Wakely Consulting Group analysis also finds
that high-cost claimant members utilizing Personify Health's
comprehensive benefits platform have 14% lower costs vs. market
benchmarks
PROVIDENCE, R.I., July 16,
2024 /PRNewswire/ -- Personify Health, the first
and only platform company to bring health, wellbeing, and
navigation solutions together, today announced the results of a new
independent actuarial study demonstrating that key company programs
drove significantly lower healthcare costs for members compared to
the same-year market average. Conducted by Wakely Consulting Group,
the analysis showed that Personify members in elected programs had
23% lower allowed costs vs. market average – equating to
$762.96 per employee per year,
including the member cost-share, and with risk and geography
adjustment. With PwC's Health Research Institute projecting a
7% year-over-year (YOY) medical cost increase for employers this
year, addressing health costs and outcomes have become business
imperatives.
The Wakely study demonstrated detailed cost savings that were
made possible by Personify Health's approach to health plan
administration. Key findings include:
- 27% lower outpatient costs
- 17% lower emergency room costs
- 14% savings for high-cost claimants
- 80% lower out-of-network spend
These areas of improvement drive a significant portion of
healthcare expenses for employers and must be addressed to lower
the overall cost of care. According to Wakely, Personify
Health had materially lower costs in each of these areas.
Personify's timely and targeted AI-optimized member outreach,
payment integrity capabilities, advocacy, and coaching programs
contributed to lower risk-adjusted medical costs for members across
a range of care settings. Inpatient, outpatient, and professional
services saw 34%, 27%, and 10% lower costs, respectively, compared
to risk-adjusted claims in the same geographic regions. Wakely's
rigorous independent analysis compared Personify Health medical
claims from 2022 to comparable market data from the same time
period, sourced from the Merative™
MarketScan® Research Database, and is a continuation
study of 2019 data.
The Wakely analysis also found 14% lower total medical costs
(risk-adjusted) across members who exceeded $100,000 in medical claims. These high-cost
claimants using Personify Health also saw 23% lower NICU-related
costs and 26% lower claims among those using dialysis services.
"Historically, high-cost, high-need patients accessing inpatient
care have represented the largest driver of health care costs in
commercial insurance – underscoring the need to encourage the
utilization of care settings that provide better outcomes," said
Dan Mendelson, CEO of Morgan Health,
the JPMorganChase business unit focused on improving the quality,
equity, and affordability of employer-sponsored health care. "By
integrating care management and cost containment programs,
employers can help empower patients to access high quality care at
a more efficient cost."
Previous research has shown that U.S. emergency department
treatment costs increased from $54
billion to $88 billion between
2012 and 2019 – a staggering annual growth rate of 5.4%. With
Personify Health, members saw 17% lower emergency room costs vs.
market average in the same year. Some of this activity was shifted
to the more affordable urgent care setting. Additionally,
Personify's out-of-network (OON) spend makes up only 1.2% of total
medical costs, while 7.3% of total market spend is incurred OON
according to the MarketScan data.
"Escalating health costs are putting the squeeze on employers
and staff. It's critical that they have the means to reduce spend
while still offering the benefits that provide quality, holistic
support. That's where Personify Health comes in," said Chris Michalak, CEO of Personify Health.
"Building on previous research, the Wakely analysis proves that our
care management and cost containment programs are highly effective
across a range of areas responsible for the biggest spend.
Combining hundreds of experts with the scalability driven by AI,
we're solving a big industry challenge and making a real difference
for our clients and members – without compromise."
Employers can ultimately see the greatest ROI and value by
offering their workforce access to Personify's comprehensive
health, wellbeing, and navigation platform. A separate independent
study recently found that engaged participants in Personify
Health's wellbeing program had 14% lower healthcare costs
YOY compared to industry benchmarks. Together, these studies
emphasize exponential value for Personify clients.
Study Methodology
The Wakely study evaluated the
following areas of Personify Health's fully integrated personalized
health platform. These are leveraged across various company
programs, including health plan administration, and navigation and
advocacy:
- Cost containment services, which include payment integrity;
fraud, waste, and abuse reviews; and out-of-network
negotiations.
- Care and condition management solution, which features 500+
associates including nurses, medical social workers, dieticians,
pharmacists, licensed therapists, and coaches. These in-house
experts provide members a high level of support along their health
journey, complementing Personify's digital offerings.
Wakely's analysis intended to examine the financial outcomes
within Personify Health's 2022 medical claims and measure
those outcomes in relation to the large group market during
the same period. To prove continuous and consistent
improvement, this study was analyzed as a continuation study from a
prior analysis conducted on 2019 data. Wakely Consulting Group
conducted the analysis using Personify Health's 2022 medical claims
data, representing the company's U.S. customer base. Service dates
in calendar year 2022 (paid through December
2023 for run-out) were included so that no completion
factors were required.
Using a multi-employer benchmark population derived from the
2022 Merative™ MarketScan® Research Database, Wakely
examined claims broken into subcategories of inpatient, outpatient,
professional, and other services. The analysis included members up
to 64 years of age. Claimants exceeding $100,000 in claims were also included and flagged
to further evaluate the impact of Personify's care management. The
Merative MarketScan® dataset was restricted to members
from employer groups with complete medical, pharmacy, and mental
health claims data present, but the analysis excluded pharmacy
claims. The analysis was geographically and risk-adjusted to
Personify members and included member cost-share to capture full
savings impact, showing consistent results.
Further Insights
More information about the Personify
Health Market Comparison Analysis, conducted by Wakely Consulting
Group, can be found in a new report available on our website.
Experts from Personify Health will also be hosting a webinar on
August 6 to share more about the
Wakely study as well as another recent independent study that
demonstrated the cost savings of the Personify Health wellbeing
program. Those interested can register here.
About Wakely Consulting Group
We are thought leaders,
going beyond the numbers. Wakely Consulting Group, an HMA Company,
is the premier source for healthcare actuarial consulting, helping
clients understand the complex and evolving world of healthcare,
using the best tools, talent, and data. For more information, visit
www.wakely.com.
About Personify Health
Virgin Pulse and HealthComp have merged to become Personify Health,
the company driven to engage and empower people to live healthier
lives. By bringing industry-leading health plan administration,
holistic wellbeing, and navigation solutions together, all in one
place, we have created the industry's first and only personalized
health platform. With decades of experience and global operations,
we empower diverse and unique businesses – and diverse and unique
people – to engage more deeply in health at a lower cost. Through
our proprietary combination of data-driven personalization,
science-backed methodology, and concierge-level clinical expertise,
our end-to-end platform makes it easier to proactively address
people's needs across their lives. With a personalized, holistic,
and powerfully simple experience, we are redefining industry
expectations and what it means to manage health. Learn more at
www.personifyhealth.com.
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SOURCE Personify Health