Point C helps employers and brokers respond earlier. We provide support to manage benefit utilization and guide members through treatment to reduce avoidable plan spend.
Most Catastrophic Claims
They build when a member misses follow-up care, receives treatment in a higher-cost setting, delays a diagnosis, struggles with a complex treatment plan, or has no one helping coordinate the next step.
Without early visibility and intervention, these situations escalate quickly.
70-80%
of healthcare costs are tied to chronic conditions, many of which are preventable or manageable with early intervention.
1%
of members can drive 25-30% of the total plan spend.
Gaps in care, poor coordination, and low engagement are some of the most common drivers of high-cost claims.
Care management is a nurse-led service that aids members navigating complex health needs while helping employers manage costs more effectively.
Point C's 30 in-house licensed clinicians are guided by our Johns Hopkins-trained Medical Director to support members during the moments that matter most.
Earlier engagement with members at risk for high-cost claims
Support that improves follow-through during treatment
Better coordination across providers, benefits, and care settings
A more disciplined approach to utilization management
A strategy that can help reduce the factors that increase stop-loss exposure
Point C has a care management model that can be tailored to employer needs and population risks.
Nurse-led support for members with emerging or ongoing health needs, chronic condition, and care coordination support.
Clinical review that guides medically appropriate care, reduces avoidable utilization, and supports responsible use of the plan.
Focused intervention for high-cost or high-complexity cases, including oncology, behavioral health, dialysis, and other specialty care needs.
Specialty case management is most valuable when a condition is complex or expensive.
Cancer care can move quickly. And become expensive just as fast. Members often need help understanding treatment plans, coordinating specialists, and managing the many decisions that come with active treatment.
Behavioral health needs often affect medical spend, absence, productivity, and retention. Specialty support connects members with care and stays engaged over time.
High-cost medications can reshape plan spend in a short period. Specialty case management supports more appropriate utilization, member adherence, and alignment between medical and pharmaceutical strategy.
Dialysis is one of the highest-cost areas for employer-sponsored health plans. Members benefit from hands-on support as they navigate treatment choices, provider coordination, and long-term care planning.
Members living with multiple chronic conditions, repeated admissions, or frequent care transitions often need more intensive support than a standard care model can provide.
Members may be identified through claims activity, referrals, utilization review, or plan-based triggers. Once enrolled, each member is connected with a dedicated nurse care manager.
The nurse completes a comprehensive assessment to understand the member's condition, treatment plan, care history, and any barriers that could affect progress.
A personalized care plan is developed around the member's diagnosis and treatment needs. The plan is built to support appropriate care and keep the member moving through the right next steps.
The same dedicated nurse care manager works with the member to prepare for appointments, understand treatment options, coordinate across providers, navigate benefits, and stay engaged in care. This is where nurse case management becomes especially valuable for members facing difficult or costly health events.
Point C tracks progress over time and adjusts support as needed. This ongoing oversight helps reduce the chance that a manageable case turns into a more severe and expensive one.
