15+ Year Tenure with U.S. Health Plan: Scaling Care and Cutting Costs
About the Client
- Plan Type: Multi-Line
- Plan Size: ~14.8 million members
- Geography: National
Issue
In 2009, one of the nation’s largest providers of Medicare Advantage and government-sponsored health plans began exploring global delivery. The goal: scale operations, reduce costs, and ease growing administrative strain. The plan started with a small but strategic pilot — transitioning 35 intake roles from U.S.-based operations to Sagility’s delivery centers.
The pilot focused on high-volume, low-licensure work. It offered an ideal test for global support with no disruption to service. Each offshore role saved an estimated $39,000 per year, ultimately generating more than $20 million in savings over 15 years. More importantly, it built a foundation of trust.
As demands grew, the health plan needed more than cost efficiency. It needed a partner who could evolve with the industry, solve operational challenges, and improve member experiences — without sacrificing clinical quality.
Action
A tactical pilot became a broader transformation. By 2016, Sagility had expanded into clinical operations, starting with utilization management and later adding behavioral health, outpatient reviews, and durable medical equipment (DME). These programs alone saved an estimated $38 million — driven by a cost gap of $92,000 onshore versus $7,000 offshore and a strong focus on performance.
As trust deepened, Sagility took on more complex work. The teams expanded into transplant and genetic test reviews, custom clinical communications, and case management support within authorization portals. These weren’t simple transitions. Sagility led process design, built targeted training, and integrated into existing workflows and systems.
Sagility also introduced operational improvements that delivered measurable results. The team reduced medical director pend rates (which can add to delays in patient care and increased administrative costs), automated high-volume codes, and streamlined processes to eliminate bottlenecks — especially in outpatient and DME. Those two programs alone added $12.75 million in value over six years.
In 2022, the health plan expanded the partnership again, this time into member-facing services. Sagility began supporting health risk assessments and care management programs for Medicare Advantage and DSNP members. Support specialists now manage scheduling, backend coordination, and urgent treatment center (UTC) data reviews — freeing nurses in the US to focus on patient care.
This coaching model of care saved more than $5 million in just two years while improving care-plan quality and member engagement.
Impact
Fifteen years later, this partnership continues to grow, delivering consistent results. Key outcomes include:
- $88M+ in validated cost savings across intake, clinical, and care coordination programs.
- 558 Sagility team members supporting the health plan, including:
- 113 U.S.-registered nurses
- 14 Philippine-registered nurses
- 431 non-clinical staff
- 100% internal leadership pipeline — every account leader promoted from within.
- CSAT score of 100 in 2024.
- Clinical quality scores consistently above 90%.
- Zero disruption during service transitions.
This isn’t just a cost-savings story. It’s a long-term partnership built on trust, shared goals, and a commitment to smarter care. Sagility continues to provide human and technological expertise to help this national health plan scale clinical operations, improve outcomes, and deliver a more resilient, human-centered model of healthcare.
in validated cost savings
Customer Satisfaction Score
Clinical Quality Scores
