Care Management

Manage Complex Care Before Costs Climb

Point C helps employers and brokers respond earlier. We provide support to manage benefit utilization and guide members through treatment to reduce avoidable plan spend.
Smiling woman in front of Point C branding on a pink background.
High-Cost Care
Most Catastrophic Claims

Don't Start That Way

They build when a member misses follow-up care, receives treatment in a higher-cost setting, delays a diagnosis, struggles with a complex treatment plan, or has no one helping coordinate the next step.

Without early visibility and intervention, these situations escalate quickly.

70-80%
of healthcare costs are tied to chronic conditions, many of which are preventable or manageable with early intervention.
1%
of members can drive 25-30% of the total plan spend.
Gaps in care, poor coordination, and low engagement are some of the most common drivers of high-cost claims.
Provider and member discussing care options.

How Care Management Changes the Course of the Claim

Care management is a nurse-led service that aids members navigating complex health needs while helping employers manage costs more effectively.
Point C's 30 in-house licensed clinicians are guided by our Johns Hopkins-trained Medical Director to support members during the moments that matter most.
Earlier engagement with members at risk for high-cost claims
Support that improves follow-through during treatment
Better coordination across providers, benefits, and care settings
A more disciplined approach to utilization management
A strategy that can help reduce the factors that increase stop-loss exposure
When a member is diagnosed with a serious or ongoing health condition, the financial impact on the plan can rise fast. Care Management helps employers and brokers address two priorities at the same time: member outcomes and plan performance.
See How
Care Management

From Everyday Support to High-Cost Intervention

Point C has a care management model that can be tailored to employer needs and population risks.

General Care Management

Nurse-led support for members with emerging or ongoing health needs, chronic condition, and care coordination support.

Utilization Management

Clinical review that guides medically appropriate care, reduces avoidable utilization, and supports responsible use of the plan.

Specialty Case Management

Focused intervention for high-cost or high-complexity cases, including oncology, behavioral health, dialysis, and other specialty care needs.
Solutions

For the Conditions That Carry More Complexity

Specialty case management is most valuable when a condition is complex or expensive.
Person resting on grass, representing oncology care and support during cancer treatment.

Oncology

Cancer care can move quickly. And become expensive just as fast. Members often need help understanding treatment plans, coordinating specialists, and managing the many decisions that come with active treatment.
Two people having a conversation, representing behavioral health support and collaborative care.

Behavioral Health and Collaborative Care

Behavioral health needs often affect medical spend, absence, productivity, and retention. Specialty support connects members with care and stays engaged over time.
specialtyPharmacy

Specialty Pharmacy and Drug Optimization

High-cost medications can reshape plan spend in a short period. Specialty case management supports more appropriate utilization, member adherence, and alignment between medical and pharmaceutical strategy.
Healthcare provider reviewing care information with a patient during an office visit.

Dialysis and Kidney Care

Dialysis is one of the highest-cost areas for employer-sponsored health plans. Members benefit from hands-on support as they navigate treatment choices, provider coordination, and long-term care planning.
complexChronicConditions

Complex Chronic Conditions

Members living with multiple chronic conditions, repeated admissions, or frequent care transitions often need more intensive support than a standard care model can provide.
The Point C Process

A structured experience that combines clinical oversight with real member engagement.

Step 01

Member Enrollment

Members may be identified through claims activity, referrals, utilization review, or plan-based triggers. Once enrolled, each member is connected with a dedicated nurse care manager.
Step 02

Care Assessment

The nurse completes a comprehensive assessment to understand the member's condition, treatment plan, care history, and any barriers that could affect progress.
Step 03

Care Plan and Goals

A personalized care plan is developed around the member's diagnosis and treatment needs. The plan is built to support appropriate care and keep the member moving through the right next steps.
Step 04

Intervention and Support

The nurse helps members prepare for appointments, understand treatment options, coordinate across providers, navigate benefits, and stay engaged in care. This is where nurse case management becomes especially valuable for members facing difficult or costly health events.
Step 05

Progress Tracking

Point C tracks progress over time and adjusts support as needed. This ongoing oversight helps reduce the chance that a manageable case turns into a more severe and expensive one.
Smiling man wearing glasses and a green shirt, representing personalized health plan support and member care.

Access Custom Plans and Experienced Member Care

Frequently Asked Questions

How does care management reduce healthcare costs?
Care management reduces healthcare costs by helping members get timely support, make more informed treatment decisions, and stay engaged with the right course of care. It also helps employers reduce avoidable utilization, improve coordination, and manage the factors that often increase claim severity.
What is the difference between utilization management and case management?
Utilization management reviews whether care is medically appropriate and necessary. Case management helps members navigate care, understand next steps, and stay engaged through treatment. At Point C, these functions work together instead of operating in separate silos.
When should an employer consider specialty case management?
Employers should consider specialty case management when they see exposure to oncology, behavioral health, dialysis, specialty pharmacy, repeated admissions, or other complex conditions that are likely to drive significant plan spend.