We believe we can help eliminate waste in healthcare. Health plan spend is one of employers’ highest expenses, which averages $10,000 annually per employee.
This analysis was conducted to evaluate the effectiveness of our care management programs by comparing costs and utilization to industry averages. Given the large variations in costs that occurred due to the COVID-19 pandemic, 2019 claims costs were evaluated.
We examined the following clinical care management programs:
- Utilization Review
- Case Management
- Disease Management and Population Preventive Care
- Cancer Awareness
- Nurturing Together
- Emergency Room Solutions
These programs are recommended in part by the Health Risk Assessment (HRA). HealthComp’s in-house clinical team proactively touches an employer’s entire member population via messaging and call campaigns to conduct an HRA. This approach helps produce trust in the HealthComp member relationship and better outcomes by uncovering health risks early.
Five Key Findings
- Utilization – 30% lower overall utilization, including 14% lower outpatient utilization, by engaging members and improving treatment selections favoring lasting health results.
- Inpatient costs – Inpatient-allowed costs were 48% lower (representing $14.25 per employee per month, or PEPM, in savings) by helping members with chronic conditions sustain habits to avoid acute exacerbations and prevent readmissions.
- Emergency Room Solution Services – 32% lower emergency room utilization (representing $16.09 PEPM in savings) by rapidly aiding members to find alternate sites of care after single non-emergency visits.
- Radiology – 27% lower radiology lab spending by engaging members and their care teams early to achieve optimal diagnostic intensity.
- Mommies 2-Be Program – 40% lower maternity spend by improving the rate of full-term pregnancies and supporting mothers with postpartum symptoms.
Proven Results
Overall, for the metropolitan statistical areas and enrollee subsets studied in this analysis, HealthComp achieved reductions in the cost and utilization of services compared to the large group employer market in those same areas.
Visit our Clinical Care Management program webpage to access the full report.