Client

Four organizations, spanning nonprofit, public sector, private business and K-12 education, turned to Kinetiq Health to access a partner program designed to provide financial assistance in managing the impact of high-cost claimants on their health plans:

• Client A, a 501(c)(3) nonprofit organization
• Client B, an Indiana-based public sector employer
• Client C, a family-owned business
• Client D, one of Indiana’s largest school systems

Across industries and organization sizes, each faced the same reality: a small number of members with serious medical conditions were driving an outsized share of plan costs.

Challenge

Health care costs continue to climb nationwide, and high-cost claimants are the fastest-growing driver of that trend. A single member undergoing treatment for cancer, kidney disease or another serious condition can generate claims in the millions, placing significant financial strain on both the health plan and the member managing a health crisis.

Each of these four organizations experienced this challenge firsthand: members facing serious, ongoing medical challenges whose treatment costs put pressure on the plan’s renewal and added financial stress to an already difficult diagnosis.

Solution

Kinetiq Health’s clinical team identified members who qualified for an external financial assistance program, which connects eligible members with outside funding sources to help cover the cost of treatment (see sidebar).

For members who are successfully enrolled, the program covers their premiums and out-of-pocket medical expenses for treatment, removing a significant source of financial stress from an already difficult diagnosis.

Kinetiq Health partnered directly with each organization’s team to drive awareness and engagement, providing customized marketing materials, hosting member-facing webinars to explain the program and answer questions and delivering weekly enrollment updates throughout the process.

Results

The core measures below reflect each organization’s applicants, enrolled members and projected high-cost claims savings for the applicable plan year.

Across these four organizations, Kinetiq Health identified an average of $3.35 million in projected high-cost claims savings per client, proof that meaningful savings are available to organizations of every size and industry, not just the largest self-funded plans.

Beyond the financial outcomes, these results demonstrate a partnership. Kinetiq Health’s clinical team walked alongside each organization throughout the entire process, from initial identification to program enrollment, and supported members navigating some of the most difficult moments of their lives. The result: organizations gained control over rising claims costs, and members received the freedom to focus on getting better.