Self-funded employers are facing many overwhelming healthcare and market challenges right now.
What are you supposed to do to support your employees and protect your organization with these compounding challenges?
Health Navigator success stories
Situation
• 54-year-old male diagnosed with high-risk prostate cancer, requiring immediate treatment
• Referred to radiation oncologist and given recommendation for intensity-modulated radiation therapy (IMRT)
How we helped
Collected medical records & pathology slides within 2 days
Evaluated local radiation oncologist credentials
Coordinated pathology review
Facilitated second opinion with a top urologic oncology expert at a Center of Excellence (COE)
Breaking down the impact
• Expert pathology review downgraded diagnosis to low grade disease
Avoided overtreatment: Intensity-modulated Radiation Therapy (IMRT)
Total cost avoided (based on 40 treatments, average for original diagnosis)
$77,720+
Situation
• 62-year-old male experienced increased pain in his right hip for three months after undergoing a total replacement of the same hip, resulting in limited mobility and the use of a cane
• Local orthopedist found no evidence of infection and recommended continued use of cane, rest, additional healing time and prescribed Celebrex (an anti-inflammatory drug).
How we helped
Reviewed current treatment plan and suggested that the member seek a second opinion with a specialist
Researched and identified physical medicine and rehabilitation (PMR) specialists
Facilitated and secured an appointment within 10 days
Breaking down the impact
• Specialist discovered member’s pain was consistent with greater trochanteric pain syndrome or inflammation of the bursa
• Recommended a different course of treatment, including a greater trochanter steroid injection, focused physical therapy, and prescribed Tramadol and topical diclofenac cream
Changed treatment plan:
Situation
• 63-year-old female reported to physician she was experiencing a feeling of choking when attempting to eat
• A local specialist diagnosed esophageal achalasia, a rare disorder of the esophagus, and recommended surgical intervention (Heller Myotomy)
How we helped
Collected medical records and images within 3 days
Identified top regional experts for esophageal achalasia
Expedited appointment with an identified expert
Breaking down the impact
• Expert recommended against the invasive surgery and instead performed an endoscopic therapy (dilation)
• Fast and easy recovery
Avoided surgery and medication removal:
Heller Myotomy
Total cost avoided
$44,940**
**This average is based on a study from SAGES: Economic Impact of Per Oral Endoscopic Myotomy Versus Laparoscopic Heller Myotomy and Endoscopic Pneumatic Dilation.
Prostate Cancer
Increased hip pain
Complex Gastrointestinal disease
We understand the challenges you're facing
You are well aware of the real-world implications of these statistics, as you are facing these challenges every day—healthcare is expensive and complicated and attracting and retaining top talent is harder than ever. But the big question is:
A focus on happier, healthier employees and their families
Member
Personalized support
Care navigation
Health advocacy
health
navigator
powered by PinnacleCare
Click here to visit our Health Navigator digital experience
Care optimization review
Cost-containment
Risk management
Sun Life
Clinical 360
Click here to visit our Clinical 360 digital experience
Protection for high-cost claims, review for claim errors, potential savings and care optimization opportunities
Robust benefits that focus on the care of individuals keep employees happy, healthy, loyal and return to work faster.
The right care, at the right place, at the right time can positively impact health and well being for members - and control costs
Focusing on care coverage to support the whole employee and have better business outcome
Employers
Supporting members and employers from all angles
We think starting to solve these challenges at the individual level—focusing on each of your employee’s care—can have major impacts to the overall health and wellbeing of your employees, greater satisfaction and retention of your team, and healthcare cost savings for your organization.
You can do this by adding Health Navigator, powered by PinnacleCare to your current benefits, alongside your Sun Life stop-loss coverage with Clinical 360! While both services work to support members and employers on their own, when offered together, they provide comprehensive support to the member, and benefits to the employer.
Take a moment to watch the brief videos and listen to how we’re approaching these challenges with health advocacy and care navigation to create better outcomes for employees AND employers.
