Improved health outcomes and cost savings
Health Navigator, powered by PinnacleCare
Improving health outcomes for our members is our top priority. Navigating the healthcare system can be difficult, time-consuming, and stressful, especially for someone with a complex health condition. We believe that supporting members with expert, objective guidance during these critical times in their lives will not only improve their experience but can also improve their health outcomes. And by doing the right thing for the member, we can also improve the cost of care.
Member Success Stories
We leverage our relationships nationwide to connect members with the leading experts for their specific condition and preferences. We work to ensure members have confidence in the decisions they are making around their health, across a wide variety of conditions, locations, and circumstances.
Explore our library of member success stories by condition type or health outcome.
Prostate Cancer
Prostate Cancer 2
Thyroidectomy
Neuroendocrine Tumor
Cervical Spinal Fusion
Lumbar Radiculitis
Thoracic pain
Neck fracture
Hip Osteoarthritis
Shoulder pain
Hip Arthroplasty
CAD/Ischemic Cardiomyopathy
Colovesical Fistula
Esophageal Achalasia
Urinary frequency
CIDP
Click here to filter
Type of Condition
Health Outcome
Cancer
Musculoskeletal
ALL SUCCESS STORIES
CANCER SUCCESS STORIES
MUSCULOSKELETAL SUCCESS STORIES
Avoided Overtreatment
Avoided Surgery
Medications
ORTHOPEDIC AND JOINT SUCCESS STORIES
CARDIOLOGY CONDITIONS SUCCESS STORIES
GASTRIC DISORDERS SUCCESS STORIES
Click here to learn more!
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.
SLPC #1354532445 04/24 (exp 04/26)
UROLOGY CONDITIONS SUCCESS STORIES
NEUROLOGY SUCCESS STORIES
All Stories
Parkinson's fatigue
Orthopedic and Joint
Cardiology
Gastric Disorders
Urology
Neurology
Occipital Neuralgia
Prostate Cancer
Prostate Cancer 2
Thyroidectomy
Neuroendocrine Tumor
Cervical Spinal Fusion
Lumbar Radiculitis
Thoracic pain
Neck fracture
Hip Osteoarthritis
Shoulder pain
Hip Arthroplasty
CAD/Ischemic Cardiomyopathy
Colovesical Fistula
Esophageal Achalasia
Urinary frequency
CIDP
Parkinson's fatigue
Occipital Neuralgia
Treatment Change
Surgical Intervention
AVOIDED OVERTREATMENT SUCCESS STORIES
AVOIDED SURGERY SUCCESS STORIES
Parkinson's fatigue
MEDICATION REMOVAL SUCCESS STORIES
Occipital Neuralgia
TREATMENT CHANGE SUCCESS STORIES
SURGICAL INTERVENTION SUCCESS STORIES
Prostate Cancer
Neuroendocrine Tumor
Thoracic pain
Shoulder pain
CIDP
Thyroidectomy
Cervical Spinal Fusion
Lumbar Radiculitis
Neck fracture
Hip Osteoarthritis
CAD/Ischemic Cardiomyopathy
Colovesical Fistula
Esophageal Achalasia
Urinary frequency
Hip Arthroplasty
Prostate Cancer 2
Medical director review
Research
Specialist identification
Appointment facilitation
Consultation
Diagnosis confirmation & recommedation
Healthcare Bluebook analysis
Client Profile:
Industry: Manufacturing
Size: 10,000+
Total Engagements
Health Condition breakdown
Treatment Outcomes
Member Satisfaction
Cost containment
Total Engagements: 523
An engagement is anytime an employee reaches out to Health Navigator.
Engagement totals by month:
40%
60%
Advisory Support: 315
Advisory Support Services include, but are not limited to, the full scope of advisory support which may include medical record collection, review and transfer of medical records, medical research report; physician referral report; decision support including providing recommendations on next steps; appointment facilitation, remote written expert second opinions, and virtual consultations via a remote video/telephonic consult.
Benefit Navigation: 208
Benefit Navigation includes, but is not limited to, educating Eligible Members on the PinnacleCare benefits available to the Eligible Member and how and when to access them. In addition, PinnacleCare will refer Eligible Members to existing vendor partners where appropriate.
