Employing Clinical Process Outsourcing to Drive Down Medical Costs For a Major Payer

Sagility collaborated with a major healthcare payer to address the problem of unnecessary medical visits and expenses by developing a Case Management Program staffed by over 1,200 trained nurses. By offering health assessments, coaching, and cost tracking, the program significantly lowered medical costs, with customer referrals to case management increasing from 7% to 48%.

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About the Client

The client is a prominent global healthcare payer committed to enhancing individuals’ health, security, and well-being while lowering medical costs. Working closely with brokers and consultants, the client aims to develop innovative programs that alleviate unnecessary medical expenses and fear, ultimately improving overall customer satisfaction.


Case Management Ineffectiveness

It’s no secret that healthcare costs are one of the highest expenses in people’s budget. In many cases, people seek medical assistance when they display a certain set of symptoms, even though there often is nothing to worry about. This can lead to increased medical costs for customers, a heightened sense of fear, and decreased well-being. 


The client recognized that many of their customers were needlessly visiting medical facilities and incurring high medical bills. To remedy this problem, they turned to Sagility’s team of highly-trained nurses. They believed that if their customers could seek advice from medical professionals, it would save them a visit to the doctor and an unnecessary medical bill. 


Performing Health Assessments

Initially, incoming phone calls related mostly to standard clinical intake questions regarding benefits and eligibility. However, the Case Management Program has quickly vamped up so that Sagility’s nurses could answer symptom-related calls from concerned customers. 


Upon receiving the call through the client’s health information line, the nurses conduct a level of care assessment and advise the customer as to whether or not they should seek medical attention. This is especially helpful for members who have had high-dollar claims in the past and can’t afford additional claims and bills.


Coaching Customers

In addition to performing health assessments, Sagility’s nurses offer coaching services. Through these services, they educate customers about practical ways to improve and monitor their health, when and where to seek medical attention, and how to make the most of their future visits.


Tracking Costs

Sagility also keeps track of each customer’s treatment plan to ensure that they don’t incur unnecessary medical costs. This is important in the client’s efforts to save their customer’s money while saving money themselves. 

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