From Operations to Experience: Driving Outcomes That Truly Matter

By Krithika Srivats

In today’s value-driven healthcare environment, success is measured not just by process efficiency, but by the tangible outcomes delivered to patients, members, and health plans. Optimizing cost, quality, and experience requires a strategic blend of clinical insight, data-driven interventions, and whole-person care. An outcome-focused approach — exemplified by our Sagility Smart Step™ program — goes beyond compliance to deliver measurable improvements in health outcomes, operational efficiency, and member satisfaction. By targeting high-risk populations such as frail, older adults, we help healthcare organizations proactively manage care, reduce unnecessary utilization, contain costs, and enhance the quality of life for vulnerable members.

End-to-End Frailty Program Components

While frailty is a debilitating condition, modification is possible with early identification and targeted interventions. A whole-person care program that includes clinical, community, and member communications makes improvements possible.

A specialized, end-to-end program enables individuals to age on their own terms, in their homes. The program applies evidence-based assessments with specific clinical interventions designed to identify and address frailty.

The Program Elements Necessary to Launch Sagility Smart Step Include:

• Frailty predictive analysis: Frailty is the key leading indicator of diminishing health and risk of falls. Using predictive analytics, health plans can identify frail members and enroll them into a frailty program.
• Evidence-based interventions: Validated screening tools, such as the Tilburg Frailty Indicator assessment, include physical, behavioral, social, and life factors identification and treatment options where appropriate.
• Whole person care approach: This method identifies and addresses the root causes of unhealthy behaviors and considers multiple factors that promote health. It also helps members build resiliency and self-sufficiency.
• Concierge member engagement: This member-focused approach helps build trust and relationships with members through omnichannel engagement. Member-centric clinicians bring empathy and behavior change expertise. They also coordinate health plan benefits, including those provided by Medicare.
• Technology platform: Smart Step members make use of a highly secure, yet flexible platform that distributes program updates and changes, as well as clinical content. Such omnichannel member engagement includes email, a portal, text messages, chatbots, and calls.

Bringing It All Together

As Baby Boomers and Gen X populations age, the World Health Organization estimates that roughly 2 billion people will be over 60 by 2050. The National Institute on Aging maintains that nearly 93% of adults 65 and older have at least one chronic condition, while 79% have two or more. As the number of older adults continues to increase, our Sagility Smart Step program with a frailty focus becomes not only important to this population but mandatory for health plans to remain competitive in the future.

Sagility Smart Step has helped reduce claims by 18% and emergency room visits by 12%, enabling more seniors to age safely at home. Similarly, our UM solution for a large payer led to a 22% reduction in unnecessary inpatient admissions, directly lowering total medical costs. These examples illustrate how we enable cost efficiency, quality, and experience to drive outcomes that support the growth of healthcare organizations.

As the aging population grows and healthcare demands intensify, programs that deliver measurable outcomes across cost, quality, and experience are no longer optional — they are essential. We recommend the use of predictive analytics, evidence-based interventions, and compassionate member engagement to transform care for frail populations and their caregivers. Focusing on outcomes helps healthcare organizations not only meet today’s challenges but build a stronger, more sustainable future.

Read more in our white paper, Fixing the Friction: How Strategic Operations Management Unlocks Healthcare Efficiency at Scale, to explore how the four BPM pillars can reduce operational burden, improve patient outcomes, and drive resilience across the care continuum.