Elevating
Care.
Reducing
Cost.
A comprehensive proposal for Atiba Holdings, LLC
Executive Summary
Atiba Holdings is facing a projected Cigna renewal of $803,550. With claims already exceeding premiums—and a plan that likely keeps any surplus—this proposal outlines solutions that enhance member experience, drive long-term sustainability, and guarantee that **100% of unused claim fund dollars are returned to you.**
Strategy Options Overview
We present three strategic pathways, each designed to provide increasing levels of savings and plan control while enhancing the member experience.
✅ Option 1: Upgraded Plan Designs
Preserves current 3-plan structure with significant benefit enhancements.
Annual Cost: $776,238.32 | Savings vs Cigna: $27,311.68 (3.56%)
✅ Option 2: HSA Consolidation
Unifies all HSA members under one simplified Silver H303 plan for efficiency.
Annual Cost: $701,499.12 | Savings vs Cigna: $102,050.88 (13.3%)
✅ Option 3: GAP Strategy
HSA Members move to Bronze H404 + GAP; PPO Members move to Bronze H405 + GAP.
Total Combined Cost: $594,680.00 | Savings vs Cigna: $208,870.00 (25.99%)
A Journey Reimagined
Health365+ is built on a different idea: real support should feel personal, accessible, and proactive. We’re on a mission to transform health coverage from a frustrating maze into an experience that is guided, transparent, and genuinely helpful for everyone.
Our Philosophy: A Fundamentally Better Approach
A True Concierge Experience
We provide a dedicated, human-first point of contact for every member, moving beyond call centers to build real relationships and provide expert guidance.
Improving Health to Reduce Costs
Our model is designed to address the root cause of claims. By proactively engaging members to manage and improve their health, we deliver better outcomes and generate sustainable, long-term savings for your plan.
Human-Centric Technology
We leverage powerful, integrated digital tools not to replace human interaction, but to enhance it. Our apps and platforms free our care teams to focus on what matters most: your people.
Our Integrated Care Model
This is how we deliver better care and lower costs. Our model isn’t a set of disconnected services; it’s one intelligent system that connects technology, data, and human expertise to proactively guide members at every turn.
Care Coordination System
1. AI-Powered Pre-Certification
Our pre-auth service, powered by an AI engine and reviewed by clinicians, dramatically accelerates approvals to meet the CMS 72-hour guideline. This eliminates frustrating delays and creates critical data for our care team.
2. Proactive Clinical Outreach
The moment a procedure is approved, the data alerts the member’s dedicated health coach. They don’t wait for a call; they reach out immediately to begin care coordination.
3. High-Value Care Guidance
The coach guides the member to the best in-network providers, schedules appointments, and arranges follow-up care. This ensures a better experience, improved outcomes, and lower costs for the plan.
This isn’t just about speed; it’s about intelligence. Every administrative step is transformed into a proactive care opportunity, ensuring better care, a better experience, and lower costs.
Core Plan Services
The integrated flow is powered by these foundational services, designed to provide comprehensive support across all aspects of care.
Virtual Direct Primary Care (DPC)
The digital front door to our system. For a $0 copay, members get unlimited, on-demand access to a dedicated care team for acute issues, chronic condition management, wellness visits, and prescription renewals.
Proactive Chronic & Whole-Health Management
Using data from across the ecosystem, we identify at-risk members and engage them with a health coach and no-cost remote monitoring devices. This program is proven to save over $2,040 per engaged member annually.
A Conflict-Free Pharmacy Model
We fundamentally redesign pharmacy benefits to eliminate conflicts of interest, netting 30-40% savings on total drug costs. We use transparent, acquisition-cost pricing and guarantee 100% of all rebates are returned to the plan.
Claims Impact & Savings Modeling
Health365+ delivers savings in two key ways: lower plan premiums and reduced claims exposure through proactive management.
Claims Exposure and Renewal Driver
Cigna has paid a total of $379,676 through May 2025 across both medical and pharmacy claims, while only $261,811.77 has been funded — leaving a net funding deficit of $117,864.24. This is a primary contributor to the high renewal of $803,550, which assumes the group will continue to run hot. Health365+ offers a clean reset against this renewal baseline.
