Southcoast Health partnered with consulting firm Cammack Health in 2010 to reduce costs of its employee health plan and improve member health. Through strategies like population health management, domestic steerage, and personal health management programs, Southcoast achieved the Triple Aim of improved health outcomes, better patient experience, and lower costs. After 4 years, Southcoast saved over $17.2 million compared to national trends, employee contributions remained stable, and members showed positive health changes like reduced ER visits, hospital admissions, and improved management of chronic conditions.

1. 1
Achieving the Triple Aim
How One Health System Reduced Costs and
Improved Member Health
Executive Summary
Southcoast Health began working with consulting group Cammack Health in 2010
in an effort to control the spiraling costs of its employee health plan and improve
members’ health. Cammack Health specializes in helping health care systems
achieve the Triple Aim: improved health, better patient experience and lower costs.
Four years later, Southcoast has achieved industry-leading results.
 Costs reduced – Its employee health plan has saved more than $17.2 million
compared to national trends.
 Contributions stable – After increasing in nine of the previous 10 years,
employee contributions have remained the same for the last four years.
 Domestic usage up – Members’ use of the system’s own facilities and
providers nearly doubled.
 ER visits down – Members’ emergency room visits declined 55 percent.
 Admissions down – Members’ hospital admissions declined 43 percent.
 Members healthier and more engaged –
o The percentage of members participating in biometric screenings
increased 149 percent.
o The percentage of members participating in health risk assessments
increased 155 percent.
o The number of high-risk members who agreed to engage in a personal
health management program rose from 66 in 2011 to 227 in 2014.
o Members showed positive changes in regard to weight loss, smoking
cessation, glucose management, blood pressure, compliance with
routine screenings and more.
 Return on investment substantial – Overall, ROI for the health management
programs was 4.2-to-1 in the most recent year.
Southcoast had an operational and strategic imperative to succeed in population
health in order to control health plan costs. Cammack Health was the ideal partner,
bringing to the engagement attributes critical to Southcoast’s achieving its goals.
Those attributes include:
 Operational experience – Consultants have hands-on experience and
expertise in hospital operations and healthcare delivery.
 Data-driven intelligence – Expertly analyzes data from multiple sources to
obtain vital knowledge and identify opportunities.
 Grasp of root causes – Uncovers the underlying factors driving cost increases.
“We had made several
changes to plans, but we
had continued to have
double-digit cost increases
every year. Cammack
Health spoke the language
about addressing disease
management and wellness
and more actively
managing in real time the
components of the plan.
In the first four years of
this plan, we had zero
increase in our budget
related to health care,
reduced by half our
emergency room visits and
significantly increased
domestic utilization of our
services.”
David DeJesus,
Senior Vice President,
Human Resources,
Southcoast Health

2. 2
 Understanding of human behavior – Ascertains how members actually use
health services and develops creative, customized solutions.
 Multifaceted approach – Achieves genuine organizational change by
addressing all elements, including plan design and governance, population
health management, stakeholder engagement and effective communication.
Achieving the Triple Aim
In 2010, Southcoast Health was struggling with challenges common to the industry
nationwide. Its self-insured employee benefit plan, then a $50 million budget line
item, had seen double-digit cost increases in nine of the previous 10 years. Medical
management offered by its insurance carrier had no effect. The plan had an
abundance of data, but no way to organize and mine it for usable information.
Employee contributions increased nearly every year.
Recognizing that radical transformation
was needed, Southcoast management
decided to partner with Cammack
Health LLC, a consulting firm
specializing in helping health systems
achieve the Triple Aim of improved
health, better patient experience and
lower costs.
Southcoast’s decision proved wise; four
years after engaging the firm, the
system’s health plan has saved more
than $17.2 million compared to national
trends (see graph, p. 8). Employee
contributions have held steady. The
health system is saving money, because
employees are increasingly using
Southcoast’s own facilities and providers. Just as important, population health
management strategies have not only decreased utilization costs, but helped
members and their families become healthier and more productive.
Cammack Health and Southcoast employed a wide range of strategies to achieve
positive results.
“To survive in today’s health
care environment, hospitals
know they must transition to
a value- based/accountable
care model, but they’re
unsure of exactly how to
accomplish it.
We identify the right path
for each client and guide
that transformation by
collaborating with them to
bring about organizational
change.”
Erin O’Connor, Esq., Partner,
Cammack Health LLC
Southcoast Health
at a Glance
Southcoast Health is a community-
based, not-for-profit health delivery
system providing a continuum of health
services in 33 communities in
southeastern Massachusetts and Rhode
Island. The system includes three
hospitals, VNA services and more than
40 medical office practices. The system
employs approximately 7,000 people. Its
self-insured health plan provides
coverage to more than 10,000
employees and dependents.
“We looked to Cammack
Health to help us save
money, improve health and
have the plan more in concert
with Southcoast’s philosophy
and mission. We’re not a for-
profit system; we’re here to
improve the health and
wellness of our
community.”
Beth Barker, Director of
Compensation and Benefits,
Southcoast Health

