Continuing Decades of Successfully Achieving Healthcare Triple Aim Results

Proven Results Short and Long-Term

A currently active employer

Health Plan Cost Comparison
Savings historic comparison $850,383.23
Savings marketplace comparison $1,998,350.51

Long-Term Proven Results

Cammack Health

Sustained Focus Yields Results for Adventist Healthcare

Adventist Healthcare's experience proves that sustaining a culture of well-being over the long term means healthier employees and costs that are consistently below the national average.

Highlights of AHC's results include:

  • AHC's average annual compounded trend from 2011 to 2015 was 2.9% versus 7.3% for AHIP1 (America's Health Insurance Plans) and 6.6% for Milliman2
  • AHC's per member per year costs are more than 30% lower than Cammack Health's 2015 hospital survey median3 which included data from 89 health systems and 160 hospitals. Based on AHIP's cost trends for the last five years, AHC on average has saved $4.3 million annually based on their lower trends.
  • In 2015, AHC realized a return on investment of 437% on its investment in utilization review and personal health management.
  • In 2015, AHC captured 65% of total inpatient spending and 73% of outpatient spending within their domestic network.
  • 84% of eligible plan members who were contacted work closely with personal health nurses (PHNS), versus less than 25% nationally.
  • Among members engaged with PHNs, compliance with evidence-based metrics exceeds regional National Committee for Quality Assurance (NCQA) data in every category.
  • From 2013 to 2015, the number of members seeing primary care physicians has remained consistent due to AHC's continued wellness initiatives, while the number seeing specialists decreased by 6.5%.

AHC's achievements demonstrate the power of sustained commitment and offer insights other organizations can use to create a high-performing health plan and advance their journey to the Triple Aim.

Operating Structures Achieving Results Plus RealPHN Offerings

Individual Health Interface

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Ten Plan Management Strategies

Ten Health Plan Strategies for At-Risk Stakeholders
1. Membership
2. Plan Design 5. Health improvement, safety, and Medical Management 8. Risk Management
3. Finance, Budgeting, and Reporting 6. Direct Health System (all levels) Relationship Management 9. Administration
4. Data Control and analytics 7. Pricing, contracting, and Networks 10. Compliance

RealPHN Offerings

  1. The Health Plan, TPA, collaborative relationship.
  2. Data Management, Reporting, analytics through MyHealthPlace.TM
  3. Strategic operations.
  4. Personal Health Nursing.TM

Healthcare Stakeholders

Defined/Outlined

  1. Individuals, from most viewpoints, "most at risk".
  2. Employers, cover over half of the US population.
  3. Federal Government, Single payer for aged and disabled.
  4. State and Local Governments, emerged as major player, multiple roles.
  5. Health Systems, deliver the care to populations of 1-4 and 6 on Figure 1. Responsive to demands. Variable contracts and reimbursement. Cost shifting is the established norm.
  6. Insurers and Health Plans, administrators, customer service and ancillary services.
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Figure 1

Individuals, #1 Stakeholder-from this view, clearly get caught amongst stakeholders 2-6 and all the systems, rules, regulation, reimbursement. They need someone to simply be there and help.

Functions/Roles

  1. Individuals, live with their own health, health care, costs and administration.
  2. Employers, major force, need healthy employees, nominal success in historic cost control, impacted by health system cost shifting.
  3. Federal Government, major force in all areas of health and health care.
  4. State and Local Governments, play all roles, individuals, employers, payer, providers, regulators, diverse groups in many ways.
  5. Health Systems, deliver the care to populations of 1-4 and 6 on Figure 1. Typically hospital centric for many reasons. Insurers and health Plans, administrators and customer service. Negotiate contracts with health systems and administer them for governments and employers.
  6. Insurers and health Plans, administrators, customer service and ancillary services.

Three RealPHN Fundamentals

  1. Population health defined by the National Institutes of Health in 2003.
  2. "NIH definition the health outcomes of a group of individuals, including the distribution of such outcomes within the group, and we argue that the field of population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two"
    Source
  3. Nursing defined by the International Council of Nurses in 2002.
  4. "Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people"
    Source
  5. Primary Care defined by American Academy of Family Practice in 1977 & 2021.
  6. "Primary care is the provision of integrated, accessible health care services by physicians and their health care teams who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community."
    Source

Personal Health NursesTM Stories

Meals on Wheels Stories

  1. Lady stuck in ICU. Hospital won’t discharge due to complexity of discharge for someone who’s in hospice. Nurse arranged place to go for end of life. Avoided going on a vent.
  2. Vet couldn’t get from car to clinic for needed tests. Nurse resolved that problem. In process determined his walker was too large to get through doors in his home plus no safety bars in house. Nurse resolve those problems.
  3. Numerous examples of mailboxes being down and not able to get mail, hearing aid batteries need replacing, utilities turned off, smoke alarms need batteries, housing problems, domestic problems, homelessness, endless others.

Employer Stories

  1. An employee who have not gone to any doctors or trust any doctors came to me asking to help finding an eye doctor. I’ve sent him to an ophthalmologist and with lots of conversation, he agreed to see our PCP. He was diagnosed with DM with a very high level of A1C. He does not like routine lab works, or checking his sugar daily, nor compliant with his appointment. With an established relationship I have with him, he agrees to have telehealth visits with me, he takes his medications. His PCP is very patient and works with me to help strengthen his trust. His diabetes is well under controlled and a great A1C level.
  2. Another employee’s BP is very high though she did not have any symptoms. She has been taking medication knowing it didn’t help her and her blood pressure could kill her anytime. I worked with her PCP and had her on another medication which helped lower it down. She followed through my recommendation seeing cardiologist and working on lifestyle changing.
  3. One of the employee who has been struggling with his mental stability where he feel frustrated to himself and low self esteem. He was able to express his concerns and feeling to me. I referred him to a psychiatrist and therapist. He feels better now and less frustration.
  4. One of the employees who also did not see any doctors in the past and she did not want to have anything to do with me. Our relationship started to establish after a long period of time being there for her. She came and asked me to see a primary care. I established her with our PCP where she got all her preventative work up done. She is in good health and her trust to me is priceless.

For Further Discussion Contact

Harry.Spring@RealPHN.com