New Independent Actuarial Study Shows Personify Health Lowers Healthcare Spend by 23%

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Jul 16, 2024, 09:00 ET

Wakely Consulting Group analysis also finds that high-cost claimant members utilizing Personify Health's comprehensive benefits platform have 14% lower costs vs. market benchmarks

PROVIDENCE, R.I., July 16, 2024 /PRNewswire/ -- Personify Health, the first and only platform company to bring health, wellbeing, and navigation solutions together, today announced the results of a new independent actuarial study demonstrating that key company programs drove significantly lower healthcare costs for members compared to the same-year market average. Conducted by Wakely Consulting Group, the analysis showed that Personify members in elected programs had 23% lower allowed costs vs. market average – equating to $762.96 per employee per year, including the member cost-share, and with risk and geography adjustment. With PwC's Health Research Institute projecting a 7% year-over-year (YOY) medical cost increase for employers this year, addressing health costs and outcomes have become business imperatives.

The Wakely study demonstrated detailed cost savings that were made possible by Personify Health's approach to health plan administration. Key findings include:

27% lower outpatient costs
17% lower emergency room costs
14% savings for high-cost claimants
80% lower out-of-network spend

These areas of improvement drive a significant portion of healthcare expenses for employers and must be addressed to lower the overall cost of care. According to Wakely, Personify Health had materially lower costs in each of these areas.

Personify's timely and targeted AI-optimized member outreach, payment integrity capabilities, advocacy, and coaching programs contributed to lower risk-adjusted medical costs for members across a range of care settings. Inpatient, outpatient, and professional services saw 34%, 27%, and 10% lower costs, respectively, compared to risk-adjusted claims in the same geographic regions. Wakely's rigorous independent analysis compared Personify Health medical claims from 2022 to comparable market data from the same time period, sourced from the Merative^™ MarketScan^® Research Database, and is a continuation study of 2019 data.

The Wakely analysis also found 14% lower total medical costs (risk-adjusted) across members who exceeded $100,000 in medical claims. These high-cost claimants using Personify Health also saw 23% lower NICU-related costs and 26% lower claims among those using dialysis services.

"Historically, high-cost, high-need patients accessing inpatient care have represented the largest driver of health care costs in commercial insurance – underscoring the need to encourage the utilization of care settings that provide better outcomes," said Dan Mendelson, CEO of Morgan Health, the JPMorganChase business unit focused on improving the quality, equity, and affordability of employer-sponsored health care. "By integrating care management and cost containment programs, employers can help empower patients to access high quality care at a more efficient cost."

Previous research has shown that U.S. emergency department treatment costs increased from $54 billion to $88 billion between 2012 and 2019 – a staggering annual growth rate of 5.4%. With Personify Health, members saw 17% lower emergency room costs vs. market average in the same year. Some of this activity was shifted to the more affordable urgent care setting. Additionally, Personify's out-of-network (OON) spend makes up only 1.2% of total medical costs, while 7.3% of total market spend is incurred OON according to the MarketScan data.

"Escalating health costs are putting the squeeze on employers and staff. It's critical that they have the means to reduce spend while still offering the benefits that provide quality, holistic support. That's where Personify Health comes in," said Chris Michalak, CEO of Personify Health. "Building on previous research, the Wakely analysis proves that our care management and cost containment programs are highly effective across a range of areas responsible for the biggest spend. Combining hundreds of experts with the scalability driven by AI, we're solving a big industry challenge and making a real difference for our clients and members – without compromise."

Employers can ultimately see the greatest ROI and value by offering their workforce access to Personify's comprehensive health, wellbeing, and navigation platform. A separate independent study recently found that engaged participants in Personify Health's wellbeing program had 14% lower healthcare costs YOY compared to industry benchmarks. Together, these studies emphasize exponential value for Personify clients.

Study Methodology
The Wakely study evaluated the following areas of Personify Health's fully integrated personalized health platform. These are leveraged across various company programs, including health plan administration, and navigation and advocacy:

Cost containment services, which include payment integrity; fraud, waste, and abuse reviews; and out-of-network negotiations.
Care and condition management solution, which features 500+ associates including nurses, medical social workers, dieticians, pharmacists, licensed therapists, and coaches. These in-house experts provide members a high level of support along their health journey, complementing Personify's digital offerings.

Wakely's analysis intended to examine the financial outcomes within Personify Health's 2022 medical claims and measure those outcomes in relation to the large group market during the same period. To prove continuous and consistent improvement, this study was analyzed as a continuation study from a prior analysis conducted on 2019 data. Wakely Consulting Group conducted the analysis using Personify Health's 2022 medical claims data, representing the company's U.S. customer base. Service dates in calendar year 2022 (paid through December 2023 for run-out) were included so that no completion factors were required.

Using a multi-employer benchmark population derived from the 2022 Merative™ MarketScan^® Research Database, Wakely examined claims broken into subcategories of inpatient, outpatient, professional, and other services. The analysis included members up to 64 years of age. Claimants exceeding $100,000 in claims were also included and flagged to further evaluate the impact of Personify's care management. The Merative MarketScan^® dataset was restricted to members from employer groups with complete medical, pharmacy, and mental health claims data present, but the analysis excluded pharmacy claims. The analysis was geographically and risk-adjusted to Personify members and included member cost-share to capture full savings impact, showing consistent results.

Further Insights
More information about the Personify Health Market Comparison Analysis, conducted by Wakely Consulting Group, can be found in a new report available on our website.

Experts from Personify Health will also be hosting a webinar on August 6 to share more about the Wakely study as well as another recent independent study that demonstrated the cost savings of the Personify Health wellbeing program. Those interested can register here.

About Wakely Consulting Group
We are thought leaders, going beyond the numbers. Wakely Consulting Group, an HMA Company, is the premier source for healthcare actuarial consulting, helping clients understand the complex and evolving world of healthcare, using the best tools, talent, and data. For more information, visit www.wakely.com.

About Personify Health
Virgin Pulse and HealthComp have merged to become Personify Health, the company driven to engage and empower people to live healthier lives. By bringing industry-leading health plan administration, holistic wellbeing, and navigation solutions together, all in one place, we have created the industry's first and only personalized health platform. With decades of experience and global operations, we empower diverse and unique businesses – and diverse and unique people – to engage more deeply in health at a lower cost. Through our proprietary combination of data-driven personalization, science-backed methodology, and concierge-level clinical expertise, our end-to-end platform makes it easier to proactively address people's needs across their lives. With a personalized, holistic, and powerfully simple experience, we are redefining industry expectations and what it means to manage health. Learn more at www.personifyhealth.com.

SOURCE Personify Health