprise value at the time of sale.
$3.38 million of savings in 2016 compared to average
trend created $31.3 million in additional enterprise value.
Note: All calculations use the Milliman Mid-market Survey average 2012-2016 trend of 5.38% per year.

3. National, Multi-site Health Care Provider Case StudyMinus30
Member Experience Improvements
1. The company captured the financial savings in this case study without meaningfully
changing non-HSA employee contributions. In fact, they decreased over the 5-year
period we analyzed.
2. Implementation of direct-contracted centers of excellence model ensures that
patients with the most serious health issues have access to the highest quality care.
3. Benefits concierge & care management solution simplifies member’s entry point to
the health care system.
4. Early adopter of covering preventive drugs for HSA plans and eliminating coverage
of brand PPIs (July 2014), assisting this transition through free generic versions for
first few months.
5. Early adopter of Bswift for enrollment, improving member experience through
Bswift’s decision support tool and in-person OE communications for several years
during transition to HSA plans.
Financial & Operating Impact
Significant impact across multiple fronts:
1. Higher EBITDA each year, $3.38 million higher in 2016 ($1,807 per employee)
2. Increased free cash flow by more than $8 million from 2012 to 2016
3. ~$31.3 million higher enterprise value in a 2017 sale to a publicly traded company
4. Managed national program (18 locations) with a single benefits manager
5. Contributed to higher than average exit multiple as a result of comparatively higher
margins than other companies in the client’s sector
Conclusion
As the summary introduced, the likelihood of financial and care quality impact when
adopting proven innovative solutions can be high with the right combination of
transparent advisor relationships, strategic focus on quick wins, and expertise in
executing a long-term strategy that captures ongoing opportunities. The end result is a
more sustainably lower cost and effective health care supply chain.
Learn More
• Contact Brian Uhlig at brian.uhlig@aleragroup.com
• Learn more at healthrosetta.org/employers
• Get a complementary copy of The CEO’s Guide to Restoring the American Dream at
healthrosetta.org/brianuhlig