IV infusion alternative
Having a second set of eyes
Out-of-network bill negotiation
Verifying medication costs
Validating high cost cancer drug charges
Investigating anti-rheumatic drug charges
Repricing for multiple dosages
Lowers injectable drug prices
Correcting duplicate charges
Site of care change
Recognizing incorrect charges
Making site of care more convenient
Transitioning to infusions at home
From hospital to home infusions
Treatment delays lead to change in care
Member's choice of at home provider
Saving time moving to home infusions
ALL SUCCESS STORIES
Out-of-network bill negotiation
Lowering injectable drug prices
Correcting duplicate charges
Site of care change
Recognizing incorrect charges
Making site of care more convenient
Transitioning to infusions at home
From hospital to home infusions
Treatment delays lead to change in care
Member's choice of at home provider
Saving time moving to home infusions
TPA SUCCESS STORIES
IV infusion alternative
Having a second set of eyes
Verifying medication costs
Validating high cost cancer drug charges
Investigating anti-rheumatic drug charges
Repricing for multiple dosages
ASO SUCCESS STORIES
Validating high cost cancer drug charges
Investigating anti-rheumatic drug charges
Lowers injectable drug prices
Recognizing incorrect charges
Transitioning to infusions at home
From hospital to home infusions
CENTRAL SUCCESS STORIES
WEST SUCCESS STORIES
Out-of-network bill negotiation
Correcting duplicate charges
Making site of care more convenient
Treatment delays lead to change in care
Member's choice of at home provider
Saving time moving to home infusions
IV infusion alternative
Having a second set of eyes
Verifying medication costs
Repricing for multiple dosages
Site of care change
NORTHEAST SUCCESS STORIES
Site of care change
Making site of care more convenient
Transitioning to infusions at home
From hospital to home infusions
Treatment delays lead to change in care
Member's choice of at home provider
Saving time moving to home infusions
SITE OF CARE SUCCESS STORIES
IV infusion alternative
Having a second set of eyes
Out-of-network bill negotiation
Verifying medication costs
Validating high cost cancer drug charges
Investigating anti-rheumatic drug charges
Repricing for multiple dosages
Lowers injectable drug prices
Correcting duplicate charges
Recognizing incorrect charges
SAVINGS OPPORTUNITIES SUCCESS STORIES
Third Party Administrator
ASO Administrator
Northeast
Central
West
Site of Care
Savings Opportunity
Administrator
Region
Type of outcome
All Stories
Click here to filter
Since 2020, Sun Life's Clinical 360 program has achieved over $40 million in savings.
Nearly $25 million of that was saved in 2021 alone.***
***Data as of December 31, 2021
PinnacleCare is a member of the Sun Life family of companies. PinnacleCare and its employees do not diagnose medical conditions, recommend treatment options or provide medical care, and any information or services provided should not be considered medical advice. Any medical decisions should be made only after consultation with and at the direction of your medical provider. Any person or entity who provides health care services following a referral or other service provided does so independently and not as an agent or representative of PinnacleCare.
Group stop-loss insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 07-SL REV 7-12. In New York, group stop-loss insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 07-NYSL REV 7-12. Product offerings may not be available in all states and may vary depending on state laws and regulations. Product offerings may not be available in all states and may vary depending on state laws and regulations. Not approved for use in New Mexico.
© 2022 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. The Sun Life name and logo are trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us.
SLDX-905 SLPC 31697 07/22 (exp. 07/24)
To learn more, reach out to your Sun Life Stop-Loss Specialist
or email us at ask.an.expert@sunlife.com.
50%
Up to 50% of healthcare spend is a 'waste'
Maximum costs based on Healthcare Blue Book Analysis
“My Care Advisor did an amazing job to help me work through the medical, emotional, and mental aspects my cancer diagnosis second opinion. They were caring and compassionate which is exactly what I needed. Having them on my team gave me the support I needed to get a second opinion without consuming a lot of my time.”
• Recommendation against treatment with guidance that treatment may never be necessary
• Confidence in decision because recommended oncologist is a leading researcher and expert in their field
One-year check-in:
no disease progression
Greter trochanteric pain syndrome
“My Care Advisor did an amazing job to help me work through the medical, emotional, and mental aspects my cancer diagnosis second opinion. They were caring and compassionate which is exactly what I needed. Having them on my team gave me the support I needed to get a second opinion without consuming a lot of my time.”
One-year check-in:
symptom free
“Thanks for taking the bull by the horns and helping me when my own doctor showed very little concern about referring me. (TWO years went by!) I was happy with your help and with the doctor/hospital you referred me to. I would definitely use your help again. Really, I am so glad I found the link on my company’s insurance page! Procedure went well and I am “cured” for a few years, if not longer.”
1
How to make Health Navigator, powered by PinnacleCare work for you?
Our collaborative, member-focused approach to care, including internal expertise, ongoing support and relationships with top physicians and hospitals, provides your employees and their families with the knowledge necessary to navigate the complicated healthcare system and create better outcomes.