Cancer/Abnormal Tissue Growth
Our team of medical experts, ready to support members’ healthcare needs:
Internal
40
MD, PhD and specialized medical researchers
85
Care Advisors (MDs, NDs, RNs, BSNs, MSAs)
8
Medical Directors
20
Academic Medical Centers contacted to provide remote written opinions
Clinical
130+
Relationships at top regional and national hospital systems
1000+
In-person meetings with physician leaders and hospital executives
Dedicated Behavioral Health Researcher
Solutions
Centers of Excellence facilities contracted to provide written medical opinions
27
4500+
Experts contracted to provide direct-to-patient video consultations
Identified and provided provider recommendations
30K
Musculoskeletal
Nervous System
Circulatory
Abnormal Test Results
Genitourinary
Digestive
Exploratory Examinations
Behavioral Health
Injury, Poisoning
Eye
Respiratory
Endocrine and Metabolic
40%
17%
8%
9%
4%
4%
4%
2%
2%
1%
4%
1%
3%
Total Treatment outcomes: 139
Click on a chart bar to learn more!
Want to see more details for each condition?
Access Outcomes
A treatment outcome is a significant outcome with savings attached. A treatment outcome could be a change in diagnosis or a change in treatment.
36 Confirmation of Diagnosis/Treatment
8 Change in Treatment
9 Change in Diagnostic Strategy
3 Change in Diagnosis
Treatment outcome breakdown:
12 Confirmation of Diagnosis/Treatment
5 Change in Treatment
3 Change in Diagnostic Strategy
3 Change in Diagnosis
1 Avoided Surgery
Musculoskeletal
7 Confirmation of Diagnosis/Treatment
2 Change in Treatment
1 Change in Diagnostic Strategy
1 Avoided Unnecessary Testing
Nervous System
5 Confirmation of Diagnosis/Treatment
4 Change in Treatment
3 Change in Diagnostic Strategy
1 Change in Diagnosis
Cardiovascular/Circulatory System
4 Confirmation of Diagnosis/Treatment
1 Change in Diagnostic Strategy
1 Change in Diagnosis
Abnormal Test Results
4 Confirmation of Diagnosis/Treatment
1 Change in Treatment
1 Change in Diagnosis
Genitourinary
Click here to access our national and regional hospital map
3 Confirmation of Diagnosis/Treatment
1 Change in Treatment
1 Change in Diagnostic Strategy
Digestive
3 Confirmation of Diagnosis/Treatment
Exploratory Examinations
2 Confirmation of Diagnosis/Treatment
1 Change in Diagnosis
Behavioral Health
2 Confirmation of Diagnosis/Treatment
Injury, Posioning
1 Confirmation of Diagnosis/Treatment
2 Change in Treatment
1 Change in Diagnostic Strategy
2 Change in Diagnosis
Eye and Adnexa
1 Change in Diagnostic Strategy
Respiratory
2 Confirmation of Diagnosis/Treatment
1 Change in Treatment
1 Change in Diagnostic Strategy
Endocrine and Metabolic
691 Access Outcomes
An access outcome is any service from Health Navigator that provides timely access to health services or health expertise for a member.
Delivered Expert Physician Opinion
Expedited Consultation
Facilitated Access
Provided Expert Referral
Transferred Care to COE
Transferred Care to Expert
38%
7%
21%
28%
2%
4%
Member Satisfaction
Health Navigator aims to provide an exceptional member experience. Member satisfaction rating is tracked for three categories: support received, advisor met expectations met, and likelihood to use again.
Health advocacy
Medical Intelligence
A better member experience and improved outcomes
Health Advocacy
High-touch, highly personalized engagement model delivered by experienced care advisors.
Medical Intelligence
In-depth medical knowledge on a wide range of health conditions combined with deep expertise in nuances of the healthcare system.
A better member experience and improved outcomes
Successful navigation of the complex healthcare system
Peace of mind regarding healthcare decisions
Improved health outcomes, often leading to reduced costs
Our approach to improved member outcomes
Our client success managers work closely with every client to develop a dynamic communication plan to ensure their members are aware of the Health Navigator benefit throughout the year, including how it can help them and how to use it. We meet regularly with clients to review utilization, member experience and satisfaction, and review any financial outcomes as a result of Health Navigator.
