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HealthComp's High-Touch Clinical Programs for Members Prove Valuable, New Independent Study Finds

Wakely researchers compared cost savings and utilization to industry averages to assess the effectiveness of HealthComp’s care management programs.

UNITED STATES, April 5, 2022 / -- A new report from HealthComp, the nation’s largest third-party administrator (TPA) and a New Mountain Capital Company, details how HealthComp drove compelling financial outcomes and cost savings for its customers, as evidenced by its 2019 medical claims. Independent researchers specifically found new evidence about what makes HealthComp’s clinical care management effective and efficient.

This analysis, conducted by the independent actuarial firm, Wakely, was adjusted for both risk and geography. Researchers found those who adopted HealthComp’s clinical care management programs saw 19% lower medical costs compared to the industry average and 30% lower utilization (i.e., the number of healthcare services administered for a given population).

“Waste in healthcare is no secret. The future of health benefits administration is about eliminating waste to re-invest savings towards improving the lives of entire employee populations, their families, and communities,” said Justin Tran, HealthComp’s Senior Vice President of Medical Cost Management. “One of employers’ highest business spends is on health plans, which averages $10,000 annually per employee. Our research demonstrates how important it is for health plan administrators to serve as plan members’ human touchpoints and advocates. Doing so better directs plan members to appropriate care and reduces unnecessary procedures and costs – by up to 30%, according to this empirical research,” he emphasized.

Five Key Findings
• Utilization – 30% lower overall utilization, including 14% lower outpatient utilization, by engaging members and improving treatment selections favoring lasting health results.
• Inpatient costs – Inpatient-allowed costs were 48% lower (representing $14.25 per employee per month, or PEPM, in savings) by helping members with chronic conditions sustain habits to avoid acute exacerbations and prevent readmissions.
• Emergency Room Solution Services – 32% lower emergency room utilization (representing $16.09 PEPM in savings) by rapidly aiding members to find alternate sites of care after single non-emergency visits.
• Radiology – 27% lower radiology/lab spending by engaging members and their care teams early to achieve optimal diagnostic intensity.
• Mommies 2-Be Program – 40% lower maternity spend by improving the rate of full-term pregnancies and supporting mothers with postpartum symptoms.

“These findings are profound for both the greater TPA industry and the health plan industry at large. More efficient, effective, and affordable healthcare is simply a dire necessity in today’s overburdened health systems. Our research provides hope for what’s possible,” said Paul Johnson, HealthComp’s Vice President of Clinical Services. “Thanks to continual in-house cost containment service investments, HealthComp has built distinctive solutions aimed to increase better clinical outcomes for members while keeping medical costs low.”
With greater staffing and deeper technology, HealthComp creates results-driven member engagement and runs a full suite of in-house clinical care management programs. Here, collaboration with members and their physicians drives optimized decision-making and increases care delivery quality. Most HealthComp employer clients – 90% – choose HealthComp’s clinical services, which include utilization review and pre-certification, case management, disease management, population health, proactive cancer awareness, lower-cost emergency room solutions, and personalized prenatal programs. Together, these programs help participating clients mitigate costs and improve care outcomes.

For more information and to read the research in full, visit Actuarial Report: The Value of HealthComp’s Clinical Care Management and Claims Excellence

Carrie Williams
+1 800-442-7247
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