For a PEPM fee, you can add Health Navigator to your benefits plan, creating a more robust health offering. Providing the right care to employees in critical moments makes them feel supported by their employer, which leads increased employee satisfaction, healthier employers that can return to work faster, and better retention and attraction of top talent. Though we encourage our clients to include Health Navigator as part of their open enrollment benefits education, there is no enrollment process for employees and no cost to them for our services.
Our dedicated team of Client Success Managers will help you educate your employees on the services Health Navigator provides. We work with you to develop the best strategy for ongoing communication with employees and referral collaboration with your other vender partners. From communication support during open enrollment to new educational content relevant to your employees, we’re focused on helping you increase utilization.
By doing the right thing for your employees’ health, we can also help to improve the cost of care. Based on more than 20 years of experience and data, we see an average cost savings of $13,000 for member treatment outcomes.* We meet regularly with clients to review utilization, member experience and satisfaction, and review any financial outcomes as a result of Health Navigator.
Empowering employers and employees to meet today's healthcare and market challenges
spend
1 in 5
1 in 5 serious medical conditions are misdiagnosed
conditions
2
1 in 3
1 in 3 US healthcare consumers have no experience with healthcare systems
Consumers
4
50%
50% of the population has at least one chronic condition
population
3
39%
39% of employees will look for a new job within 12 months if they aren't satisfied with benefits
employees
5
86%
86% of self-funded employers have a stop-loss claim in a given year' and million-dollar+claims are up 21% from 2020 to 2021
self-funded employers
6
Clinical 360, included as part of your stop-loss coverage, provides confirmation that cost-containment and care optimization opportunities are being identified and pursued for your high-cost claims. And Health Navigator ensures your members have support during any healthcare situation, and helps them get the right care at the right time- leading to healthier employees, who can get back to work sooner, and avoid unnecessary medical costs. The ultimate win-win-win.
1. James, B., & Poulsen, G. (2016, November 7). The Case for Capitation. Harvard Business Review. Retrieved July 26, 2022, from https://hbr.org/2016/07/the-case-for-capitation
2. Bernstein, L. (2017, April 4). 20 percent of patients with serious conditions are first misdiagnosed, study says. Washington Post. Retrieved July 25, 2022, from https://www.washingtonpost.com/national/health-science/20-percent-of-patients-with-serious-conditions-are-first-misdiagnosed-study-says/2017/04/03/e386982a-189f-11e7-9887-1a5314b56a08_story.html
3. Boersma, P. (2020, September 17). Prevalence of Multiple Chronic Conditions Among US Adults, 2018. CDC. Retrieved July 26, 2022, from https://www.cdc.gov/pcd/issues/2020/20_0130.htm
4. The Hidden Cost of Healthcare System Complexity. (2018). Accenture. Retrieved July 26, 2022, from https://www.accenture.com/_acnmedia/pdf-104/accenture-health-hidden-cost-of-healthcare-system-complexity.pdf
5. GOBankingRates. (2022, April 20). Half of US Employees Would Leave Their Job for This One Reason, But Will Stay for These Benefits. Retrieved July 29, 2022, from https://www.gobankingrates.com/money/jobs/half-employees-would-leave-job-for-this-reason/
6. 2022 High-cost claims and injectable drug trends analysis_ distribution.pdf. (2022, June). Sun Life. Retrieved August 1, 2022, from https://sunlife.showpad.com/share/R2IfIX5dHmaweOlkHgPlV
*Average cost savings of $13K for treatment outcomes based on 20 years of data. Outcomes may be avoided treatments, less invasive testing or surgery or a change in treatment.
Health Navigator and Clinical 360 success stories
Health Navigator success stories
Clinical 360 success stories
Select between Health Navigator and Clinical 360 to see applicable success stories:
Clinical 360 success stories
Connect with us!
We think starting to solve these challenges at the individual level—focusing on each of your employee’s care—can have major impacts to the overall health and wellbeing of your employees, greater satisfaction and retention of your team, and healthcare cost savings for your organization.
You can do this by adding Health Navigator, powered by PinnacleCare to your current benefits, alongside your Sun Life stop-loss coverage with Clinical 360! While both services work to support members and employers on their own, when offered together, they provide comprehensive support to the member, and benefits to the employer.
