Case Studies

Signature HealthCARE

At a glance

Signature HealthCARE
Long-Term Care
Louisville, Kentucky

Signature HealthCARE is an award-winning company in the long-term care industry, including skilled nursing, rehabilitation, assisted living, memory care, home health, cognitive care and telemedicine.


To manage risk under its self-funded insurance model, Signature HealthCARE contracted with a big-box carrier to provide claims administration, network access, utilization review, disease management and program management concepts, etc. Eventually, Signature grew frustrated with the lack of transparency. “What really drove us nuts was not being able to see what was behind the contracts that the carrier had with providers,” said Nick Porter, Vice President, Total Rewards for Signature HealthCARE.
“We had millions of dollars riding on contracts that we couldn’t see.”

In 2016, due to a drastic increase in healthcare costs, Signature was forced to increase premiums and deductibles for employees. This hit to their benefits package had a negative impact on staffing, and made it more difficult to fill positions, especially nurses.


Porter’s research to contain costs led him to ELAP Services’ reference-based pricing (RBP) solution, which is backed by unlimited client and member advocacy and support. ELAP’s model considers both the cost of service and the Medicare reimbursement rate to determine a payment that is fair and reasonable for employers, members and health systems.

A signature achievement

Listen to Nick Porter describe how ELAP helped Signature HealthCARE reduce costs, optimize benefits and dramatically improve recruitment.


Since partnering with ELAP, Signature HealthCARE has experienced:

NET SAVINGS $11 Million*

*Savings based on estimated PPO charges.

Since implementing ELAP as a pilot in 2018, the results have been staggering. And in 2019, when Signature HealthCARE gave their employees the option to choose benefits through ELAP Services or a traditional PPO plan, more than 70% chose the more affordable ELAP model. In 2020, they started working exclusively with ELAP for their health plan for all covered employees and family members.

The give back

“By moving away from big-box carriers, we are saving a ton of money – probably 40 or 50 percent in admin fees alone,” said Porter. “That’s in addition to the money you’re saving on claims.”

Since introducing the enhanced benefits package made possible by ELAP savings, Signature HealthCARE has more than doubled the size of its staff each quarter and reduced turnover.

Signature reinvested all their savings into employee benefit programs:

  • Subsidized daycare/babysitting
  • Free ride-sharing to work
  • Tuition forgiveness
  • Rewards and recognition programs
  • $250k increase in benefit support staff
  • Enhanced wellness programs

The bottom line

After shifting models and working with ELAP Services the past few years, Porter has become a staunch advocate of the ELAP RBP model. When it comes to choosing an RBP firm, he adds that he would hands-down recommend ELAP Services. “ELAP is the best company in the United States that does reference-based pricing,” said Porter. “If you’re going to do reference-based pricing, I don’t know that I trust anyone else to manage a program like this other than ELAP.”

“Before reference-based pricing, we were scraping for pennies and trying to figure out how to do a presentation to a group of employees and have them leave with a smile even though we were increasing their premiums by 10 to 15%.”

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