{"id":14812,"date":"2025-05-12T16:37:24","date_gmt":"2025-05-12T21:37:24","guid":{"rendered":"https:\/\/www.premisehealth.com\/?post_type=success_stories&p=14812"},"modified":"2025-05-12T16:37:26","modified_gmt":"2025-05-12T21:37:26","slug":"how-a-food-production-company-saved-over-1-2m-by-optimizing-specialty-care-referrals-with-care-navigation","status":"publish","type":"success_stories","link":"https:\/\/www.premisehealth.com\/resources\/success-stories\/how-a-food-production-company-saved-over-1-2m-by-optimizing-specialty-care-referrals-with-care-navigation\/","title":{"rendered":"How a food production company saved over $1.2M by optimizing specialty care referrals with care navigation"},"content":{"rendered":"\n
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The Challenge<\/h2>\n
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Based in northeast Georgia, this organization first began their partnership with Premise in 2004 by offering primary care and pharmacy services to their employees and dependents. Nearly twenty years later their population has expanded to over 7,000 eligible lives, is largely Spanish speaking, and made up of many first-generation Americans.\u00a0<\/span>\u00a0<\/span><\/p>\n

With many members experiencing the U.S. healthcare system for the first time, their leadership team knew their people would need help navigating in-network providers when referrals were necessary. The fact of the matter is, hospitals provide a wide array of healthcare services; however, they\u2019re not great at everything, and both quality and cost can vary significantly for the same type of care within the same market. The organization required a solution that could direct their people to high-quality, cost-effective care. With an emphasis on providing concierge support to underserved populations, they worked with Premise to improve health equity across their workforce.\u00a0<\/span>\u00a0<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n <\/div>\n<\/section>\n<\/div>\n\n\n\n

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\nDid you know <\/span>t<\/span>he price of <\/span>the same procedure can vary over 500% <\/span>in the communi<\/span>ty? To put it in perspective<\/span>, i<\/span>f gas prices varied as much as procedure<\/span> costs<\/span>,<\/span> you would see anywhere from $2.50 per gallon to <\/span>$14.60 per gallon depending on the station<\/span>.<\/span> On top of that, <\/span>many <\/span>stations would be<\/span> offering <\/span>a lower<\/span> quality gasoline for a much higher <\/span>price<\/span>.<\/span> <\/span><\/p>\n

See what this looks like in one sample market for three common procedures:<\/span><\/span><\/p>\n

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The Solution<\/h2>\n
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With the goal of facilitating simplified access to the best specialty care, the organization identified their top priorities:<\/p>\n

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  • Bridge the language gap with an onsite bilingual resource that can help manage referrals<\/li>\n
  • Reduce total medical spend by optimizing referrals to high-value, cost-effective providers and facilities<\/li>\n
  • Improve the member experience by enabling people to get to the right specialist and avoid duplicative care<\/li>\n<\/ul>\n

    With those goals in mind, the employer expanded their benefits offering to include Premise Health\u2019s referral coordination solution, care navigation. As a core component of an advanced primary care model, care navigation guides members to the highest-value care through data-driven referral matching, concierge support, and integration with a collaborative care team. The onsite wellness center was staffed with a dedicated bilingual care navigator to improve communication with members and ensure referrals for specialty care were sent to the right providers and facilities.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n <\/div>\n<\/section>\n\n\n\n

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    A critical component of advanced primary care.<\/h2>\n

    Care navigation fulfills multiple pillars of advanced primary care, the highest quality of care available:<\/strong><\/p>\n <\/div>\n<\/section>\n\n\n\n

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    Enhanced access<\/span><\/span><\/strong>
    \n<\/span>T<\/span>hrough a concierge approach, <\/span>care navigators oversee communication and scheduling with <\/span>specialty<\/span> providers and facilities<\/span> to ensure members have access to the right care at the right price<\/span>.<\/span><\/span><\/p>\n <\/div>\n<\/section>\n<\/div>\n\n\n\n

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    Team-based<\/strong>
    \n<\/span><\/span>C<\/span>are navigators keep the members<\/span>\u2019<\/span> care team, including their primary care provider, <\/span>up to date<\/span> on <\/span>follow-up<\/span> recommendations<\/span> from specialists<\/span>.<\/span><\/span><\/p>\n <\/div>\n<\/section>\n<\/div>\n<\/div>\n\n\n\n

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    Outcomes-driven
    \n<\/b><\/span><\/span>By focusing on getting members to the right specialist as early as possible, members can avoid unnecessary care and see positive health outcomes sooner.<\/p>\n <\/div>\n<\/section>\n<\/div>\n\n\n\n

