Project Description

Problem: High Cost Chronic Disease

In almost every plan we administer, 2%-3% of members consume 40%-50% of the benefit costs. In most plans, about 25% of all members have chronic diseases including diabetes, hypertension, elevated cholesterol, asthma, or COPD. These members are “at risk” for becoming next years’ catastrophic claim

The Stirling Solution

  • For the top 2-3%, we help make sure these members get the best care for their illness. The best care is not the most care or care in a high price facility. Our contracted doctors and nurses help patients get the appropriate care at the right time in the right setting. Depending on the plan, we can at times save 40% on the cost of these episodes of care.

  • For the 25% that are emerging risks, we design programs that encourage healthy behavior. This could include biometric screenings as part of the enrollment process, healthy living classes when a member has a behavioral based chronic condition or reducing copayments for primary care. The best plans encourage members to utilize appropriate lower level care instead of high cost ER and hospitalizations.

     

Savings

0%
By facilitating the best care for catastrophic cases and improving the disease state for emerging risks, we can stabilize plan costs and reduce risk charges. This can result in a 10% decrease on average plan costs over several years.