3. 3
New Governance Structure
Cammack Health’s experience had shown
that establishing a broad-based governing
body is critical to achieving the desired
results. Its view was—and continues to
be—that only with all the right parties
collaborating on decision-making can a
health system achieve the Triple Aim and
ensure that the employee health plan
takes into consideration the health
system’s overall population health
strategy.
With the firm’s guidance, Southcoast
established a reconfigured governance
structure. The new structure enlisted
broad internal expertise that included
physician leadership; clinicians such as
pharmacists, care managers, diabetes
educators and exercise physiologists; and
representatives from managed care, finance, marketing and other areas. The
executive committee would make the ultimate decisions, but with input from the
wellness committee and clinical advisory committee. The role of the committees was
to:
 Establish expectations and set goals
 Provide ongoing performance improvement review for the health plan by
reviewing the population, processes and metrics in the areas of engagement,
clinical quality and economics
 Determine resources, plan design, clinical programs and other key areas to drive
results
Data Analysis Reveals Opportunities
To understand the factors driving costs and design solutions to address them, the
firm conducted a rigorous analysis of data from several sources, including medical
and pharmaceutical claims, lab values (from hospital and reference labs), biometric
screening results, health risk assessment data, provider information and more.
Cammack Health first aggregated the data into one repository. The data warehouse
then enabled Cammack Health analysts to dive deep into the data to produce
insights. Through this analysis, the team identified two main opportunities to
reduce plan costs, improve member health and provide significant return on
investment. One was to foster domestic steerage, that is, encourage members to use
About Cammack Health
New York City-based Cammack Health
provides health care and employee
benefits consulting to help clients meet
organizational goals. The firm offers plan
and program design, advanced
technology, data warehousing and
analysis, customized solutions and
ongoing support and service. Its
consultants are former senior human
resource executives in the health care
industry. They are frequent speakers at
national conferences, including those of
the Northeast Business Group on
Health, the American Society for
Healthcare Human Resources and
Healthcare Financial Management
Association.
“Involving physicians in
the governance structure
has been critical to the
health plan’s success.
Physicians bring to the
decision-making process an
invaluable clinical
perspective as well as the
ability to recommend
solutions that improve
member health and make
good economic sense.
Participation also forges a
partnership between the
physician group and the
plan that helps achieve their
common goals: keeping
patients healthy while
controlling costs.”
Michael Hyder, MD, MPH,
FACC, Chief Medical
Information Officer, Southcoast
Health; Senior Vice President
and Chief Medical Officer,
Southcoast Physicians
Network/Accountable Care
Organization

4. 4
Southcoast’s own facilities and providers. The other was to institute a robust
population health management program.
Savings Through Domestic Steerage and Precertification
Southcoast instituted a three-tiered system that provided financial incentives for
members to utilize domestic services for inpatient, outpatient and laboratory
services – including Southcoast physicians. Most plans tier only for facilities; but
true domestic steerage starts with the providers. Members paid the least if using the
system’s own facilities and providers; standard market rates if they used a local,
partner network; and the most if they used out-of-network facilities and providers.
Concurrently, the system introduced precertification and utilization management
services through an independent third party. This allowed counselors to educate
members on the financial consequences of their choices. The interactions resulted in
significant savings, as members increasingly chose domestic services, and length of
stay and levels of service declined.
Better Health through Population Health Management
Evidence suggests that promoting good health benefits everyone—plan members,
their families, their employers and the broader community. Just as important, it
reduces health care costs, and therefore, the costs of employer-sponsored health
plans and the amount members pay in contributions and out-of-pocket fees for
services. Cammack Health and Southcoast took steps to realize these benefits by
partnering with a third-party administrator that was willing to carve out the
insurance-based medical management programs and the fees typically included in
the administrative services only (ASO) fee for the self-insured plan. These disease-
and case-management programs were replaced with a more holistic approach called
personal health management (PHM). The service is free to members who chose to
participate. It was provided by the same independent, third-party organization that
provided the precertification and utilization management functions. Under the PHM
program, the company employed local nurses to be personal health nurses (PHNs)
who worked exclusively with the Southcoast Health Plan members and providers.
The program’s goals were to:
 Modify high-risk behaviors
 Control chronic conditions
 Manage acute conditions
 Educate people to make healthy choices
 Reduce costs
The consulting team fed all the previously obtained data into the data warehouse to
provide the analytics platform. The same warehouse also fed the medical
management applications that the PHNs used to find and manage patients.
“Being able to hold our
largest budget line item to no
growth in expenses frees up
money for other purposes.”
David DeJesus,
Senior Vice President,
Human Resources,
Southcoast Health

