More savings every year. Same 95 NPS.

Alamo Heights ISD is a Texas school district running a self-funded medical plan for roughly 1,200 employees and dependents. They added the benefit in 2023. Every year since, the numbers have moved the same direction.

Year 1 saved the plan $791,548. Year 2 saved $989,125 — about $200K more, on slightly higher membership. Year 3 is six months in and has already saved $744,315, on pace to clear Year 2 by year-end. Measured against running the plan without the benefit, the savings ratio climbed every year: 65.55% → 69.27% → 75.80%.

The compounding line is the ER. The clinic absorbed 175 ER visits in Year 1, 144 in Year 2, and 100 in the first six months of Year 3. Lab savings nearly doubled from Year 1 to Year 2 ($139K → $294K) as employees got in the habit of running labs in-clinic instead of at the hospital.

What didn't move: employee satisfaction. NPS came in at 94 in Year 1 and 95 in both Year 2 and Year 3 — even as utilization grew and more members joined the plan.