Three Ways Castlight Care Guides Drive Down Healthcare Costs

For many people these days, the healthcare journey is long, costly, and frustrating. Far too often, this prevents them from getting the care they need. At Castlight, we’re proud to provide a digital home for health our members can leverage to simplify not only their employee benefits experience, but also the path to a healthier, happier life.

At times, however, some members might want a little extra help, or simply to work directly with someone to get the human support they need. That’s where Castlight Care Guides, our team of highly trained and experienced clinical and benefits experts, come in. Equipped with a holistic 360-degree, data-rich clinical profile of each member, Care Guides can provide comprehensive and personalized one-on-one live support, ultimately connecting the member to the right care and programs at the right time.

Care Guides can help members in a multitude of ways, such as: finding high-quality providers, better managing chronic conditions, resolving billing errors, improving health literacy, providing financial guidance for future care, explaining available benefits programs, closing gaps in care, and identifying and addressing barriers to care.

Launched in late 2019, our Care Guides have already had a huge impact on many members’ health and wellbeing — and employers’ overall medical spend.

3 Ways Castlight Care Guides Drive Costs Down

By focusing on care guidance (driving members to high-quality, lower-cost care), program engagement, and billing and claims advocacy, Care Guides play a central role in decreasing healthcare spending. In fact, within 12 months of working with Care Guides for one or more of these three reasons, medical spending is reduced by double-digit percentage points.

Here are three specific ways Castlight Care Guides decrease employer medical spend:

  • Care guidance leads to 20% medical savings: On average, after helping members connect to high-value providers (those who are high quality and lower cost), Care Guides drove down medical spend by $854 per engaged member per year (PMPY). Prior to Care Guide intervention, the average spend PMPY was $4,373 — after, it was $3,519.

  • Increased program engagement results in 13% medical savings: After helping members utilize recommended programs — those best for the member according to their personalized clinical profile — Care Guides drove down medical spend by $440 PMPY. Pre-Care Guide engagement, the average spend was $3,507 PMPY. After, it was $3,067 PMPY.

  • Billing and claims advocacy leads to 39% medical savings: By providing members with these services — in which the Care Guide reaches out to the provider, pharmacy benefit manager, or health insurance plan on the member’s behalf to discuss and/or rectify a bill — Care Guides help save $2,214 PMPY. Prior to leveraging Care Guides advocacy services, the average PMPY cost was $5,611, as compared to $3,397 after Care Guide involvement.

Cost Savings Driven by Creating High-Value, Meaningful Interactions

These decreases in employer medical spending didn’t happen by chance. Our navigation platform is designed to identify members with higher clinical risk or rising clinical risk, and to connect those members to a Care Guide with the right clinical expertise, in order to drive better outcomes through longitudinal Care Guide-member relationships. We’ve found that members who are “high-risk” or “very high-risk” rely more heavily on high-touch guidance — they engage with Care Guides 39% more than members with very low clinical risk — meaning Castlight Care Guides can be instrumental in making sure these higher clinical risk members get the care they need.

Additionally, when members interact with a Care Guide for any reason — even if it’s just because they forgot their password — Care Guides have a full view of their clinical profile, including condition-specific needs, adherence to preventive care protocols, and opportunities to optimize site-of-care choices, uplift health literacy, and encourage the utilization of relevant programs. Equipped with this information, our Care Guides successfully convert an average of 31% of all inbound interactions into higher-value healthcare navigation experiences that address members’ highest priority health needs.

We’ve found that members who are high-risk or very high-risk rely more heavily on high-touch guidance — they engage with Care Guides 39% more than members with very low clinical risk — meaning Castlight Care Guides can be instrumental in making sure these higher clinical risk members get the care they need.

These efforts pay off, as these more meaningful discussions are quite effective at getting members to engage in programs that enhance their health and wellbeing. Within 60 days of their first interaction with a Care Guide, program engagement increased among members who had no evidence of participating in a program prior. Participation in health assessments increased by 24%, nutritional programs by 15%, behavioral health by 13%, virtual care by 10%, and diabetes management programs by 5%.

As our Care Guide program continues to grow, we are excited to see the life-changing impact our Care Guides team will have on so many members’ lives.

Interested in learning more about Care Guides? Schedule a demo.