Client

A major school district partnered with Kinetiq Health to take a proactive approach to managing its health plan claims and controlling rising costs.

Solution

The Kinetiq Health team implemented BenInsights, a cutting-edge platform combining clinical and financial data from more than 160 sources to pinpoint and interpret workforce-level risks. Using these insights, our clinical team identified a substantial opportunity for savings.

A plan member diagnosed with breast cancer was prescribed Keytruda, a high-cost infusion, at $44,317 per dose for a three-week regimen. Since treatment typically lasts one to two years, the total cost to the plan would be substantial.

We evaluated the cost and determined it should have been $15,834 per dose. After reviewing options for a site-of-care change and engaging in direct negotiations with the existing provider, the existing provider offered the lowest cost per dose, allowing us to maintain the patient’s care team while substantially reducing the cost to the plan.

Results

 After we shared these insights, the current provider agreed to renegotiate the price for this member, down from $44,317 to $15,834 per dose, creating potential annual savings of $484,211 for the client. This high-cost claim would not have been identified through data alone. By unifying analytics from multiple sources, the BenInsights data platform, combined with the power of Kinetiq Health’s risk management expertise, transforms complex data into actionable, cost-saving interventions.