5. 5
Cammack Health used the platform to identify opportunities to optimize patient
care, engage members and providers in PHM and uncover gaps in information.
Southcoast had long offered biometric screenings and health risk assessments for
employees. However, only a small percentage of people had taken advantage of the
programs. In addition, the information collected through those programs was
provided only to the employee, so it was of limited value. At Cammack Health’s
suggestion, Southcoast increased financial incentives to encourage more members to
complete biometric screenings and health risk assessments. As a result, the number
of members completing a biometric screening increased from 1,180 in 2010 to 2,934
in 2014 and the number of members completing a health risk assessment increased
from 1,441 in 2010 to 3,678 in 2014. More importantly, the data from these
screenings and assessments were integrated into existing data to better identify
members at risk. For employees who did not have claims, this data uncovered risks
that had not been identified previously. This information was used to reduce the
unknown risk in the population.
Making Health Improvement Personal
To engage members more in their own health, Cammack Health and Southcoast
made several innovations, including launching the PHM service mentioned above
and recruiting local nurses as PHNs. The PHNs’ role was to reach out to members
at risk for health problems. They also worked closely with primary care and other
providers who cared for members. The PHM service focused on members who
were at high risk and those with an acute episode of high-intensity care. PHNs
identified the high-risk patients through risk stratification tools and predictive
modeling incorporated in the medical management technology, using all of the
available data to create the risk scores. The high-risk members the nurses contacted
were those the risk algorithms showed had complex medical conditions and were
spending five to eight times what the average member spent on health care. The
patients with acute episodes were brought to PHNs’ attention through the
precertification/utilization management service on a real-time basis. The PHNs
could start working with a member immediately upon finding out they were
planning to have a high-cost service or as soon as they got the call about an
emergency admission. They didn’t have to wait for claims to hit the system – usually
two to three months after a hospital stay.
PHNs worked with members to identify issues that were preventing them from
optimizing care, health outcomes and cost. They also integrated clinical and wellness
resources provided by Southcoast Health and/or community agencies and
coordinated with members’ providers. PHNs leveraged relationships with primary
care providers’ offices to obtain help reaching the member and getting him or her to
engage with the nurse. In 2014, the PHNs also began working with care managers
who had recently been added to the team in the Southcoast Physician Group
primary care offices.
“The best piece for
me is knowing that our
efforts are being rewarded
by improvements in
the health of our members
and their families.
The data show that
our members truly
are healthier. It’s a
positive for me, personally,
that we’ve been able to
impact people’s lives.”
Beth Barker, Director of
Compensation and Benefits,
Southcoast Health

