A religious organization in Wisconsin

Rigid rules for high-cost treatment

Identified new treatment option for reduced cost

Lower cost for employer and better experience for the member

Case Study Overview

A self-funded religious organization was receiving a renewal that included a significant laser on a member. The individual had been diagnosed with a chronic disease and was to undergo recurring treatment at a high cost and inconvenient location. The group asked Point C for help assessing healthcare treatment options.

The Challenge

The member had been diagnosed with Fabry disease, a rare genetic disorder that prevents the body from producing an enzyme that breaks down the fat GL-3. Fabry disease causes serious problems including chronic pain, problems with eyesight, hearing loss, and kidney damage that worsens overtime. The member had been receiving treatment via a monthly Fabrazyme infusion that reduced the buildup of GL-3 in the body, but the infusion was $30k per month and the member was required to travel to the Mayo Clinic in person.

“By utilizing the Point C network, we were able to simultaneously reduce costs and enhance the experience for the member.”

The Solution

Point C conducted a thorough review of claims and plan spend as part of its ongoing commitment to optimizing client benefit plans. During the analysis, we identified both the pain point of member travel to the clinic, and the opportunity to reduce the cost of the Fabrazyme infusion. We reached out to a specialty pharmacy provider and negotiated a 10 percent discount through an infusion nurse network. In addition, the treatment would be delivered by a nurse at the member’s home.

Result

By utilizing the Point C network, we were able to simultaneously reduce costs and enhance the experience for the member. The employer saved over $30k annually in infusion treatments, effectively getting one treatment for free each year. On top of these savings the employer was able to eliminate the laser. Most importantly, the member’s intensive treatment was simplified and made more accessible, eliminating the time and cost associated with travel and increasing consistency in monthly care.

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About Us

Point C is family of third party administrators of self-insured healthcare plans. Each of our partners has local expertise and knowledge of specific regions and industries to best serve the needs of small to medium sized employers.

All of our partners have decades of experience curating custom healthcare plans that simultaneously reduce healthcare spend for employers and help employees get the quality care they need.