Sagility Smart Step
18% Claims Reduction After Implementing a Frailty Care Management Program
Number of participants
Age of participants
Duration of analysis, validated by 3rd party
Issue
A national, long-term care insurance company wanted to minimize the total cost of care for pre-claim members. The company chose to implement Sagility Smart Step™ to lower costs associated with frail members.
Frailty impacts the total cost of care and includes weakness, isolation, memory concerns, a fall, and other health issues that cause members to be more vulnerable to adverse outcomes. Early identification and targeted interventions can modify frailty. If health plans identify and manage frailty, members can defer the need for custodial care and avoid submitting excessive claims.
Action
Sagility implemented its wellness program for approximately 14,000 long-term care insurance policyholders, aged 70-89. For outcome comparison, Sagility established a control group of like individuals that would not receive any program engagement.
Predictive analytics determined individual suspected risk and initiated prioritized outreach to members with the highest suspected risk. Sagility’s proprietary evidence-based assessment identified frailty and fall risks, determined the final risk level, and additional member engagement. Each member received access to the Sagility Smart Step portal, individualized resources, and educational outreach materials and campaigns.
Based on risk level, care managers worked to assess needs, set goals, and determine tasks which included care coordination, physical activity recommendations, health recommendations, caregiver and social support, and safety equipment. Sagility helped seniors build resilience and maintain or improve functional independence.
After 12 months, Sagility conducted an analysis, validated by the long-term care insurer, and confirmed by a 3rd party.
Impact
After the first year comparing expected vs. actual claimants, the program saw an 18% decrease in member claims and resulting reduced cost of care as compared to the control group. Factors contributing to the reduced cost of care include:
Reduction of falls and related injuries
Of active participants who made changes to improve resilience
Of active participants who adopted home/personal safety recommendations
Of active participants who engaged in exercise/ walking/ other physical activity
