Imagine360, an alternative health plan, launched a new product called Complete Care on Wednesday, which includes direct contracting with providers and a transparent pharmacy solution.
Wayne, Pennsylvania-based Imagine360 serves self-funded employers, including manufacturing companies, nonprofits, restaurants and more. The new Complete Care product builds on its current offerings with Imagine360Rx, a pharmacy benefit manager solution that is powered by Liviniti, a PBM that shares an investor with Imagine360 (Water Street Healthcare Partners).
Imagine360Rx provides all drug discounts and rebates to employers and offers alternative sourcing for drugs, such as finding lower-cost medications from the U.K. and Canada. It offers reporting for employers on healthcare claims and pharmacy costs as well. Members can also receive answers on both their medical and pharmacy needs via one portal and phone number.
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“Prior to this, we would partner with some 70 different types of PBM solutions that were out there. … This is the first year that we’re launching and promoting one that will be kind of branded and aligned with Imagine360 and it’s nice because the same people who are helping our employees and family members all day, every day with all their current health plan needs can now be those same people when they have a pharmacy need,” said Jeff Bak, president and CEO of Imagine360, in an interview.
In addition to Imagine360Rx, Complete Care provides direct contracting with health systems and providers and uses a reference-based pricing model. In this model, the company uses a benchmark like what Medicare pays for a service or the actual cost of the procedure reported by the healthcare facility, and adds a profit on top of that.
The launch of this new product comes at a time when healthcare costs are increasing rapidly, and prescription drug costs are a major part of that. Pharmacy costs represent about a quarter of total healthcare costs for employers, according to the Business Group on Health. Traditional PBMs — including Optum Rx, Express Scripts and CVS Caremark — have been facing a lot of scrutiny lately due to a lack of transparency. This is leading to many employers adopting or considering adopting transparent PBMs.
“We’re trying to bring together what we think are the two most stubborn areas of cost for employers and employees and their families, which are the cost of medical services when delivered by hospital systems and providers, and then pharmacy and the cost of prescription drugs for families and employers. … Our main goal here is to try to, one, save money in both of those areas of spend,” Bak said. “Two, make the member experience a heck of a lot better and easier when they are accessing care. And lastly, be able to share the data, the claim information, with everybody so that there’s complete transparency with who’s utilizing and why.”
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To measure the success of Complete Care, Imagine360 will track savings, the member experience and growth, Bak added. A recent actuarial report discovered that Imagine360 decreases employers’ healthcare costs by about 20% compared to traditional health plans. Now with the Complete Care product, the company expects to achieve an additional 5-10% in savings for employers.
Imagine360 isn’t the only alternative health plan out there. Others include Centivo and Surest.
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