Total Financial Benefit by Strategy
| Strategy Option | Premium Savings | Projected Claims Savings | Total Financial Benefit |
|---|---|---|---|
| Option 1: Upgraded Designs | $27,311 | $194,000–$294,000 | $221,311–$321,311 |
| Option 2: Silver HSA Only | $102,051 | $194,000–$294,000 | $296,051–$396,051 |
| Option 3: Bronze + GAP | $208,870 | $194,000–$294,000 | $402,870–$502,870 |
Projected Claims Savings include Rx reform (ACI & redirect savings) and medical containment (steerage, navigation).
Pharmacy Risk – Annualized Modeling
| Scenario | Savings Rate | Projected Annual Rx Spend |
|---|---|---|
| Current (Cigna PBM Model) | — | $480,000 |
| Health365+ (Conservative) | 30% | $336,000 |
| Health365+ (Moderate) | 40% | $288,000 |
| Health365+ (Aggressive) | 50% | $240,000 |
| Conservative Projected Rx Savings: | $144,000 | |
Detailed Cost & Benefit Comparison
Here is a detailed breakdown of the costs and benefits for each strategic pathway compared to your Cigna renewal.
Detailed Cost Comparison
| Plan | Carrier | Annual Cost |
|---|---|---|
| Current Cigna Renewal | ||
| HSA (HDHP Option 2) | Cigna | $273,910.68 |
| HSA (HDHP Option 1) | Cigna | $286,762.32 |
| PPO (Option 3) | Cigna | $242,876.76 |
| TOTAL Cigna | $803,550.00 | |
| Health365+ (Option 3: GAP Strategy) | ||
| HSA (Bronze H404 + GAP) | Health365+ | $456,915.00 |
| PPO (Bronze H405 + GAP) | Health365+ | $137,765.26 |
| TOTAL Health365+ | $594,680.00 | |
| Total Savings | $208,870.00 (25.99%) | |
A Stronger, Smarter Network
Health365+ delivers equivalent or better access than Cigna by pairing the HPN network with a PHCS national wrap—ensuring seamless coverage across all major Nashville-area systems, including Vanderbilt.
Nashville-Area Hospital Access: Before & After
Tristar Centennial (HCA)
Nashville, TN
Cigna Open Access
✓ In-Network
Health365+
✓ In-Network
Ascension St. Thomas
Nashville, TN
Cigna Open Access
✓ In-Network
Health365+
✓ In-Network
Vanderbilt University Med Ctr
Nashville, TN
Cigna Open Access
✓ In-Network
Health365+
✓ In-Network (via Wrap)
Williamson Medical Center
Franklin, TN
Cigna Open Access
✓ In-Network
Health365+
✓ In-Network
Skyline Madison
Madison, TN
Cigna Open Access
✓ In-Network
Health365+
✓ In-Network
GAP Strategy Overview
Health365+ offers a fully integrated GAP plan that allows employers to reduce fixed plan premiums while preserving a rich member experience.
How it Works
PPO Example: MRI
- Member has $6,000 MRI at outpatient facility
- Bronze H405 plan applies deductible and coinsurance → member would owe $4,200
- GAP reimburses $4,000 of that, leaving the member with only $200
HSA Example: Surgery
- Member incurs $7,500 in surgery expenses
- First $1,650 (IRS-required HSA floor) is member responsibility
- GAP reimburses $5,850, reducing member exposure to just $1,650
This model preserves HSA eligibility, simplifies plan design, and aligns cost control with a better employee story.
Our Partnership Pledge
Choosing Health365+ is the first step in transforming your healthcare into a strategic benefit. We are not a vendor; we are an extension of your team, and our success is measured by your success.
Our Pledge to You, the Employer
- We pledge absolute transparency. You will have the access to the data you need to make informed decisions.
- We pledge a proactive partnership. We will bring you data-driven insights and strategic recommendations to continually improve the health of your population and the value of your investment.
- We pledge to deliver a measurable return. We are committed to improving health outcomes that result in lower costs and a more productive workforce.
Our Pledge to Your Employees
- We pledge to always be a compassionate, human-first point of contact. You will be treated with dignity and respect by a care team that knows your name.
- We pledge to be your trusted health advocate. We will help you navigate the complexities of the healthcare system, coordinating care between your providers.
- We pledge to empower you. We will provide the tools, information, and on-demand coaching support you need to achieve your personal health goals.
Jeremy Spreitzer
Chief Executive Officer
Joshua Parise
Chief Innovation Officer
Select Your Plan Strategy
Please select your preferred strategic option below. This will generate a pre-filled email to notify us of your choice so we can prepare the final documents for your review.