A 220-life Cleveland company kept seeing their healthcare costs escalate and wanted to do more to educate their members and help them to not only control existing conditions, but avoid or mitigate future large claims.
- Although they have had fairly sophisticated wellness program for several years, they found they were not reaching all members and the carrier’s disease management program was very limited in scope and was more reactive than proactive.
- They wanted a solution that would allow them to manage the risk under their healthcare plan – similar to how they manage Worker’s Compensation and Liability Coverage.
- A program was introduced and implemented that utilizes the pharmacy data to identify future risks.
- The Rx data is run through a nationally recognized best in class predictive modeler program that reviews in excess of 60 conditions.
- Once risks are identified, individuals are engaged in ongoing one-on-one coaching sessions with a Registered Nurse who educates members on how to better manage their conditions and suggests and helps implement needed lifestyle changes.
- First Year – 7 of 11 high risk members were actively engaged with a care manager.
- Compliance with treatment plans increased from 33% to over 50%.
- Potential costs for high risks members reduced a total of $197,459.
- Realized Return on Investment first year was 19.95:1.
- The aggregate savings trended over three (3) years is almost $654,000.
- Significant savings were generated without any plan design changes.