Overview
The member is a female in her 30s with a history of Crohn’s disease of both the small and large intestines, without complications. The member was referred to Case Management by the Wellness team through the wellness Health Assessment. The Health Assessment ascertains a member’s healthy/at-risk categorization and can assist in identifying members who may benefit from case management. HealthComp Case Management services provide access to our in-house nursing staff, who intercept members during high-cost events to help drive cost savings through pre-admission counseling, second opinions, discharge planning, and other care coordination.
Challenge
While reviewing the member’s claims, it was noted that the patient was receiving her medication via injection once every two months at an in-hospital clinic. The cost of the treatment was crippling for the member; she had had to refinance her house to help cover the cost of these injections.
Solution
The injection the member was receiving can be administered at home as a self-injection. The member had experience using self-injectables previously, and after talking with the case manager, she felt confident in her ability to administer them going forward. The provider approved the change. Additionally, while investigating the drug, the case manager discovered a coupon available to the member through the drug provider. With the move to home injections and with the coupon, the member was able to reduce her cost responsibility from over $1,500 every eight weeks to $5. The case manager also helped coordinate for the injection to be shipped directly to the member to help reduce any pharmacy costs.
Impact
The member drastically reduced her bi-monthly costs from $1,500 to $5. She also reduced the time she needed to be away from work to travel to the clinic for the injections. Moving the injections into the home and out of the hospital clinic saved the group over $9,000 every eight weeks. After following up with the member for a season, where she continued to do well and showed no complications, she was discharged from case management.
“This member was one of my favorites. I had just finished orientation and wasn’t sure about the move to case management. This made me realize I really love this job; it was very rewarding.”
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