Business problem
Executives wanted to address the high musculoskeletal spend, improve access to high-quality providers, ensure appropriate care for all conditions, and help employees understand claims and explanation of benefits (EOB) issues. Sanofi US offers a robust benefits package and 90% of its employees are enrolled in one of two available medical plans (PPO and CDHP/HSA). The organization offers additional support for pharmacy benefits, behavioral health, weight loss, and prediabetes. All of these programs are coordinated through a personalized wellness and communication platform.
Our Solution
Sanofi US launched ConsumerMedical’s Ally TotalSupport and Claims Advocacy products in 2019. This product offers unlimited medical and surgical decision support for all medical conditions, expert second opinions, network optimization capabilities, and evidence-based information modules for patient education. Claims Advocacy offers support with interpreting EOBs, understanding out-of-pocket costs, fixing claims errors, and identifying and correcting billing errors.
Sanofi US offered a $400 incentive to employees to engage with ConsumerMedical’s Surgery Decision Support (SDS), which is customized to help employees considering knee or hip replacement, lower back or weight loss surgery, or a hysterectomy consider all of their options. Evidence-based information helps employees understand their diagnoses and compare different treatment options. We estimate that U.S. employers spent about $100 billion in 2019 on elective surgeries for hips, knees, backs, bariatric surgery, and hysterectomies. Yet, we know that up to $30 billion of that spend is potentially unnecessary and suboptimal in terms of patient outcomes. However, if employees decide to get surgery, ConsumerMedical guides them to centers of excellence to ensure high-quality care.
Key Takeaways
-
Sanofi US engagement increased using promotional tactics such as onsite events and targeted home mailers with customized support options for employees in specific, remote regions.
-
Virtual second opinions using telehealth ensures employees have access to expertise from the highest quality doctors, which is especially important during the COVID-19 pandemic.
-
Claims Advocacy services act as an extension of Sanofi US’s benefits team, helping employees navigate confusing billing issues with providers and insurers and saving thousands of dollars in multiple cases.