Situation
• 63-year-old female reported to physician she was experiencing a feeling of choking when attempting to eat
• A local specialist diagnosed esophageal achalasia, a rare disorder of the esophagus, and recommended surgical intervention (Heller Myotomy)
How we helped
Collected medical records and images within 3 days
Identified top regional experts for esophageal achalasia
Expedited appointment with an identified expert
One-year check-in:
symptom free
Breaking down the impact
• Expert recommended against the invasive surgery and instead performed an endoscopic therapy (dilation)
• Fast and easy recovery
Avoided surgery and medication removal:
Heller Myotomy
Total cost avoided
$44,940**
**This average is based on a study from SAGES: Economic Impact of Per Oral Endoscopic Myotomy Versus Laparoscopic Heller Myotomy and Endoscopic Pneumatic Dilation.
“Thanks for taking the bull by the horns and helping me when my own doctor showed very little concern about referring me. (TWO years went by!) I was happy with your help and with the doctor/hospital you referred me to. I would definitely use your help again. Really, I am so glad I found the link on my company’s insurance page! Procedure went well and I am “cured” for a few years, if not longer.”
We understand the challenges you're facing
Health Navigator Success Stories
Situation
• 54-year-old male diagnosed with high-risk prostate cancer, requiring immediate treatment
• Referred to radiation oncologist and given recommendation for intensity-modulated radiation therapy (IMRT)
How we helped
Collected medical records & pathology slides within 2 days
Evaluated local radiation oncologist credentials
Coordinated pathology review
Facilitated second opinion with a top urologic oncology expert at a Center of Excellence (COE)
Breaking down the impact
• Expert pathology review downgraded diagnosis to low grade disease
Avoided overtreatment: Intensity-modulated Radiation Therapy (IMRT)
Total cost avoided (based on 40 treatments, average for original diagnosis)
$77,720+
Situation
• 62-year-old female experienced increased pain in his right hip for three months after undergoing a total replacement of the same hip, resulting in limited mobility and the use of a cane
• Local orthopedist found no evidence of infection and recommended continued use of cane, rest, additional healing time and prescribed Celebrex (an anti-inflammatory drug.
How we helped
Reviewed current treatment plan and suggested that the member seek a second opinion with a specialist
Researched and identified physical medicine and rehabilitation (PMR) specialists
Facilitated and secured an appointment within 10 days
Breaking down the impact
• Specialist discovered member’s pain was consistent with greater trochanteric pain syndrome or inflammation of the bursa
• Recommended a different course of treatment, including a greater trochanter steroid injection, focused physical therapy, and prescribed Tramadol and topical diclofenac cream
Changed treatment plan:
Situation
• 63-year-old female reported to physician she was experiencing a feeling of choking when attempting to eat
• A local specialist diagnosed esophageal achalasia, a rare disorder of the esophagus, and recommended surgical intervention (Heller Myotomy)
How we helped
Collected medical records and images within 3 days
Identified top regional experts for esophageal achalasia
Expedited appointment with an identified expert
• Expert recommended against the invasive surgery and instead performed an endoscopic therapy (dilation)
• Fast and easy recovery
Avoided surgery and medication removal:
Heller Myotomy
Total cost avoided
$44,940**
**This average is based on a study from SAGES: Economic Impact of Per Oral Endoscopic Myotomy Versus Laparoscopic Heller Myotomy and Endoscopic Pneumatic Dilation.
Prostate Cancer
Increased hip pain
Complex Gastrointestinal disease
Take a moment to watch the brief videos and listen to how we’re approaching these challenges with health advocacy and care navigation to create better outcomes for employees AND employers.
To learn more, reach out to your Health Navigator Sales Specialist or email us at ask.an.expert@sunlife.com.
Maximum costs based on Healthcare Blue Book Analysis
“My Care Advisor did an amazing job to help me work through the medical, emotional, and mental aspects my cancer diagnosis second opinion. They were caring and compassionate which is exactly what I needed. Having them on my team gave me the support I needed to get a second opinion without consuming a lot of my time.”
• Recommendation against treatment w/guidance that treatment may never be necessary
• Confidence in decision because recommended oncologist is a leading researcher and expert in their field
One-year check-in:
no disease progression
Greter trochanteric pain syndrome
“My Care Advisor did an amazing job to help me work through the medical, emotional, and mental aspects my cancer diagnosis second opinion. They were caring and compassionate which is exactly what I needed. Having them on my team gave me the support I needed to get a second opinion without consuming a lot of my time.”
