Personalized Member Engagement Drives Benefits Utilization and Lowers Costs

As a sense of normalcy resumes in the US, new needs and expectations around how employers procure, manage and deliver their workers’ healthcare have emerged. A reshaped workforce landscape demands rethinking, and for good reason.

New realities around healthcare demand that those charged with crafting and managing benefit packages develop solutions that create a smooth and seamless experience for the end user.

Annual financial and human costs of inadequate care management include almost $300 billion in avoidable costs due to noncompliance,1 approximately 125,000 deaths, up to 25% of hospital and nursing home admissions, almost half of prescriptions being taken incorrectly, and lack of adherence by as many as 40% of patients.2  A J.D. Power survey of almost 35,000 members of 147 health plans found that 64% of the members did not fully trust their plans, and only 25% trusted their plan at all.3 Other issues include healthcare staffing shortages, real or perceived biases among providers, language barriers and transportation.4

A New Way

Benefit teams and managers must address these issues through holistic solutions that include creating networks of vendors to meet a wide variety of needs. However, as that mix grows, so do complexities around collaboration and coordination. The solution is a blended suite of vendor services delivered in a connected and personal manner that improves utilization of benefits.

PHNs provide accountability and reliability that serves all stakeholders, and with tangible results.

Conifer Personal Health Nurses (PHNs) are clinicians who reach out to employees to offer support and guidance, and to educate them about symptoms and integration of their employer’s care providers into a highly personalized package, connecting members with primary care, labs, physical therapy, nutritionists, classes, and even same day primary care appointments.

Return on investment for these programs, which are often a per member per month price, stem from members using the benefit point solutions due to education and active referral. PHNs provide accountability and reliability that serves all stakeholders, and with tangible results.

A Plan in Action

Conifer partnered with a nationwide company on a pilot healthcare program to determine the impact of an initiative-taking, holistic approach to reducing ED and In-Patient (IP) admissions among the organization’s 100,000+ employees.

Many employees worked long shifts, standing on hard floors that often lead to chronic orthopedic issues that sometimes required surgery. Unnecessary ED visits and IP admissions were common because employees were largely unaware that they had access to free urgent care. This resulted in long recovery periods for employees, absenteeism for the organization, and high costs: $1500 for an ED visit, with a co-pay of up to $200 incurred by the employee, vs. a clinic that was free for employees and only cost the employer $150.

PHNs, whose clinical backgrounds and training established trust, reached out to high-need members, educated employees about symptoms, and met weekly with utilization management providers about patient needs and best practices around behavioral health, pharma and physical therapy. In concert they changed the workplace culture through new awareness and support for a prevention-focused healthcare approach.

Engaging in 2020 Decreased Top Conditions’ 2021 Costs
Average Cost Per Claimant in 2020 vs. 2021 chart
Average Cost Per Claimant in 2020 vs. 2021 chart
Personal Health Nurses Impact on Top Two Issues:
  • Heart Failure – decreased expenses by $2,318 vs. increase $2,483: Net impact $4,801.
  • Ischemic Heart Disease – decreased expenses by $5,458 vs. increase $1,913: Net impact $7,371.

In addition to substantial savings in heart failure and ischemic heart disease, Conifer PHNs drove a 30% decrease in avoidable Emergency Department visits over a two-year period.

Success Story

A 55-year-old man, whose health issues included obstructive sleep apnea, narcolepsy, osteoarthritis and back surgery, was admitted to the hospital for a pulmonary embolism. After discharge he returned home with new orders for oxygen, but still struggled with breathing and walking. No follow up of any kind was scheduled, his prescription for a high-cost drug was not covered by his plan, and attempts to speak with anyone about these issues were unsuccessful and distressing.

A routine follow-up by a Conifer PHN led to action. The nurse contacted his pulmonologist, resolved the formulary issue, arranged a follow-up appointment for post-discharge evaluation, reviewed his treatment plan, and addressed the patient’s immediate concerns. The PHN educated him about oxygen safety, blood thinners, noncompliance, non-medical pain treatment, and safe use of non-prescription medications.

The patient understood and adhered to his post-discharge treatment plan. In short order he no longer needed oxygen, managed his pain with ice and Tylenol, and returned to work approximately six weeks after surgery.

Good Thinking

New realities around healthcare, employer/employee relationships, and societal expectations demand that those charged with crafting and managing benefit packages develop solutions that acknowledge that, contain costs for their organization and create a smooth and seamless experience for the end user.

These goals are not at cross purposes, and success satisfies all stakeholders. Services are robust and easily accessible, expenditures and absenteeism are lowered, and health outcomes are improved. Caring professionals who manage networks of vendors and their interconnected offerings, then proactively connect employees to them, is a real solution that recognizes and addresses needs within all stakeholder groups.


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