For about the price of a cup of coffee for each employee per month, Pfizer provides its 30,000 U.S. staff members with a health advisory service that helps them to navigate their health care benefits and use them in a more efficient, cost effective way.
Because the pharmaceutical company’s highly educated workforce is aging, employees are experiencing more and more acute complex conditions including different kinds of cancers and other more atypical diseases.
The company looked for and found a vendor that could help its employees make connections with the right health providers and ensure the proper personal medical information is on hand to get care quickly.
“Our challenge was how to provide our employees and their family members with access to the right diagnosis and treatment,” says Pfizer’s V.P. of Global Benefits Steven First. “We truly believe that if you get them fast, appropriate care at the beginning, the overall outcome will be better, ultimately leading to lower cost.”
He also thinks that better supporting the health needs of the Pfizer population will lead to fewer sick days for ill or disabled employees and more productive family members who spend less company time worrying about and coordinating care.
First was part of a team that selected PinnacleCare Connection to deliver this benefit to Pfizer associates and their families. “We spoke to a number of different vendors but ultimately what distinguished PinnacleCare Connection for us was their combination of clinical focus and the more concierge support for individuals,” First says. “We felt Pinnacle Care provided the most ‘high- touch’ service.”
Depending on the size and demographics of the workforce, PinnacleCare Connection costs from $2 to $4 a month for each employee. Pfizer believes it is money well spent. However, First says, “Companies considering adding a similar service to their healthcare programs need to buy into the assumption that if the underlying condition is addressed at an earlier stage than it might otherwise be, the cost of the program will be more than paid for by improved outcomes.”
Anyone who has been diagnosed with a complex medical condition needs to understand the disease, what it means, the treatment options and the potential risk vs. benefits of proposed treatments. “We provide anyone who comes to us for help with three things: intelligence, facilitation and access,” says Dr. Miles Varn, chief medical officer at PinnacleCare Connection. “If you just try to Google your problem, you will likely get information overload plus inaccurate or incorrect information.”
Not to mention getting scared out of your wits.
Patients also need to figure out who has the specialization and experience to treat their problem. PinnacleCare Connection helps employees figure out whether they need a second opinion and who they need to see. Their team also assists patients to gather the necessary information to set up their appointments.
“They may need images and pathology slides. Every institution is different. That whole process, particularly in the face of confronting a serious problem can be overwhelming for any consumer,” Varn explains. “And because we have relationships with multiple physicians and institutions around the country, we can generally set up more timely appointments. We don’t go through the front door. We go through a side door.”
The team that identifies specialists always considers the parameters of the company’s health plan and the patient’s preferences to stay in network, with the vast majority preferring to stay regional or even local depending on the situation. “Although the corporate health plan may not cover travel expenses, some employees will elect to go out of network or further away and we can help them with that as well,” Varn continues.
The point of entry for employees who want to take advantage of the PinnacleCare Connection program is a dedicated telephone number for each client company that employees can call. An intake team confirms eligibility and basic information and then hands the employee off to a client advisor. All calls are answered in real time or at least the same day. Then the client advisor talks the employee through the process, the information required to assist them plus their needs and expectations. Varn says. “They do a fantastic job of reassuring employees that we are taking this incredible burden off their shoulders.”
The Pfizer healthcare advisory program was officially rolled out in January 2017. The company wanted to ensure PinnacleCare Connection was integrated with all of their other healthcare vendors. “I saw the new program as being part of the Pfizer benefits ecosystem, so we really spent a lot of time up front having group conversations with our different vendors so that the referral process and the roll out captured as many different inputs and outputs as possible,” says First.
Pfizer heavily marketed the program to employees when it was initially launched, sending out home mailers that looked like a cell phone to remind people of the phone number and the website. On an ongoing basis, they ensure that benefits brochures, annual enrolment materials and their wellness website include a callout box reminding employees the service is available. “In addition, we worked with our insurance carriers and clinical programs so referrals are consistently made,” says First.
There is no cap on employee usage of PinnacleCare Connection, but Varn says, “It’s meant to be an episodic service. We work with people until their questions are resolved, they are handed off to the right people or places and they are comfortable.”
Pfizer’s goals in implementing the program were to encourage as much participation as possible and ensure that PinnacleCare Connection makes quality referrals to other clinical programs. “Right now around 2-3% of our U.S. population have used PinnacleCare Connection and from what I can tell looking at the conditions our employees have been diagnosed with, the right people are using it,” First says.
Based the recorded analysis of client data, PinnacleCare reports that in 28% of cases where their service is used, there is a change in diagnosis, change in treatment or the patient is able to avoid surgery. On average employers realize significant cost savings in 50% of these cases.
Ohio-based employee assistance program (EAP) provider IMPACT Solutions is both a PinnacleConnect client and partner. While the company typically has only 25-30 full-time employees, they contract with over 7,000 psychologists, counsellors and trainers nation-wide to provide face-to-face and onsite services. PinnacleCare Connection is available only to the small core employee group.
IMPACT Solutions is also a partner in a combined hybrid program that links their EAP and work/life program into the PinnacleCare Connection program. Dr. Joel Gecht, president and CEO of IMPACT says, “We recognized that many of our EAP calls were based on some sort of a health care issue linked with depression or a financial issue but we were frustrated that we could not provide our clients with direct access to healthcare advocacy on the physical health side.”
About six years ago, IMPACT Solutions began developing a personalized medical guidance service as part of their EAP offering, but soon realized that their program did not have the depth and scalability required by their broader book of business. “As a result, two years ago, we did a national search for a prospective partner and PinnacleCare Connection came on top. We were impressed by their flexibility, ease of use and how they integrate so many components for the program user.”
After 10 months of offering PinnacleCare Connection in addition to more traditional EAP services to a segment of their clients, Gecht is pleased with the results. “Our projection is that in the next couple of years we will see this as a natural progression, comparable to when EAPs started to integrate online, legal and financial services.”
But Gecht’s experience when one of his own senior employees, Director of Client Services Luci Styles Payne, received advice from PinnacleCare Connection is really what sold him on the value of the service for both his own employees and those of his EAP clients. At virtually the same time, Payne’s mother was diagnosed with cancer and heart problems and her father had a stroke.
“I just didn’t know where to go or what to do,” Payne says. “PinnacleCare Connection really helped me through that whole thing right from the beginning, looking at records, confirming when we were on the right track and helping us to evaluate whether or not we needed a second opinion.”
A big part of the service was researching rehab options for her father and figuring out which facilities had openings and whether they took Medicare. “Of course I had to go and do the final walk-throughs and check things out, but they narrowed it down to the top three,” she says.
Payne was particularly impressed that barely an hour after she called PinnacleCare Connection in the late afternoon, the liaison she was working with had one of their specialists on the phone talking to her. “I have a lot of responsibility at work and this allowed me to focus, knowing they were doing the research that they are so good at,” she says.
Gecht agrees. “PinnacleCare Connection services alleviated Luci’s frustration and improved her parents’ prognosis. She was able to continue working effectively because her anxiety was considerably reduced.”
First says the feedback from Pfizer employees using the service has also been positive. “There are cases where employees have been trying to nail down the correct diagnosis for years and finally they made the necessary connections because PinnacleCare Connection referred them to an expert in the field.”
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