One-year check-in:
symptom free
“Thanks for taking the bull by the horns and helping me when my own doctor showed very little concern about referring me. (TWO years went by!) I was happy with your help and with the doctor/hospital you referred me to. I would definitely use your help again. Really, I am so glad I found the link on my company’s insurance page! Procedure went well and I am “cured” for a few years, if not longer.”
Employers are facing many healthcare and market challenges right now. The statistics can be daunting.
Empowering employers and employees to meet today's healthcare and market challenges
50%
Up to 50% of healthcare spend is a 'waste'
spend
1
1 in 5
1 in 5 serious medical conditions are misdiagnosed
conditions
2
50%
50% of the population has at least one chronic condition
population
4
1 in 3
1 in 3 US healthcare consumers have no experience with healthcare systems
Consumers
3
39%
39% of employees will look for a new job within 12 months if they aren't satisfied with benefits
employees
5
4 in 10
4 in 10 American’s will be diagnosed with cancer in their lifetime; the average cost of a high-cost cancer claim was just shy of $200K
Americans
7
You are well aware of the real-world implications of these statistics, as you are facing these challenges every day—healthcare is expensive and complicated and attracting and retaining top talent is harder than ever. But the big question is:
What are you supposed to do to support your employees and protect your organization with these compounding challenges?
We think starting to solve these challenges at the individual level—focusing on each of your employee’s care—can have major impacts to the overall health and wellbeing of your employees, greater satisfaction and retention of your team, and healthcare cost savings for your organization.
How to make Health Navigator, powered by PinnacleCare work for you?
Our collaborative, member-focused approach to care, including internal expertise, ongoing support and relationships with top physicians and hospitals, provides your employees and their families with the knowledge necessary to navigate the complicated healthcare system and create better outcomes.
For a PEPM fee, you can add Health Navigator to your benefits plan, creating a more robust health offering. Providing the right care to employees in critical moments makes them feel supported by their employer, which leads increased employee satisfaction, healthier employers that can return to work faster, and better retention and attraction of top talent. Though we encourage our clients to include Health Navigator as part of their open enrollment benefits education, there is no enrollment process for employees and no cost to them for our services.
Our dedicated team of Client Success Managers will help you educate your employees on the services Health Navigator provides. We work with you to develop the best strategy for ongoing communication with employees and referral collaboration with your other vender partners. From communication support during open enrollment to new educational content relevant to your employees, we’re focused on helping you increase utilization.
By doing the right thing for your employees’ health, we can also help to improve the cost of care. Based on more than 20 years of experience and data, we see an average cost savings of $13,000 for member treatment outcomes. * We meet regularly with clients to review utilization, member experience and satisfaction, and review any financial outcomes as a result of Health Navigator.
Breaking down the impact
PinnacleCare is a member of the Sun Life family of companies. PinnacleCare and its employees do not diagnose medical conditions, recommend treatment options or provide medical care, and any information or services provided should not be considered medical advice. Any medical decisions should be made only after consultation with and at the direction of your medical provider. Any person or entity who provides health care services following a referral or other service provided does so independently and not as an agent or representative of PinnacleCare.
Group stop-loss insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 07-SL REV 7-12. In New York, group stop-loss insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 07-NYSL REV 7-12. Product offerings may not be available in all states and may vary depending on state laws and regulations. Product offerings may not be available in all states and may vary depending on state laws and regulations. Not approved for use in New Mexico.
© 2022 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. The Sun Life name and logo are trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us.
SLDX-905 SLPC 31697 07/22 (exp. 07/24)
6
1. James, B., & Poulsen, G. (2016, November 7). The Case for Capitation. Harvard Business Review. Retrieved July 26, 2022, from https://hbr.org/2016/07/the-case-for-capitation
2. Bernstein, L. (2017, April 4). 20 percent of patients with serious conditions are first misdiagnosed, study says. Washington Post. Retrieved July 25, 2022, from https://www.washingtonpost.com/national/health-science/20-percent-of-patients-with-serious-conditions-are-first-misdiagnosed-study-says/2017/04/03/e386982a-189f-11e7-9887-1a5314b56a08_story.html
3. Boersma, P. (2020, September 17). Prevalence of Multiple Chronic Conditions Among US Adults, 2018. CDC. Retrieved July 26, 2022, from https://www.cdc.gov/pcd/issues/2020/20_0130.htm
4. The Hidden Cost of Healthcare System Complexity. (2018). Accenture. Retrieved July 26, 2022, from https://www.accenture.com/_acnmedia/pdf-104/accenture-health-hidden-cost-of-healthcare-system-complexity.pdf
5. GOBankingRates. (2022, April 20). Half of US Employees Would Leave Their Job for This One Reason, But Will Stay for These Benefits. Retrieved July 29, 2022, from https://www.gobankingrates.com/money/jobs/half-employees-would-leave-job-for-this-reason/
6. 2022 High-cost claims and injectable drug trends analysis_ distribution.pdf. (2022, June). Sun Life. Retrieved August 1, 2022, from https://sunlife.showpad.com/share/R2IfIX5dHmaweOlkHgPlV
7. Costly conditions: Identifying and addressing top clinical cost drivers. (2022). Health Action Council. Retrieved July 28, 2022, from https://healthactioncouncil.org/getmedia/0f6eb427-7d56-4bc9-9c58-7475ace4d46e/2022-UHC_HAC_WhitePaper-Costly-Conditions_FINAL
*Average cost savings of $13K for treatment outcomes based on 20 years of data. Outcomes may be avoided treatments, less invasive testing or surgery or a change in treatment.
