Better health outcomes. Lower claim risk.
Challenge
A manufacturing employer with more than 700 covered members was facing growing pressure from rising healthcare costs tied to oncology care, chronic condition prevalence, behavioral health access challenges, avoidable ER utilization, and high-cost pharmacy trends.
Like many manufacturing employers, the organization needed a more proactive strategy focused on improving employee access to care, reducing avoidable utilization, and supporting members with complex healthcare needs before conditions escalated into higher-cost claims.
The employer wanted a solution that could improve employee experience while creating measurable opportunities to better manage long-term healthcare spend.
Solution
Pinnacle partnered with Pareto to implement a population health and advocacy strategy focused on reducing avoidable healthcare utilization, improving chronic condition engagement, and supporting high-risk members through proactive navigation and care management.
The strategy included:
- Oncology navigation and treatment support
- Medicare transition assistance
- Behavioral health navigation
- Chronic condition management
- Diabetes and GLP-1 oversight
- Preventive care engagement
- Advocacy and lower-cost care steerage
- ER and inpatient utilization reduction strategies
Working closely with the employer, Pinnacle helped identify opportunities to improve care coordination, reduce delayed treatment, and guide members toward more efficient and cost-effective care pathways.
Highlight Stats
- ~$30K estimated oncology savings opportunity tied to CancerCARE navigation and lower-cost care steerage
- ~$63K estimated savings opportunity through Medicare transition support and reduced large claim exposure
- 91% employee satisfaction benchmark associated with behavioral health support programs
- <2 day average behavioral health appointment access benchmark
- 8 out of 10 behavioral health users demonstrated clinical improvement benchmark
- ~25 diabetic members identified based on estimated 5% diabetes prevalence
- ~$450K estimated annual ER spend opportunity identified based on avoidable utilization analysis
- ~70 members estimated to be impacted by anxiety or depression prevalence trends
Results
Reduced large claim exposure through proactive oncology and Medicare support
Using Pareto benchmark modeling, the employer identified an estimated $30K savings opportunity tied to oncology navigation, avoided unnecessary treatment, and lower-cost care steerage for active cancer patients.
Improved access to behavioral healthcare resources
The behavioral health strategy focused on improving access to care, reducing delayed treatment, and supporting earlier intervention for employees experiencing anxiety, depression, and related behavioral health concerns. Comparable employer populations reported strong employee satisfaction, rapid appointment access, and measurable clinical improvement outcomes.
Expanded chronic condition and pharmacy management support
The program identified diabetes and GLP-1 utilization as key healthcare trend drivers and implemented proactive condition management, medication oversight, and preventive care engagement strategies to support long-term population health improvement.
Identified opportunities to reduce avoidable healthcare utilization
Through advocacy, preventive care engagement, chronic condition management, and behavioral health support, Pinnacle identified meaningful opportunities to reduce avoidable ER and inpatient utilization tied to delayed care escalation and unmanaged chronic conditions.
Reach out to learn how Pinnacle can help manufacturing employers reduce large claim exposure and improve population health outcomes through proactive advocacy, navigation, and care management solutions.
