Challenge
The Philadelphia Teamsters Health & Welfare Fund, a self-funded labor union health plan covering tens of thousands of members and families, faced rising healthcare cost trend with full financial exposure on every claim. Without early visibility into emerging member health risks, the Fund was absorbing costs that could have been identified and addressed before reaching the claims ledger.
Solution
HCS deployed HealthReach Predictive Care Management®, using proprietary AI and advanced analytics to identify at-risk members early and intervene before conditions escalated. Virtual
Nursing & Outreach kept members engaged between visits to close care gaps and prevent avoidable ER use. Medical Management Services provided clinician-led support for catastrophic, complex, and chronic cases, with real-time reporting giving the Fund full visibility throughout.
Outcome
Over seven years, HCS delivered actual healthcare trend consistently below consultant projections, accumulating $144.3M in cumulative savings versus predicted spend. The Fund averaged 6.1% in annual savings against forecast and achieved a 5:1 ROI on Medical Management Services, with improvements in member health outcomes documented alongside every dollar saved.
Outcomes Simplified
- Cumulative savings – $144.3M vs. predictive trend over 7 years
- Avg annual savings – 6.1% below consultant forecast
- Medical Management ROI – 5:1 return on investment