Connect with us!
We understand the challenges you're facing
Situation
• 54-year-old male diagnosed with high-risk prostate cancer, requiring immediate treatment
• Referred to radiation oncologist and given recommendation for intensity-modulated radiation therapy (IMRT)
How we helped
Collected medical records & pathology slides within 2 days
Evaluated local radiation oncologist credentials
Coordinated pathology review
Facilitated second opinion with a top urologic oncology expert at a Center of Excellence (COE)
Breaking down the impact
• Expert pathology review downgraded diagnosis to low grade disease
• Recommendation against treatment with guidance that treatment may never be necessary
• Confidence in decision because recommended oncologist is a leading researcher and expert in their field
One-year check-in:
no disease progression
Avoided overtreatment: Intensity-modulated Radiation Therapy (IMRT)
Total cost avoided (based on 40 treatments, average for original diagnosis)
$77,720+
Maximum costs based on Healthcare Blue Book Analysis
“My Care Advisor did an amazing job to help me work through the medical, emotional, and mental aspects my cancer diagnosis second opinion. They were caring and compassionate which is exactly what I needed. Having them on my team gave me the support I needed to get a second opinion without consuming a lot of my time.”
Situation
• 62-year-old male experienced increased pain in his right hip for three months after undergoing a total replacement of the same hip, resulting in limited mobility and the use of a cane
• Local orthopedist found no evidence of infection and recommended continued use of cane, rest, additional healing time and prescribed Celebrex (an anti-inflammatory drug).
How we helped
Reviewed current treatment plan and suggested that the member seek a second opinion with a specialist
Researched and identified physical medicine and rehabilitation (PMR) specialists
Facilitated and secured an appointment within 10 days
Breaking down the impact
• Specialist discovered member’s pain was consistent with greater trochanteric pain syndrome or inflammation of the bursa
• Recommended a different course of treatment, including a greater trochanter steroid injection, focused physical therapy, and prescribed Tramadol and topical diclofenac cream
Changed treatment plan:
Greter trochanteric pain syndrome
“My Care Advisor did an amazing job to help me work through the medical, emotional, and mental aspects my cancer diagnosis second opinion. They were caring and compassionate which is exactly what I needed. Having them on my team gave me the support I needed to get a second opinion without consuming a lot of my time.”
Situation
• 63-year-old female reported to physician she was experiencing a feeling of choking when attempting to eat
• A local specialist diagnosed esophageal achalasia, a rare disorder of the esophagus, and recommended surgical intervention (Heller Myotomy)
How we helped
Collected medical records and images within 3 days
Identified top regional experts for esophageal achalasia
Expedited appointment with an identified expert
One-year check-in:
symptom free
Breaking down the impact
• Expert recommended against the invasive surgery and instead performed an endoscopic therapy (dilation)
• Fast and easy recovery
Avoided surgery and medication removal:
Heller Myotomy
Total cost avoided
$44,940**
**This average is based on a study from SAGES: Economic Impact of Per Oral Endoscopic Myotomy Versus Laparoscopic Heller Myotomy and Endoscopic Pneumatic Dilation.
“Thanks for taking the bull by the horns and helping me when my own doctor showed very little concern about referring me. (TWO years went by!) I was happy with your help and with the doctor/hospital you referred me to. I would definitely use your help again. Really, I am so glad I found the link on my company’s insurance page! Procedure went well and I am “cured” for a few years, if not longer.”
Prostate Cancer
Increased hip pain
Complex Gastrointestinal disease