6. 6
The PHNs made a significant difference. In 2010, member engagement in the health
insurance company’s disease-management program had been approximately 20
percent. By contrast, the PHNs were able to engage 76 percent of the members they
were able to reach. This was even more impressive because the definition of
engagement was stricter under the PHM program, requiring not just a telephone
call, but an ongoing relationship between the nurse and the member.
By the end of the program’s first year, members participating in PHM had a higher
compliance rate with key evidence-based metrics than those who qualified for the
service but did not engage. Those metrics included regular HbA1c tests for diabetes
patients and LDL cholesterol tests for diabetes and coronary artery disease patients.
These results have continued in the subsequent years.
Addressing Threats to Health
The medical community recognizes that certain conditions and lifestyle choices are
highly likely to result in complex health issues if not addressed. Obesity is one
example. Obesity was found to be a substantial risk factor for members, as it is in
the general population. The health and productivity problems associated with
obesity are well known. Cammack Health worked with Southcoast to adapt an
existing weight management program into a more comprehensive service for
members and provide financial incentives for participation. The initial 106 members
who enrolled in the program lost an average of 17.8 pounds per person in the first
year, with eight people losing more than 50 pounds each. Using this experience,
Southcoast expanded the outreach to engage at-risk members through an early-
intervention program. Southcoast’s Diabetes Management Program also wanted to
offer a Diabetes Prevention Program, having recently hired someone who had run a
successful program elsewhere. Cammack Health worked with the Southcoast
Diabetes Education team to develop a program that could be offered specifically to
employees who were obese or overweight and pre-diabetic. On an overall basis, the
employees who had their BMI tested during biometric screening in two consecutive
years saw a slight decrease in people who were overweight.
Cammack Health created a special risk stratification protocol to identify members
whose biometric screenings or health risk assessments showed they were at risk of
developing chronic disease in the future. These included people who were
overweight or obese or showed signs of incipient diabetes, hypertension or high
cholesterol. Southcoast’s wellness coordinator, acting in the role of health coach,
reached out to engage these members, steering them to Southcoast-sponsored
Weight Management and Diabetes Prevention programs to reduce health risks.
The system also introduced the Virgin Pulse online wellness platform, including on-
site health stations for screening blood pressures and measuring body mass.
Southcoast also ramped up on-site wellness initiatives by offering healthy cafeteria
choices, yoga, stress management and tobacco-cessation programs. Often, the
system offered discounts and other financial incentives to encourage member
participation.

7. 7
Communicating Effectively
Throughout the planning and
implementation of these and other
innovations, the consulting team and
Southcoast’s internal marketing
experts worked together to conduct
communications campaigns to keep
members, physicians and other
stakeholders informed about changes
and explain how those changes would
benefit them. In addition to creating
written communications, the firm
arranged for personal
communications and face-to-face
meetings. For example, physicians
serving on the plan’s governing board
were asked to telephone physician
colleagues to let them know about
upcoming medical management
initiatives and suggest they take part.
The firm also used a continuous
improvement process, meeting
regularly with the client’s core team
to evaluate progress and ensure the
project was moving forward as
planned.
Member Satisfaction
Southcoast Health Plan was eager to understand how members felt about their
experience with the plan, the PHNs and their providers. Cammack Health created
and managed an online member survey to assess several key aspects of members’
experience. The survey included questions, based on the HCAHPS (Hospital
Consumer Assessment of Healthcare Providers and Systems) instrument, about
their experience with their primary care provider. Approximately one-third of the
employees covered by the plan participated in the initial survey. In most areas,
members rated their experience as very good or good 80 to 90 percent of the time.
Ninety-seven percent said they would recommend their primary care provider to
their friends or family, and 95 percent said they would recommend their personal
health nurse.
Solving the Real Problem
A Southcoast Health Plan member with
diabetes had an inpatient admission,
including a stay in the ICU, due to poorly
regulated blood glucose levels. The
Personal Health Nurse found that the
person needed an insulin pump to properly
regulate his blood sugar, but that the plan’s
deductible made the equipment
unaffordable for him. In reality, the
impatient stay wound up costing the plan
far more than the pump would.
The solution: provide the member (and
others) with the pump at no charge to
improve his health while reducing the
financial burden on the plan. The
recommendation was approved by the
Clinical Advisory Council for the Health
Plan and adopted by the Executive
Committee. “This is an example of what
makes us different from conventional
benefits consulting firms,” says Cammack
Health Partner Erin O’Connor. “We find the
root causes of high costs and then address
the human factors behind them.”

8. 8
Industry-Leading Results
The results of innovations described here can be seen in the illustrations below. The
data demonstrate that the decisive changes Cammack Health and Southcoast
implemented had a powerful, positive impact on the health of the plan and the
people covered under it.
Southcoast’s cost of care trend outperforms national projections. The
system has saved more than $17M compared to trend since partnering
with Cammack Health.
Medical Management Savings and Return on Investment: 2014
Service Type Cost $ Saved ROI
Utilization Review $372,888 $1,422,707 3.82
Personal Health Management $280,191 $2,103,880 7.51
Total $653,079 $3,526,587 5.40
Last year alone, Southcoast earned a return on investment of 5.40.
$443
$478
$519
$558
$594
$443
$432
$445 $441
$481
$300
$350
$400
$450
$500
$550
$600
$650
2010 2011 2012 2013 2014
AHIP Projected Trend
Southcoast Actual Trend

