A general contractor in Wisconsin

Chronic disease required in-person treatment, added laser to stop loss coverage

New provider engaged to treat member at home

Enhanced member experience, reduced cost of treatment, and laser removed

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.

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Making Chronic Disease Easier to Treat

Point•C

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.