Case Study: Healthcare
Deploying clinical process outsourcing to drive down medical costs
for large health insurance plan
The Sagility Case Management Program engages customers who are incurring significant medical costs based on either a chronic condition or a condition that requires long-term medical care.
The solution aimed to drive two key client and member outcomes: improving population health and reducing costs. Five hundred nurses (140 of whom are U.S.-certified) engaged with members/patients to educate them about case management. These nurses educated members on how nurse case managers could assist the member/patient on providing alternate methods of treatment. The team members could keep track of patient treatment plans so that additional costs were not incurred. Education was also provided on cost-effective providers.
Sagility provided support for neonatal ICU, chemotherapy/radiation, cardiac rehab, and maternity patients. For members, Sagility nurses answered symptoms-related calls on the client’s health information line. These nurses conducted a level of care assessment and advised when or under what circumstances to seek medical attention. Care associates worked with members who had high-dollar claims in the past to minimize future claims. They also offered preventative coaching on how to improve and monitor health, medical services options, and how to ensure productive visits.
Over the past three years, the percentage of members who enrolled in case management steadily increased from 7% in year 1 to 48% in year 3. This significantly reduced the medical costs of the client and their members.
48% Increased case management
referrals over 3 years