Improving Patient Quality of Care and Increased Savings from an Innovative Insurance Solution.

Challenge

A long-time, self-insured client made several Hylant-recommended changes to its employee benefits program to stem rising costs without adversely affecting its workforce. For example, by changing its pharmacy benefits manager, the company saved 37% of the pharmacy plan spend.

However, there was one additional area of concern and future opportunity: rising health plan costs were due in part to high incidences of cancer cases in recent years.

What could be done to ensure quality care and reduce cost?

Solution

Hylant introduced the concept of an oncology management program. This service, supported by high-quality clinical cancer specialists, reviews and optimizes cancer treatment to improve patient outcomes. After much deliberation, the retailer implemented this low-cost program. Soon, it saw the benefit.

The program discovered an initial misdiagnosed cancer with a recommended expensive drug therapy. When the oncology management program personnel reviewed the plan, they rejected it. They discovered that, per National Comprehensive Care Network guidelines, the work of 31 leading cancer centers devoted to patient care, research, and education, the proposed drug was not appropriate.

After speaking with the treating physician, who agreed with the information provided, the patient was placed on a more appropriate, approved regimen. The patient enjoyed a better health outcome, and the company saved more than $300,000 on the treatment plan