A New
Path
Forward
for Health
A comprehensive proposal for Madison County
Executive Summary
Madison County is facing an unsustainable financial trajectory. On its current path, the County is exposed to relentless, carrier-controlled premium hikes with no pathway to control costs. This proposal outlines a decisive change in course. By transitioning from a reactive, fully-insured plan to a proactive, self-funded partnership, Madison County can take direct control of its healthcare destiny and guarantee that 100% of unused claim fund dollars are returned to you.
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. Intelligent Pre-Authorization
Our proprietary pre-authorization service, backed 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, projecting a total savings of $186,368 for Madison County.
A Conflict-Free Pharmacy Model
We fundamentally redesign pharmacy benefits to eliminate conflicts of interest. Our formulary is based on clinical efficacy and lowest net cost, not rebates. We use transparent, acquisition-cost pricing and guarantee 100% of all rebates are returned to the plan, projecting a savings of $245,000 annually.
The Health365+ Digital Hub
We empower members and administrators with a unified, intuitive technology platform that simplifies benefits and enhances the human-powered support our care teams provide.
Your Central Hub for Digital Support
Our platform provides a single point of access for all plan-related information and tools, eliminating the confusion of multiple logins and disconnected systems. It's the central hub for a member's entire health journey.
Transforming Benefits Communication
We lift the burden of benefits education from your HR team. We provide continuous, on-demand education and dedicated support for new hires, helping employees understand and utilize their full benefits package.
Year-Round & New Hire Support
We go far beyond a once-a-year open enrollment meeting. Our team provides dedicated, ongoing education for all employees, including a full onboarding for new hires, ensuring everyone understands their benefits from day one.
BenefitBites: Micro-Learning
We make complex topics simple with short, interactive "BenefitBites" courses. This modern approach makes it easy for employees to get the information they need, when they need it.
Voices of Our Partners
Don't just take our word for it. Here’s what employers, members, and brokers are saying about their experience with the Health365+ model.
"For the first time, I don't feel like I'm navigating my health alone. My coach, Sarah, reached out after my surgery was scheduled and helped me find the best physical therapist. It felt less like an insurance plan and more like a support system."
"The transparency is a game-changer. We finally have access to the data we need to make strategic decisions. The proactive education has taken a huge burden off our HR team, and our employees have never been more engaged with their benefits."
"Health365+ allows me to bring a truly different solution to my clients. Instead of just managing renewals, we're having strategic conversations about controlling costs and improving care. It makes me a more valuable advisor."
Claims Impact & Savings Modeling
Health365+ delivers savings in three key ways: lower plan premiums, reduced claims exposure through proactive management, and the ability to retain 100% of your claims surplus.
Total Financial Benefit by Strategy
| Strategy Option | Premium Savings vs BCBS | Projected Claims Savings | Total Year 1 Financial Benefit |
|---|---|---|---|
| Bronze H403 (Recommended) | $142,674 | $431,368 | $573,368 |
Projected Claims Savings include Pharmacy Optimization ($245,000) and Chronic Condition Engagement ($186,368).
Pharmacy Savings – Annualized Modeling
| PBM Model | Gross Spend | Rebates to Plan | Net Plan Cost |
|---|---|---|---|
| BCBS (Status Quo) | $600,000 | ~$10,000 | $590,000 |
| Health365+ (ACI + MBM) | $390,000 | $35,000 | $355,000 |
| Projected Annual Pharmacy Savings: | $245,000 | ||
Surplus Return Potential
The $431,368 in savings directly reduces spending from the County's $1.87M claim fund. 100% of this surplus is returned directly to you.
| Claim Utilization Level | Claims Paid | Surplus Returned to Madison County | Net Employer Cost (After Surplus) |
|---|---|---|---|
| 85% Utilization | $1,591,362 | $280,829 | $3,184,137 |
| 70% Utilization | $1,310,533 | $561,657 | $2,903,309 |
| 100% Utilization (Max Liability) | $1,872,191 | $0 | $3,464,966 |
Detailed Cost & Benefit Comparison
Here is a detailed breakdown of the costs and benefits for our recommended plan compared to your Blue Cross renewal.
Detailed Cost Comparison
| Plan | EE Only Rate | EE+Spouse Rate | EE+Child(ren) Rate | Family Rate | Total Annual Funding |
|---|---|---|---|---|---|
| Projected BCBS Renewal (8.4% Trend) | ~$780 | ~$1,445 | ~$1,352 | ~$2,144 | $3,607,641 |
| H365+ Bronze H403 | $714.43 | $1,467.27 | $1,389.61 | $2,024.59 | $3,464,966 |
| Guaranteed Fixed Cost Savings | $142,674 | ||||
GAP Strategy: Financial Protection for Employees
A GAP solution can be a powerful tool when paired with an HSA-qualified plan. This supplemental benefit is designed to bridge the deductible, transforming a high-deductible plan into one with predictable, low out-of-pocket costs for your members.
What GAP Covers
- 100% of the deductible and coinsurance for covered inpatient hospital stays, including room, board, ICU, and surgery.
- 100% of the deductible and coinsurance for covered outpatient procedures, like surgery, ER visits, imaging, and labs.
What GAP Doesn't Cover
- ×Routine office visit copays and prescription drug copays (not applicable on HSA plans).
- ×Services not covered by the primary medical plan, such as cosmetic or experimental treatments.
A Stronger, Smarter Network
Health365+ offers a superior network strategy, providing broad national access via the First Health PPO network while ensuring all key local and regional facilities remain in-network for your members.
Key Local Facilities: Continued In-Network Access
Madison Memorial Hospital
Rexburg, ID
Current (BCBS)
✓ In-Network
Health365+
✓ In-Network
Mountain View Hospital
Idaho Falls, ID
Current (BCBS)
✓ In-Network
Health365+
✓ In-Network
Idaho Falls Comm. Hospital
Idaho Falls, ID
Current (BCBS)
✓ In-Network
Health365+
✓ In-Network
Teton Valley Hospital
Driggs, ID
Current (BCBS)
✓ In-Network
Health365+
✓ In-Network
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
Please select your preferred plan option below to move forward. Clicking "Submit Plan Selection" will generate a pre-filled email to notify us of your choice for the 10/1/2025 effective date.
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