HEALTH
ADVOCACY
SOLUTIONS
CASE STUDY

A National Retail Company

The evolution of Health Advocacy Solutions leads to improved cost savings and a better health care experience for all.

The Challenge
A long-term, national retail client sought a custom health benefits and management solution that they could make their own. They came to us, a trusted business partner, to design a new, highly personalized engagement model that would enable us to deliver the most integrated benefits and care management services with a focus on realizing substantive cost savings. The result was a re-imagined high-touch, comprehensive new model — Health Advocacy Solutions.

The Results
With the implementation of Health Advocacy Solutions, our client exceeded their initial goal of a 6% target trend savings. This success has grown each year, accompanied by exceptional member experience reviews and ongoing cost savings.

Health Advocacy Solutions Results

The Solution
Health Advocacy Solutions focused on better and more meaningful connections between employees, their health benefits and our Health Advocates. Deep analysis of services, data and key cost drivers fueled enhanced navigation initiatives guiding members to cost-efficient network alternatives. These factors, along with a high-touch engagement model that included optimized utilization management, and a concierge approach to member service delivered increased cost savings and an improved employee experience. Throughout this process, our client looked to us because of our willingness to create a flexible solution to meet their needs and our dedication and consultative approach in support of their health care objectives and their three- to five-year business strategy.

In 2017, once Health Advocacy Solutions was up and running, we looked at interim data, member feedback and our clients’ ongoing business needs and goals. Based on this analysis, we made recommendations resulting in the client implementing benefit changes starting in 2018 to further enhance cost savings.

We understood that an integrated and optimized network strategy aligned with Health Advocacy Solutions would help drive savings without compromising access or quality care for employees. These changes included:

• Redirecting care to the most cost-effective facilities and providers including our Blue Distinction^® Centers and Blue Distinction^® Centers Plus (BDC+) designated provider partners
• Helping participants understand their custom provider network and ensure they maximize their benefits by remaining in the network
• Zero coverage for non-emergent emergency room visits
• Addition of virtual visits telehealth component

We also worked with the client to customize engagement intensity to increase cost savings opportunities. In 2018, outpatient UM was added for high-cost services (advanced imaging, sleep testing, genetic testing, radiation therapy, cardiac imaging and musculoskeletal procedures). Specialty Drug Review was also expanded beginning in 2018.

Our relationship with the client, members, and providers positioned us well to better understand their needs. Applying our expertise and tailoring the solution to solve those challenges illustrated why we were the best longterm health care partner. Health Advocacy Solutions is affordable, adaptable and progressively effective in positively influencing healthy, cost-conscious behavior.