This case study reflects a real client’s experience over the course of a year, including the number of engagements with members, outcomes achieved, and how those members felt about their experience.
Employer Case Study
A wide array of Health Condition categories
23%
18%
10%
10%
10%
7%
6%
5%
4%
3%
3%
100%
Cancer/precancerous
Musculoskeletal
Abnormal Test Results
Exploratory Examinations
Other (less than 1%)
Cardiovascular/Circulatory System
Nervous System
Behavioral/Neurodevelopmental
Digestive System
Endocrine/Metabolic
Genitourinary System
Support Received
Advisor Met Expectation
Likelihood to use Again
9.53
9.37
9.43
Cost saving analysis
Our outcome evaluation is based on over a decade of actual results that have been validated by both client feedback and collected medical records as well as external experts. We regularly audit and validate our data through select client case studies to ensure that we are current on the cost saving to the medical plan and have a credible view of return on investment.
We represent cost containment using two models, to allow for a broad view of probable soft and hard cost savings (inferred) as well as a more precise view with real costs of a subset of member engagements (validated).
$1,807,000
$13,000
139
Total inferred savings: $3,534,500
Treatment outcomes:
Inferred savings is the sum of savings attributed to access outcomes and treatment outcomes. The Health Navigator data analytics team derived assigned values from clinical research studies that detail savings from care provided by top specialists and medical centers, expedited access to care, and productivity savings attributable to utilized services.
More than half of expert opinions identified a more appropriate treatment plan of variation to the original diagnosis.
54%
Cancer/Abnormal Tissue Growth
Treatment outcome breakdown:
0
10
Treatment outcome breakdown:
Treatment outcome breakdown:
Treatment outcome breakdown:
Treatment outcome breakdown:
Treatment outcome breakdown:
Treatment outcome breakdown:
Treatment outcome breakdown:
Treatment outcome breakdown:
Treatment outcome breakdown:
Treatment outcome breakdown:
Treatment outcome breakdown:
INFERRED COST SAVINGS
VALIDATED COST SAVINGS
Access outcomes:
691
$2,500
$1,727,500
#
COST SAVINGS AMOUNT
INFERRED COST SAVINGS
Validated savings is based on tracking the full lifecycle of a case in order to validate treatment outcomes. We seek out updates directly from members as well as changes to their medical record through our data collection process described in our release form. Our data analytics team validates our cases using internal resources including consultation from our medical and research team and the use of a cost avoidance tool through our partner, Healthcare Bluebook.
We followed three members through their experience with us to validate savings achieved (See stories here). Savings for these three individuals alone is included below, based on Fair Price and Maximum validated savings.
$74,666
Fair Price Total Validated Savings:
The Fair Price is a conservative estimate for medical services provided and, in most cases, individuals pay much more for services than the Fair Price.
Maximum Total Validated Savings:
$197,895
The Maximum Savings is a better indication of savings when working with Health Navigator.
Treatment outcomes have a $13,000 cost savings amount applied to all cases
Access outcomes have a $2,500 case savings amount applied to all cases
Percent Breakdown of Access outcomes by Type
Net Promoter Score
85
Average member survey satisfaction
94%
1
1. 2023 Internal PinnacleCare data
1. 2023 Internal PinnacleCare data
1
Putting our expertise to work for your members
A muti-disciplinary team of experts who collaborate to support our members
20
MD, PhD and specialized medical researchers
100
Care Advisors (MDs, NDs, RNs, BSNs, MSWs)
8
Medical Directors
75
Medical Advisory Board members
Data science and analytics team
Dedicated Behavioral Health researchers
Broad relationships with facilities and physicians across the country
4,500+
Experts contracted to provide direct-to-member virtual expert medical opinions
130+
Relationships at top regional and national hospital systems
20
Academic Medical Centers contracted to provide remote written opinions
In-depth knowledge of both regional specialists and national COEs
Identified and qualified providers
50,000
Solutions
Centers of Excellences contracted to provide remote written opinions
27
4500+
Experts contracted to provide direct-to-patient video consultations
Identified and provided provider recommendations
30K
Connect with a Stop-Loss Specialist to learn more!