Question / Intervention Goal / Objectives
Alight Solutions’ Healthcare Navigation directs insured plan members to lower-cost providers who meet quality standards. The program’s goal is to reduce medical costs while maintaining high quality of care.
The analysis included 75,613 cases in which a plan member had a medical service provider selected when he/she consulted with the program. The allowed amount for the member’s originally selected provider was then compared to the allowed amount for the provider he/she ultimately chose. (See Table 1.) The analysis includes cases where the member did not change providers after consulting with the program.
The allowed amount comes from the participating employer and thus represents what the plan would have paid. The amount ultimately paid came from medical claims data.
Findings / Metric/ Outcome/ Savings
The allowed amount for the providers used by 75,613 members who consulted with the program was $102 million less than the provider they originally selected. This is a 20% savings.
The savings are gross, not net of Alight’s program fees. Quality of care is not addressed in this analysis.
|Cases||Allowed Amount For Original Selected Provider||Confirmed Payment to Provider Ultimately Selected||Savings / %|
|75,613||$513,840,645||$410,947,602||$ 102,893,043/ 20%|