9. 9
Domestic Utilization % of Services
The percentage of claims utilizing domestic services rose 20 percentage
points after Cammack Health’s recommendations were implemented.
Emergency Room Visits / 1000
The number of emergency room visits was more than cut in half.
20%
32%
36%
38%
40%
0%
10%
20%
30%
40%
50%
2010 2011 2012 2013 2014
483
211 208
237 222
0
100
200
300
400
500
600
2010 2011 2012 2013 2014

10. 10
Admissions per 1,000 Members
The number of hospital admissions declined by 40 percent.
Biometric Screenings and Health Risk Assessments
95
68 65
56 57
0
20
40
60
80
100
2010 2011 2012 2013 2014
1,180
1,299
2,016
2,982 2,934
1,441 1,425
2,617
3,265
3,678
0
1,000
2,000
3,000
4,000
2010 2011 2012 2013 2014
Biometric Screenings
Health Risk Assessments

11. 11
Members are gaining insights that can help them stay healthy. The
percentage of members participating in biometric screenings and health
risk assessments has increased.
Engagement in Personal Health Management
Members are taking greater responsibility for their own health. The
percentage of high-risk members participating in personal health
management programs has increased.
Compliance with Health Screenings
The percentage of members screened for health risk has climbed steadily
over the last three years.
66
133
258
226
0
50
100
150
200
250
300
2011 2012 2013 2014
90%
75%
88% 88%
80%
88%
86% 85%
82% 84%
53%
61%
40%
50%
60%
70%
80%
90%
100%
Q4 2011 Q4 2012 Q4 2013 Q4 2014
CAD LDL Testing Compliance
Cervical Cancer Screening
Diabetes 1 HbA1c Test
Compliance
Mammogram
Diabetes LDL Testing Compliance
Diabetes Nephropathy
Compliance
Colorectal Cancer Screening

12. 12
Conclusion
Thorough a very methodical approach, Southcoast Health was able to keep its
healthcare costs nearly flat. In the plan years 2011–2014, Southcoast did not raise
employee contributions. They implemented a wellness incentive that more than
two-thirds of their employees were able to achieve. More importantly, the data from
screenings was actually put into use to help people address rising health risks.
In addition to keeping contributions flat, Southcoast did not achieve savings by
drastic changes to co-pays and deductibles. They maintained market competitive
plan design. By creating a plan tier of its own physicians, Southcoast helped direct
members to high quality and lower cost providers: Southcoast providers consistently
outperformed the health plan network as a whole on Evidence Based Measures
(EBMs). In addition, the Health Plan Member Experience survey (conducted bi-
annually) demonstrated member satisfaction with their PCP at 92%.
Overall, no cost-shifting, satisfied members, increased domestic capture, flat trend,
and improved health sustained over a four-year period are all evidence that
Southcoast Health Plan has delivered on the strategy outlined at the start of the
engagement with Cammack Health.
For Additional Information
To learn more about Cammack Health, contact Erin O’Connor, partner, at 212-227-
7770 ext. 228 or eoconnor@cammackhealth.com.

13. 13
Erin M. O'Connor, Esq., Partner
Erin joined Cammack Health (formerly Cammack LaRhette) in 2004 as a member
of the executive team. As a leader in the Accountable Solutions area, Erin develops
strategic partnerships with clients who migrating to population health management.
She works with industry leaders, clients and partners to develop best practices for
accountable care.
Key areas of Erin's expertise are organizational development, engagement, and
change management. She has developed engagement and communications programs
targeting physicians, organizational leadership and employees. Erin excels at creating
and embedding processes to overcome barriers to change. She is currently leading
engagements to integrate health and productivity management in several health care
systems in the Northeast.
Erin has 25 years of experience in human resources and health care operations.
Prior to joining Cammack Health, she was the chief HR executive at two large
health care organizations, one of which operated several health plans.
She is a graduate of Cornell University's School of Industrial and Labor Relations
and Fordham University School of Law.
212.227.7770 x228
eoconnor@cammackhealth.com
“Employers are
frustrated with off-the-
shelf ‘wellness’
programs that don’t
make a difference.
With our depth of
experience in population
health management, we’re
able to help clients
develop programs that are
game changers—
innovations that will
actually change
outcomes.”