How investing in members' health helped Southcoast Health cut costs

New England system retooled employee health plan with focus on Triple Aim

Healthcare organizations that struggle to reach the lofty goals of the Triple Aim--better health, better patient experience and lower costs--may want to take note of how one non-profit health system successfully overhauled its costly employee health plan, according to a new white paper.

Southcoast Health, which operates three hospitals and more than 40 practices in southeastern Massachusetts and Rhode Island, decided to radically transform its self-insured employee benefit plan in 2010 after repeatedly enduring steep cost increases. When it spearheaded a variety of strategic changes with the help of consulting firm Cammack Health, Southcoast's health plan saved more than $17.2 million compared to national trends and also kept employee contributions level for the past four years.

The system also reports that its plan members are healthier and more engaged, as their emergency department visits declined 55 percent, overall hospital admissions declined 43 percent, more members use the health system's own providers, and the number of members who participated in health risk assessments, biometric screenings and personal health management programs skyrocketed.

"The data shows that our members truly are healthier," Beth Barker, director of compensation and benefits at Southcoast Health, said in a statement emailed to FierceHealthPayer.

To achieve these results, Southcoast used some of the following tactics:

  • Data analysis: Southcoast pooled information from medical and pharmaceutical claims, biometric screening results, lab values, provider information and health risk assessments into one centralized data warehouse that allowed it to highlight opportunities to reduce costs and improve outcomes.
  • Better governance: Recognizing that broad-based collaboration is key to achieve the Triple Aim, Southcoast retooled its health plan's governance structure to consist of an executive committee that made final decisions with input from both a wellness committee and clinical advisory committee.
  • Domestic steerage: While many plans only tier for facilities, Southcoast chose to create a three-tiered system that provided financial incentives for members to use its own physicians as well as its inpatient, outpatient and laboratory service facilities.
  • Population health management: Southcoast replaced its disease- and case-management programs with an approach called personal health management, through which it employed personal health nurses that worked exclusively with members and providers to modify high-risk behaviors, manage chronic and acute conditions, reduce costs, and provide health education. Horizon Blue Cross Blue Shield of New Jersey also had success with a pilot program that featured care coordinators working side-by-side with clinicians to manage patients' conditions, FierceHealthPayer previously reported.
  • Effective communication: Southcoast's marketing team created campaigns--in writing, through phone calls and face-to-face meetings--to inform staffers and providers about the benefits of the upcoming changes in the employee health plan. Furthermore, it gauged member satisfaction with the new plan through online surveys.

To learn more:
- here's the white paper

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