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    Continuous
    \n<\/b><\/span><\/span>When referrals to specialty care are made, the care team stays connected to the member and closes the loop when they return to Premise as their medical home.<\/p>\n <\/div>\n<\/section>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n\n

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    The Outcome<\/h2>\n
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    Programs which improve health, reduce spend, and allow providers to engage complex members play an important role in helping employers maximize their healthcare dollars and resources. By expanding their offering to include care navigation, the organization was able to drive optimized referrals, see significant overall savings, and improve member care.<\/p>\n

    Optimized Referrals<\/strong><\/p>\n

    In order to direct members to the best specialists and facilities, Premise care navigators evaluate cost and quality data, direct contracting, payer networks, and EAP programs for every referral. Of 1,532 total referrals from the organization in 2023, 69% or 1,064 were sent to high-value, cost-effective specialists and facilities. As the year continued, the number of optimized referrals began to increase drastically compared to the first quarter, underscoring the effectiveness of care navigators as they\u2019re embedded within an organization.<\/p>\n

    Significant Overall Savings<\/strong><\/p>\n

    When members are referred to the right specialist the first time, it helps reduce duplicative care, eliminate care gaps, and ensure they get better faster. By getting them on the right track early in their care journey, the cost savings can grow quickly. In 2023, this food manufacturing company had over $1.2M in estimated annual savings achieved through optimized referrals.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n <\/div>\n<\/section>\n\n\n\n

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    1,532<\/span><\/strong><\/h2>\n

    Total Referrals Completed<\/p>\n <\/div>\n<\/section>\n<\/div>\n\n\n\n

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    1,064<\/span><\/strong><\/h2>\n

    Optimized Referrals<\/p>\n <\/div>\n<\/section>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n

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    69%<\/span><\/strong><\/h2>\n

    Optimized<\/p>\n <\/div>\n<\/section>\n<\/div>\n\n\n\n

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    $1.2M+<\/span><\/strong><\/h2>\n

    Estimated Savings<\/p>\n <\/div>\n<\/section>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n\n \n

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    Improved Member Care<\/span><\/b>\u00a0<\/span><\/p>\n

    Premise care navigators utilize our best-in-class data-driven referral matching and combine it with a hands-on, seamless concierge approach to provide members with the best experience possible. They handle everything from:<\/span>\u00a0<\/span><\/p>\n

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    • Selecting a provider and facility<\/span><\/li>\n
    • Making the appointment<\/li>\n
    • Translating for the member as necessary<\/li>\n
    • Ensuring records are transferred before and after the specialist appointment<\/li>\n
    • Following up to support ongoing care needs<\/li>\n
    • Communicating with the member\u2019s broader care team\u00a0<\/span><\/li>\n<\/ul>\n

      With their onsite care navigator, the organization was able to provide this efficient care coordination and referral management for members within one to two business days, ensuring quick resolution when specialty care was needed.\u00a0<\/span>\u00a0<\/span><\/p>\n <\/div>\n<\/section>\n<\/div>\n\n\n\n

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      The Importance of Efficient Coordination<\/span><\/b>\u00a0<\/span><\/p>\n

      The following member testimonial from this organization demonstrates the efficiency of care navigators when it matters most:<\/span>\u00a0<\/span><\/p>\n

      “A member came in for an annual physical on a Monday. Her lab studies showed iron deficiency due to abnormal blood loss during menstrual cycles. The provider consulted with the care navigator to request urgent referrals to gynecology and hematology. The care navigator was able to schedule the member with an OBGYN the next day, and hematology on Friday. <\/strong>This speed of service makes a critical difference in improving member care and ensuring positive outcomes.”<\/em>
      \n<\/span><\/p>\n <\/div>\n<\/section>\n<\/div>\n\n\n\n

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      By expanding upon their existing primary care and pharmacy offering, this organization <\/span>helped <\/span>a<\/span> large and diverse <\/span>workforce<\/span> properly<\/span> navigate the US heal<\/span>thcare system<\/span> and achieve<\/span> their goals of improving member experience and reducing total medical <\/span>spend<\/span>. <\/span>Through <\/span>offering <\/span>c<\/span>are navigation<\/span>, a critical <\/span>component<\/span> of advanced primary care, members had access to <\/span>a <\/span>bilingual care navigator <\/span>to lead a traditionally underserved population to the right <\/span>specialty<\/span> care<\/span>.<\/span> <\/span><\/p>\n

      In addition, the organization recognized significant savings through strategic navigation of specialty referrals.<\/span> In helping many first-generation Americans get the care they <\/span>need,<\/span> the organization has firmly <\/span>established<\/span> its dedication to health equity and championing employee wellbeing through t<\/span>heir partnership with Premise Health.<\/span><\/span><\/p>\n <\/div>\n<\/section>\n<\/div>\n<\/div>\n\n\n\n

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