By Jitana Bagomolny, DNP, MBA, RN, NEA-BC, CCM
You’ve tried it all—higher deductibles, narrower networks, and broader wellness efforts. Yet, your healthcare expenses keep climbing, and you’re left scratching your head and wondering why your interventions aren’t working.
The real issue lies in uncovering what’s truly driving your costs.
Most employers don’t realize that just 5% of their employees are responsible for over 56% of their healthcare costs.
Let that sink in for a minute.
That means a small group of employees—often those managing chronic conditions or complex health needs—are the source of your rising costs.
Not only that, but they’re trapped in a cycle of high-cost care thanks to a fragmented, disconnected, and inefficient healthcare system. These employees bounce between providers, battle complicated systems, and have to piece together disparate health solutions on their own.
And the cost isn’t just financial; their health and wellbeing are on the line.
The good news?
You have the power to free your employees from the cycle of high-cost care, and we’re here to show you how.
Meet care & condition management: Your solution to address high-cost, fragmented care
At Personify Health, we believe that siloed healthcare is simply unacceptable. Your employees deserve a seamless healthcare experience where everything they need is in one place, and navigating the system doesn’t feel like a maze.
That’s why we designed our care and condition management platform to break down those traditional silos and provide your employees with a seamless, connected healthcare experience. We meet your highest-cost employees where they are—on their unique and often complex healthcare journeys—and give them the 1:1 clinical support they need to truly change their health outcomes.

Here’s the thing: Your high-cost members are often managing multiple chronic conditions like diabetes, heart disease, and obesity all at the same time. Many don’t even have a primary care provider involved and turn to their local Emergency Room for care instead. This leads to care that is reactionary and more expensive. But it doesn’t have to be this way.
Care management flips the script. It’s a proactive, personalized approach to assisting your high-risk members in accessing the care they need before they become costly ER visits or hospital stays. We do this by proactively addressing gaps in care, identifying risk patterns, and promoting outcome-focused patient care.
The result? Healthier employees, increased transparency, and measurable savings for your organization.
Clients leveraging our care management services achieve significantly reduced medical costs for high-cost members, including a 17% reduction in ER expenses, a 52% decrease in NICU costs, and an 80% drop in out-of-network spending.
So now that you know what care management solution/platform does, let’s dive into how it impacts employer spend and employee health trends with our clinical capabilities.
Our care management service has four essential components, each helping to deliver timely, accurate, and compassionate care for your employees with complex care needs.
Here’s how they each work.
1. Utilization Review: Mapping out care delivery and network participation
Using industry-recognized care guidelines allows our clinical team to support evidence-based clinical decision making. Our high-touch process also allows for proactive identification of additional clinical needs for the member in alignment with plan provisions (e.g. appeals, second opinions or alternative treatments).
No more jumping through hoops. No more duplicative services. Just efficient, streamlined care that drives better outcomes without the wasted spend.
It’s all about ensuring healthcare is as straightforward as possible.
2. Case Management: Making a difference in the moments that matter
Instead of telling you how case management works, let us show you how.
A client we were working with had an employee managing Crohn’s disease. She was paying over $1,500 every two months for bi-monthly injections in a nearby hospital setting. Couple this with the high out-of-pocket expenses the member was paying to stay on course with her treatment plan, including the bi-monthly infusions.
Her care was disjointed, and no one was helping her connect the dots.
But then our case managers stepped in, found a better solution, and moved her to home-administered injections. Her out-of-pocket costs dropped to $5, which ensured she could maintain the necessary care to avoid potential hospital admissions due to disease flare ups.
That’s the power of connecting the disconnected.
That’s the power of case management.
We’re not just talking about saving money. We’re talking about changing lives.
Our case managers are the guides your employees need to navigate complex care—from pre-admission counseling to discharge planning—ensuring they get the right care and support without unnecessary steps.
No more guesswork.
No more unnecessary costs.
Just high-quality, personalized care.
3. Chronic Disease Management: Keeping your population healthy
Managing diabetes or hypertension isn’t a one-and-done deal. It’s a lifelong journey. And without the right support, it can lead to unnecessary complications—and sky-high costs.
That’s where chronic disease management comes in. We provide your employees with the ongoing support they need to stay on top of their health—whether it’s sticking to a medication plan, making lifestyle adjustments, or scheduling regular check-ins with their doctor.
What does that add up to? Less time spent in the emergency room. Fewer missed workdays. Better employee well-being. And ultimately, more control over healthcare costs.
4. Early Intercepts: Stopping problems before they start
Now, here’s where the magic happens!
With early intercepts, we use data-driven insights to spot at-risk employees before they become high-cost claimants. We don’t wait for problems to escalate. We identify health risks early and intervene before things spiral out of control.
With predictive analytics, we can identify those at risk for increased healthcare spending and proactively guide them to the right care sooner.
From preventive screenings to personalized health plans, we make sure your employees stay healthy—and your costs stay manageable.
Turn high-cost employees into your greatest cost savings
You’ve seen how rising healthcare costs are often driven by high-cost plan members —but with the right support, things don’t have to stay that way.
With Personify’s care and condition management services, you’ll have everything you need to empower your employees to take control of their wellbeing, break free from the cycle of high-cost care, and thrive—both personally and professionally.
71% of our platform members know how to continue improving their health. That’s the power of giving your employees the tools and guidance they need to succeed. And when they do, you’ll see the results reflected in your bottom line.
But look, I get it—making changes to your healthcare strategy is a big decision.
That’s why I’d like to share an example of what’s possible:
📖 How care management transformed one member’s health and saved thousands
If that case study resonated with you, imagine what we can do for your organization.
Contact us today to start building a healthier, more productive future—for your employees and your business.
Let’s make 2025 the year you take control of rising healthcare costs!
Meet the author

Jitana is an accomplished healthcare professional serving as Vice President of Care Management Solutions at Personify Health. In this role, she supports business development and clinical program strategies benefiting self-insured employer groups and industry stakeholders. She has deep insight into actionable ways to leverage clinical programs to optimize health outcomes for Plan members while containing costs. She is recognized as a key industry thought leader in the areas of care management, gene and cellular therapies, and pharmacogenomics.