Adventist HealthCare (AHC), is a faith-based, not-for-profit integrated healthcare delivery network that includes four nationally accredited acute-care and specialty hospitals, mental health services and home health agencies serving the Washington, D.C., metropolitan area. Its self-funded employee health benefit plan covers nearly 6,200 lives.
In its drive to achieve the Triple Aim of healthier populations, improved patient experience and lower costs of care, AHC sought an innovative approach to population health management through a partnership with Aon and Conifer Health Solutions. Integral to their mission, AHC also wanted to create and continuously develop an overall culture of well-being and good health that started with health plan members and their families.
In 2002, AHC engaged with Conifer Health to provide claims administration, network management and medical management services, including using Conifer Health’s nurses to provide care management to their members. After several years of positive results, AHC ramped up efforts in 2009, partnering with Conifer Health to launch a Patient-Centered Medical Home program with a hypothesis that better management of employees’ health would result in better outcomes and lower costs. Using claims data from Conifer Health’s population health management solution to identify high-risk members, AHC then identified primary care physicians to care for these members and assigned a Conifer Health care management nurse to each physician to provide outreach and establish personal care plans.
After just one year, the program’s results were dramatic, with nearly half of targeted members showing improvements in health and moving from high-risk categories into moderate or low risk. The program continues to help contain costs, and improves the overall health outcomes for the plan’s members. Conifer Health’s ongoing care management engagement with the plan’s members and participating physicians has proven to be a winning strategy for the program’s success.
“Our understanding of how to manage population health has evolved over time. Now we better understand how we can address the various components of population health management in a way that drives health plan performance to achieve health outcomes for participants.”
Marta Brito Perez
Senior Vice President, Population Health and Post Acute Care Services
Innovative Approach and Focus on Care Management Yield Sustainable Results
AHC’s achievements demonstrate the power of actionable data, a holistic approach to care and collaboration with providers.
Holistic Care Management
Conifer Health’s care management nurses holistically manage the member across the continuum of care from initial outreach and one-on-one engagement to follow-up care and wellness. Care management nurses live in the same community as the members they serve and are able to make referrals to the appropriate community resources when needed.
Establishing and maintaining a relationship with not only members, but their providers is critical to effective support and treatment. Care management nurses establish care plans in collaboration with each member’s primary care physician and regularly report on progress.
Effective care management would not be possible without reliable and actionable data to make informed decisions. Conifer Health’s technology platform provides data-driven insights to stratify and prioritize high risk members for targeted outreach and engagement.
With results outperforming industry benchmarks, AHC has built a culture of health and continues to add new features and components to its program that motivate and incentivize members to improve their own health. AHC leadership’s unwavering, long-term commitment to the program has helped it evolve and gain traction year-over-year.
AHC’s commitment to employee health improves financial and clinical outcomes
Return on Investment
Average Compounded Trend*
From 2011 to 2016
* YOY average increase in total healthcare expenditures for employee health plan