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The impact of proactive plan management

A manufacturing firm's national carrier wasn't looking for savings beyond network discounts. Healthgram's proactive approach saved them $1.2 million in claims cost.

“With all other insurances, it’s very hard to get ahold of someone – this is the first insurance I’ve had someone be hands-on.” - Healthgram member

The Outcome

  • -11% annual medical trend
  • 16% decrease in pharmacy spend
  • 91% total employee engagement
  • Over $1.2 million saved in medical claims cost overall

The Client

  • Industry: Manufacturing
  • Employees: 1,000+
  • Location: North Carolina

The Challenge

For two decades, this manufacturing firm’s healthcare was managed by a national carrier with a passive approach. The carrier relied on network discounts to control costs, which led to double-digit annual increases. Looking to reduce spending, this company came to Healthgram seeking a proactive approach to healthcare and greater control over their investment.

The Solution

When our team began to intervene, negotiate, and audit claims,  we found immediate cost savings in medical and pharmacy spending. Proactive clinical oversight over medical and pharmacy spend uncovered savings opportunities missed by the company’s previous carrier.

We also incorporated comprehensive data into the operations of the company’s onsite clinic. These metrics allowed clinicians to have fuller pictures of patient health and thus identify those patients they could help through proactive outreach.

This outreach allows us to connect with members, one-on-one, to help them negotiate healthcare decision making and find high-value care. For example, one Healthgram advisor reached out to a member who was due for a colonoscopy, asking if he needed assistance finding a provider. In this member’s zip code, a colonoscopy can cost as much as $10,403. The advisor and member discussed available options, and the member was shocked to learn of the price differential. The advisor helped the member find a provider who performed the procedure at a cost that saved the plan over $8,000.

This company now has 91% of its members using our advising service, which proactively coordinates care and identifies valuable cost savings opportunities.

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