Oct 24, 2024
Making Chronic Disease Easier to Treat
Better care doesn't have to cost more—we look for the win-wins so members can get care on their terms at a reduced cost.
Case Study Overview
A general contractor in Wisconsin had an employee diagnosed with chronic Crohn’s disease. Also known as an inflammatory bowel disease (IBD), Crohn’s disease causes inflammation of the digestive track, which leads to severe side effects and requires regular treatments.
The Challenge
The employee was receiving an Entyvio injection every eight weeks to help reduce the inflammation caused by IBD. The Entyvio injection was administered at a local ambulatory surgery center (ASC) convenient to the employee’s home, but still required travel and cost $14k per injection. Because the cost of the Entyvio injection was so high, the reinsurance carrier added a laser—increasing the specific stop loss premium for that member.
“…reduced cost for the employer while simultaneously allowing the member a better treatment experience by delivering the care at home.”
The Solution
Point C looked into alternatives for the employee’s care. Specialty pharmacies and home infusion were the target, as they could reduce cost for the employer while simultaneously allowing the member a better treatment experience by delivering care at home. Point C also worked with the reinsurance carrier on a plan to have the laser removed.
Result
The Entyvio injection was complicated due to the rules of the laser, so the employer and employee worked together to move the treatment to a gastrointestinal (GI) specialist at a reduced cost. Once the laser was removed, a specialty pharmacy took over administering the injection at the employee’s home, recognizing a 57% savings per injection.