Third-Party Administrator Achieves Results for its Clients Through Cost Savings
About
This established third-party administrator (“TPA”) of self-funded employee benefit plan services currently manages more than 150,000 lives. The TPA focuses on providing employer and union groups with healthcare products and services that allow for customization and competitive pricing.
Challenge
This organization, like similar TPAs, struggled with finding an innovative and integrated population health management solution for high-quality, cost-effective medical management for its employer clients.
Solution
In 2010, the organization partnered with Conifer Health to more effectively control its employer clients’ healthcare costs while enhancing employee care. Conifer Health’s population health solution enables a comprehensive, in-depth understanding of employee populations while empowering its care management nurses with actionable data to identify high-risk, high-cost members for targeted engagement efforts. This partnership has achieved sustainable success, delivering the TPA a 4:1 ROI for each dollar invested in 2016.1
Clinical and Financial Data Empowers Cost-Effective Care Management
Conifer Health has helped this client achieve sustainable, cost-effective care management for its employer and union clients by leveraging its robust solution and arming care management nurses with the data needed to drive positive outcomes.
Actionable Data
Integrating data from disparate sources and providing actionable insights are critical to effectively managing multiple populations and stabilizing cost trends. Employers benefit from Conifer Health’s solution that stratifies populations based on level of risk, performs predictive analytics to identify potential utilization trends, and drives interventions.
One Population, One Nurse
Equipped with powerful, comprehensive data, a Conifer Health care management nurse — responsible for a specific population — holistically manages the member across the continuum of care. The process starts with an initial outreach, followed by one-on-one engagement and follow-up after care — all while establishing and maintaining a relationship with the member and his or her health care providers. Because the vast majority of Conifer Health’s care management nurses live in the community in which they work, they also know the resources that are available for quality referrals and cost-effective programs.
Focus on Follow-Up
The relationship between a care management nurse and a member doesn’t end when the member’s health stabilizes. The care management nurse continues to track data and reports associated with that member and re-engages if there is a change in health status. Members are also encouraged to contact their nurse with questions or to discuss challenges they may be facing. Maintaining that connection helps members stay on track with healthier habits and behaviors, which can lead to lower overall healthcare costs.
What’s Next
Our client continues to experience steady, pro table growth, adding employer groups and increasing total covered lives. In 2017, so far 14 additional employer groups are targeted to join the TPA and the number is expected to increase signi cantly by year’s end.
Note
*URAC accreditation through Conifer Care Continuum Solutions, a Conifer Health Solutions company. All logos and trademarks are the sole property of their owners.
TPA achieves real results for its clients through cost savings and high member engagement.
$4 saved
for every $1 invested
in Care Management
70%
engagement rate
by members
We have URAC accreditation for health utilization management, case management, and transitions of care services.*
