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HEALTH
ADVOCACY
SOLUTIONS
CASE STUDY

A National Software Company

The Challenges
This pioneering software solutions company founded on the core values of innovation, prioritizing people and delivering results for their customers, was looking for similar values in a care management program to enrich their health benefit plan.

Their employees and covered family members were dealing with significant health challenges including cancers, heart conditions and musculoskeletal injuries which were driving 40% of medical costs. In fact, high-cost claimants were responsible for 30% of this employer’s total cost.

Initially, they signed on to our Wellbeing Management Enable program in 2019, and while it did deliver on savings, the client was not getting the personalized customer service, navigation support and integration of benefits they wanted for all of their employees. So, in January 2021, they upgraded to Health Advocacy Solutions.

The Solution
Health Advocacy Solutions provides the high-touch, holistic, concierge care management services this client wanted, in order to meet the needs of their entire population. They were looking for a care management program that felt like a natural extension of their own benefits team.

Health Advocacy Solutions offers:

“She explained my benefits and then connected me with a medical provider. The three of us were on the call together. I learned all the details and costs during that conversation.”

Software Company Member

“Tom was very helpful. He placed a lot of calls on my behalf that he could have just told me to go do myself.”

Software Company Member

“I really appreciate you walking through this with me and being patient and having compassion. I really appreciate you.”

Software Company Member

The Results*
Hard Dollar Savings
In 2021, with Wellbeing Management this client saw savings of $694K. After implementing Health Advocacy Solutions, they saw annual savings increase to $1.05M in 2022 and $1.08M in 2023. This represents an annual increase of 34%.

This was reflected in the PEPM program savings:

$1.08 Annual Savings in 2023

Improving Engagement Among Those Who Need It Most
Health Advocacy Solutions increased outreach approach engaged and managed more of the member population responsible for the majority of health care spend.

High-Cost Claimants
In 2021, with Wellbeing Management in effect, this client saved $48.6K on high-cost claimants. This increased by 317% after implementing Health Advocacy Solutions with savings of nearly $203K in 2022 and $236K in 2023 on high-cost claimants. By year two of Health Advocacy, we were managing nearly 25% of the population responsible for almost 80% of health care costs. Increased overall member engagement with Health Advocacy Solutions was evident, as household interactions doubled from 11 times with the Wellbeing Management product to 22 times with Health Advocacy. In year two of Advocacy services, household interactions rose to 30 times.

Clinical Management Year-Over-year

Excellent Member Experience
This client places a lot of emphasis on employee and member satisfaction and they got it with Health Advocacy Solutions. The increased engagement and the quality of the interactions with Health Advocates was clearly appreciated by this population. This is not only evidenced by the satisfaction and net promoter scores below, but also by the quotes from employees seen on the previous page.

Member Experience

Increased overall member engagement with Health Advocacy Solutions was evident, as household interactions doubled from 11 times with the Wellbeing Management product to 22 times with Health Advocacy. In year two of Advocacy services, household interactions rose to 30 times.

Program Interactions Household

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*Note: Data provided is based on one group’s experience. Results may vary from group to group.

Data Sources

The reporting period represents claims from January 1, 2021, through December 31, 2023, and paid through February 29, 2024. Activity based metrics represent engagement from January 1, 2021, through December 31, 2023.

Key Definitions

Household Engagement: The interactions represented in this report are restricted to meaningful bi-directional activities with or by the member. Examples include connected calls, web engagements and cost searches, fitness program utilization and strategic business partner utilization. Email and print communications are excluded.

Clinically Managed: This is a category intended to capture management activities that are tied to a members’ clinical needs and are provided via self-service tools and resources or by a clinical/professional staff. This includes members who have engaged in clinical program participation, received clinical program participation education and resources or had a UM authorization clinically reviewed. Anything automatically/systematically reviewed is excluded (i.e. maternity requests).