Transforming population health to drive value and access for the public sector members
Client profile
Solution
All-Included Care™ by Included Health
Members
50,000+ employees
Key Results at a Glance
- Nearly 70% of eligible households engaged with Included Health in the first year, with most households using multiple services.
- Of the highest-needs members reached, 80% actively used Included Health, with half engaging directly in clinical services like longitudinal care plans.
The Challenge: Unsustainable costs and fragmented care
A prominent public sector entity was facing significant hurdles within its preferred provider organization (PPO) plans. The organization was experiencing double-digit premium increases, severe access challenges (including monthslong wait times for primary care), and quality scores that lagged behind their health maintenance organization (HMO) offerings. They needed a bold intervention to stabilize costs without sacrificing member experience or clinical quality.
The Solution: A strategic "front door" partnership
Moving away from a traditional vendor model, the organization established a first-of-its-kind, five-year strategic partnership. They integrated their third-party administrator (TPA) with Included Health to serve as the dedicated "front door" for their members. Included Health provided an all-in-one personalized healthcare experience, combining navigation, population health management, and supplemental virtual care options (primary care, behavioral health, and urgent care) to simplify a highly fragmented system.
Key strategies for success
Unified navigation (mind, body, wallet). Members were given a single entry point for all healthcare needs, from understanding billing and benefits to finding high-quality specialists and accessing virtual urgent care.
Prioritizing primary care. The partnership is laser-focused on improving population health through provider matching, proactive guidance to primary care, and virtual care as an alternative to in-person visits when needed — recognizing that high-quality care starts with accessible primary care.
Targeting high-needs members. Rather than just managing overall population health, the clinical teams collaborated to wrap comprehensive support around the most complex, high-cost claimants.
Omnichannel engagement. Recognizing that member preferences vary, Included Health offered 24/7 support via phone, video, chat, and self-service tools.
First year outcomes
Despite the magnitude of change for a population accustomed to an incumbent TPA that had been in place for two decades, the first-year results demonstrated the power of a member-centric navigation model:
- Household engagement. Nearly 70% of all eligible households engaged with Included Health services within the first year, with the majority utilizing multiple services.
- High-need population. Of the highest-needs members reached, 80% actively used Included Health, with half engaging directly in clinical services like longitudinal care plans.
- Member satisfaction (MSAT). The program achieved an MSAT score of over 80% and a strong Net Promoter Score (NPS), proving that cost containment and quality improvement do not have to come at the expense of the member experience.
- Behavioral shifts. While members initially preferred phone calls, building trust led to a significant shift toward digital chat and self-service app utilization.
~70%
Year 1 household engagement
>80%
Member satisfaction score (MSAT)
The takeaway
Achieving financial predictability and clinical efficacy requires more than just network design; it requires an authentic, clinically excellent partnership. By implementing a comprehensive navigation and population health model, group purchasers can successfully guide members to higher-quality care, eliminate systemic waste, and deliver a healthcare experience that members trust and value.
