Increasing engagement to decrease cost
In the fall of 2019, Proactive MD revitalized a clinic that was operated for over 5 years by another vendor. Soon after the transition, Health Center engagement rates skyrocketed. Member engagement grew to 60% three months after the transition and exceeded 80% after another six months. Health Center staff also engaged over 90% of patients with chronic conditions such as diabetes, hypertension, and hyperlipidemia. The increase in engagement dramatically reduced plan-paid claims, resulting in significant employer cost savings.
Within 12 months of transitioning to Proactive MD, with adjustments to account for the impact of COVID-19, the employer experienced:
- 11% decrease in total per member per month (PMPM) costs
- 26% decrease in outpatient hospital PMPM costs
- 18% decrease in inpatient facility PMPM costs
- $415 average savings per member per year (PMPY)
We compared a 20-month baseline period under the employer’s previous onsite healthcare provider to a 12-month measurement period after the transition to Proactive MD. To account for the impact of COVID-19, Proactive MD’s 12-month period was broken into two timeframes: 4 months pre-pandemic and 8 months post-pandemic. Using estimates provided by The Segal Group, Inc, we adjusted claims between January and August 2020. The full analysis included over 28,000 member months and 21,000 unique medical claims.
A major limitation to our analysis was relying on plan-paid amounts; however, this was the only available cost figure provided by the employer’s insurance carrier. This analysis is also limited because of its sole reliance on medical claims and exclusion of pharmacy claims. Pharmacy claims were available but not considered due to lack of research on COVID-19’s impact on pharmacy cost.
The effects of COVID-19 cannot be ignored, but there is little research at this time on the full impact of the pandemic on plan-paid amounts. As elective surgeries and routine preventive examinations are delayed, costs could rise as complex conditions worsen.