Health Insurer Boosts Member Services, Reduces Costs with Diagnostic Test Kits | Life Sciences

2/7/2023 RRD

RRD’s diagnostic test kit solution provides diagnostic and treatment plan cost savings, offers comprehensive support for insurer’s members 

CHALLENGE

A leading insurance company with millions of members was contending with the rising costs of diagnosing and treating various conditions. As members were being tested and receiving treatments for these conditions — including COVID-19 — from a wide range of service providers, the resulting costs were being passed back to the insurer. Tests and treatment plan costs vary widely across different providers, and without a proactive approach, the insurer had little control over their outgoing spend. Amidst skyrocketing diagnostic demand due to the pandemic, they sought a way to manage these growing reimbursement costs.

The insurer envisioned mitigating costs related to doctor visits, treatment, and pharmaceutical interventions by giving members direct access to in-home diagnostic test kits. Particular areas of interest included COVID-19, as well as sexually transmitted infections (STIs) due to their increased prevalence amongst the U.S. population. The insurer sought an end-to-end partner who could develop and deploy a comprehensive test kit fulfillment solution to bring more control in-house.

In tandem, they sought a means to improve their star rating, a key metric driving an insurer’s level of reimbursement and ability to attract new members. Ideally, the test kit solution would meet this broader goal of high member retention and member engagement, provide enhanced and proactive care, and also lessen the diagnostic and treatment cost burden. 

SOLUTION

RRD worked hand-in-hand with internal client teams to develop and deploy an end-to-end solution providing members with at-home diagnostic kits and treatment plans for these conditions. RRD interfaces directly with the insurer’s app, validating qualifying members’ data and enabling them to order diagnostic test kits directly to their homes. RRD manages the data in-house in a highly secure, SOC2+- and HIPAA-compliant data center. 

RRD’s comprehensive fulfillment support works in tandem with the insurer’s laboratory, providing the following benefits to members:

• Member information privacy and security
• Integration with member service level validation and diagnostic kit ordering in-app
• Diagnostic devices and instructions delivered directly to a member’s home
• Return mailers to send kits to the laboratory 
• Test result communication direct to patient
• Treatment protocol managed by the insurer’s approved partners

The workflow provides significant cost savings by managing test kit ordering, distribution, and treatment protocol — limiting costly doctor visits for testing, results, and treatment that can be done in-home. For necessary treatments, the insurer is able to utilize negotiated costs with preferred providers, removing the previous substantial cost burden of varied pricing. With COVID-19 test kits, for example, members receive an in-home diagnostic test, a flyer explaining the virus, and test instructions. 

RRD has the capacity to produce over 30,000 diagnostic kits each day, and stores them in appropriate, environment-controlled conditions. Both COVID and STI test kits are fulfilled for individual member households and for doctors’ offices and hospitals in bulk. All orders placed before 2:00 PM ship out same-day via the U.S. Postal Service. 

The insurer proactively sends out emails to its members providing instructions on ordering and obtaining the test kits, which increases program participation. Future states include deploying diagnostic test kits for additional conditions, such as urinary tract infections.

RESULTS

The diagnostic test kit solution has generated substantial cost savings due to a reduction in unnecessary or costly doctor visits, tests, and treatment plans. Additional outcomes from this solution include:

• Supported kit volumes ranging from 5K to 100K kits per week
• Positive star ratings due to the high level of provided customer service
• A streamlined discrete, at-home diagnosis and treatment option for members 
• Increased member agency over their experience with a condition
• Increased insurer control over the test-to-treatment lifecycle and associated costs
• Increased usage of preferred providers and negotiated treatment costs due to proactive approach