The Pulse | Issue 22

A Message from Sally‑Ann Polson,

President & CEO

At MedWatch, we know every claim represents a real person, someone who is trying to understand their health benefits while managing a new or ongoing condition. That’s where MedWatch’s Pathways Concierge shines! It offers personalized guidance through complex healthcare choices, delivered by a compassionate concierge representative who is well‑versed in each member’s specific benefit plan.

Pathways Concierge isn’t just another service; it’s a high‑touch, single point of contact that should be a core part of every plan. It enhances the member experience by helping them understand and effectively access their benefits. With this level of support, members report greater satisfaction, better health outcomes, and meaningful cost savings for the plan and plan members.

Pathways Concierge fits any plan design, giving members the support they need to better use their benefits. Pathways even provides an option to handle provider calls, which can eliminate the amount of time required and help reduce the overall cost to administrators managing these inquiries.

Why is Pathways Concierge so successful? Below, you’ll find real feedback from the members and clients we serve. If you’re not yet on board, we’d love to connect and show how Pathways Concierge can boost benefit utilization and enhance member satisfaction.

Here are a few key elements that help place Pathways a cut above the rest:

• • Single Point of Contact: One phone number. One solution. Members connect directly with a dedicated advocate who understands their plan and guides them through every aspect of their benefits.
• • Experienced Support: Pathways Customer Service Representatives (CSRs) are highly skilled professionals with industry experience and a strong foundation in customer care, ensuring every interaction is handled with expertise and empathy.
• • Call Resolution: Pathways monitors success by how many calls / member inquiries can be resolved on that first call, not how many calls CSRs complete in an hour. Providing members the information they need is priority #1.
• • Knowledge of YOUR Benefit Plan: CSRs access real‑time data for claims, billing, in‑network providers, balance billing, and more.
• • Seamless Navigation: Facilitates steerage to preferred programs, providers, and other plan nuances.
• • Real‑Time Cost Management: CSRs flag cost drivers and direct members to clinically appropriate, cost‑effective care.
• • Proprietary Technology: Custom‑built platform streamlines service, improves coordination, and delivers detailed reporting.
• • AI‑Enhanced Member Engagement: Real‑time AI prompts help CSRs uncover member needs and deliver personalized support.
• • Lasting Member Satisfaction: Pathways connects members to the right resources, reduces costs, and earns NPS scores well above the industry average.

Pathways has already made significant impacts for over 100,000 eligible employees—nearly 250,000 members! We’re extremely proud of the positive responses we receive from members and clients every day. Below are a few of those kudos.

My name is Roland Brewer, and I serve as the President of Realm Health. We currently write group business through one of your clients.

I wanted to take a moment to share a recent positive experience we had with MedWatch and one of their team members.

A group owner contacted our account management team regarding an issue one of their employees was facing. The employee’s long‑time primary care physician stated they did not accept the plan and said they were not in‑network. Concerned, I reached out to a MedWatch Concierge member for assistance.

The MedWatch team went above and beyond. They contacted the physician’s office directly, explained the Health Plan and the PHCS network, and within a few hours, the office agreed to accept the plan. MedWatch even scheduled an appointment for the employee. A follow‑up call after business hours confirmed the issue was resolved and the physician would now accept other employees as well. What began as doubt about switching plans became a moment of reassurance and satisfaction.

Thanks to the dedication and persistence of the MedWatch team, one employee’s issue was resolved in a way that positively impacted an entire company.

We truly appreciate the support. Thank you, MedWatch!

“My wife reached out to the Pathways Concierge back on the 23rd, and the experience she had was one that EVERYONE should have. The Concierge went as far as 3‑way calling the doctor’s office and stayed on to ensure any and all necessary info was given. Please pass on my appreciation to MedWatch—they have a great one there who deserves recognition.”

“Buenos Dias! For the second time, I contacted Karla to solve problems with my medical insurance and was very happy with her treatment and skills. I’m super grateful for all the help, and I wanted you to know it’s very hard to find people just like her.”

“I have NEVER worked with an agent who didn’t make it sound like I was bothering them. From the very beginning, she treated me with respect and understanding. She reassured me everything was going to be okay so I could relax and enjoy the evening. She is a true asset to your team and deserves recognition every single day.”

We are a full‑service, comprehensive population‑management and medical‑cost‑containment provider. More than a vendor, we are a collaborating partner. With over 37 years of experience, MedWatch is committed to helping plans build smarter strategies for cost control and care management.