How Sagility Supported Transforming a Global Health Plan
About the Client
- Plan Type: Multi-Line
- Plan Size: ~19 million members
- Geography: National
Issue
In 2014, a global health services organization—one of the largest payer organizations in the United States—approached Sagility with cautious interest in expanding its clinical operations abroad.
The organization faced growing pressure to improve turnaround times, reduce costs, and scale processes to better support its member population. Stretched thin by unmanageable workloads, clinical staff struggled to keep up, while operational inefficiencies drove up costs and delayed care decisions.
Although the organization was initially skeptical about working with external clinical partners, it saw potential in a collaborative model as long as care quality and compliance could be preserved. The initial engagement was relatively small:
- 24 prior authorization nurses.
- 13 triage line staff.
- 15 care advocates.
Action
Sagility became a seamless extension of the client’s internal team—bringing operational discipline, transparent collaboration, a sharp focus on clinical accuracy, and a continuous drive for improvement. Built on trust, the partnership grew steadily, one service line at a time, as we proved our ability to solve complex problems and deliver high-quality services.
A key early breakthrough came in prior authorization. By separating clinical from administrative tasks, Sagility uncovered process bottlenecks that had gone unnoticed. Working closely with the client, we streamlined standard operating procedures, aligned workflows across departments, and improved prior authorization turnaround times.
We also addressed a major barrier to efficiency: unnecessary medical director (MD) reviews. Analysis showed two primary drivers—provider coding errors and nurse uncertainty around clinical policy. In response, we educated providers on coding accuracy, clarified policy intent through collaborative discussions, and empowered nurses to make confident, within-scope decisions. This reduced MD escalations and improved the speed and quality of care decisions.
As trust deepened, the partnership expanded into 19 clinical lines of business, including:
- Nurse triage operations
- Care coordination
- Transition of care management
- Inpatient case management
- High-dollar medical necessity reviews
- Wellness coaching
- Quality review of internal clinical work
- Behavioral health support and benefit coordination
What began as a high-stakes pilot evolved into a multi-service clinical partnership delivering scalable improvements and measurable outcomes.
Impact
Sagility helped the client achieve significant improvements across multiple areas of care delivery and operations, including:
- 5-point increase in member engagement (from 20% to 25%) driven by improved outreach and trust-building efforts.
- 40-point increase in reach rates (from 50% to 90%) achieved by enhancing contact success in transition-of-care programs.
- Resolved 29% of the root causes behind misrouted or voided prior authorization cases, reducing controllable errors by 5%.
- Achieved a Net Promoter Score of 90, reflecting high satisfaction.
- Kept error rates below 1% on complex clinical reviews.
- Achieved consistent quality scores over 90%, reflecting scalable excellence.
- Reduced medical director escalations, leading to faster, more consistent clinical decisions.
- Enhanced satisfaction for both members and providers through improved efficiency and communication.
This collaboration truly elevated the standard of care. Operating as one integrated team, Sagility and the client built a scalable, clinically sound model that improves outcomes, drives value, and delivers lasting impact.
point increase in member engagement
point increase in reach rates
root cause resolution of misrouted prior authorizations
with <1% error rate on complex reviews
