Success in Alaska, Florida and Ohio points the way for our future

1. The Future
We Choose
March 9, 2016
“Hellth”
April 4, 2033
“Wellth”

2. Reestablishing
Health Sovereignty

3. “DIVIDEND”
ALLOWS EMPLOYER
TO INVEST IN KIDS
AND EDUCATION
RESTORING THE
AMERICAN DREAM
“One thing I quickly learned is that there is as much
intellectual talent in the underserved neighborhoods as
there is in gated communities. And this investment pays off.”
HARRIS ROSEN (hotelier & philanthropist funding Tangelo Park
Program)

4. IN THE EARLY 1990S, TANGELO PARK WAS WHERE
TOURISTS VISITING ORLANDO AMUSEMENT PARKS
WOULD GO IF THEY WERE SEEKING DRUGS.

5. SIMILAR TO MOST LOW-INCOME NEIGHBORHOODS
NATIONWIDE, TANGELO PARK WAS
SOCIOECONOMICALLY UNDERSERVED AND ISOLATED
Chances of Graduating from College By Income Level
4th
1st
2nd
3rd
77%
9%
17%
34%
INCOME
QUARTILE
TANGELO PARK
Most of its 3,000 residents fell in the
first income quartile.
Statistically, children born into these
families had a 9% chance of
graduating college.

6. IN THE EARLY 1990S, TANGELO PARK COMMUNITY MEMBERS
WANTED TO TAKE THEIR COMMUNITY BACK TO ENSURE
KIDS HAD AN OPPORTUNITY FOR SUCCESS.

7. THE TANGELO PARK PROGRAM (TPP) ALIGNS PRIVATE, PUBLIC,
AND COMMUNITY ORGANIZATIONS TO PROMOTE CIVIC
COMMITMENT TO CHILDREN’S EDUCATIONAL SUCCESS
Majority of the programs’ preschool students enter elementary school
on or above track and demonstrate superior readiness skills.
Quality educational programs that nurture
children’s developmental, social, and
emotional skills.
College scholarships to qualifying graduates
of Dr. Phillips and Jones High Schools.
Family support to create parent involvement
in their children’s education.

8. “This program is drastically different
from others because it wraps both
arms around the community and says
we are here to serve you and help you
become the best person you can be.
A lot of these programs, they have only
one piece here and one piece there.”
– DR. BERNICE KING, DAUGHTER OF MARTIN LUTHER KING, JR.

9. SINCE THE START OF TPP, THE TANGELO STUDENT HIGH
SCHOOL GRADUATION RATE HAS APPROACHED 100%
Percentage of Tangelo Students Receiving
High School Diplomas
An average increase of approximately
30% over the 1991-93 school years.

10. AND THEIR LIKELIHOOD OF GRADUATING COLLEGE HAS
INCREASED BY 8X
Chances of Graduating from College By Income Level
4th
1st
2nd
3rd
77%
9%
17%
34%
INCOME
QUARTILE
78%
TP*
*TPP: 4-year graduation rate for students
who maintain residence

11. CRIME RATES PLUMMET
Tangelo Park Crime Rates
Estimated savings from a reduction in crime:
$270,000 to $300,000 for the community
+3%
-78%

12. STUDENTS WHO RECEIVE COLLEGE SCHOLARSHIPS
THROUGH TPP GRADUATE DEBT FREE
Percentage of Bachelor’s Recipients with Loan
Debt (Nationally)
TP Bachelor’s Recipients with Loan Debt:
0

13. STUDENTS WHO RECEIVE COLLEGE SCHOLARSHIPS
THROUGH TPP GRADUATE DEBT FREE
Lifetime Earnings Based on Education
Estimations for the increase in the total annual benefit and lifetime earning per
student to a cohort of said students are $50,000 and $1.05 million, respectively.
Total 26 Year Investment: $12,807,800
1/2 early childhood programs | 1/2 scholarships
$7
ROI
$1
INVESTMENT
Return on investment to society

14. INSPIRING OTHER COMMUNITIES
TO RESTORE THE AMERICAN DREAM
TANGELO PARK’S SUCCESS IS BEING REPLICATED IN SIMILAR LARGER NEIGHBORHOODS IN
ORLANDO. WHY NOT IN YOUR COMMUNITY?

15. NUKA MODEL:
“Health care isn't who pays for it,
it is about who cares.”
- Terry Simpson, MD, Southcentral Foundation board member
Community-
Driven Change

16. Before the Nuka model created by the Southcentral
Foundation (SCF), Alaska Natives had health outcomes
consistently worse than just about all developing countries.

17. Before the Nuka model created by the Southcentral
Foundation (SCF), Alaska Natives had health outcomes
consistently worse than just about all developing countries.

18. - They oversaw a total redesign of the health
care system literally changing everything.
- They kept the best of modern medicine and
melded it with Alaska Native values and
wisdom of the elders.
- They put the customer-owner (formerly
known as “patients”) in charge at all levels.
- They adopted a no-excuses model to provide
care in remote Alaskan villages with
no medical professionals.
In 1998, SCF assumed responsibility for health care by
taking the following approach:

19. Stunning Results
Specialist Utilization
Primary Utilization
65%
20%
Percentile in
HEDIS* outcomes
Childhood Immunization 93%
75-90%
Diabetes with 50% of HbA1c
below 7%
Diabetes with 50% of
HbA1C below 7%
Employee and customer
satisfaction 90%
ER & Urgent Care
Hospital Admissions
50%
53%
*Industry standard measuring healthcare quality

20. Stunning Results
Increase in high school
and college achievement
& opportunity.
Career opportunities
developed in health care:
over 50% of the 2300 SCF
employees being Alaska
Native. [Previously only one
Alaska native on staff.]
Results sustained for more
than a decade.

21. “This is now your health
care system. You have
control over it.”
Alaska Native people have shown, it isn't who
pays for the health care that impacts results,
health is impacted when we build relationships
between caregivers and customers.
What the customer-owner did not want, what
SCF worked hard to make certain of, was that
they were simply not going to “manage” what
had been done before.

22. It’s not a local
governing board
answering to a
higher authority
The key is
ownership to
all who would
seek treatment
What does local control mean?

23. Owners don’t
make excuses
Serving 65,000 people over the size of
Sweden with remote villages with no
medical professionals and limited access.
Yet, all their members had access to
Covid vaccine via sleds, boats and
planes (in the Alaskan winter) by the
end of January 2021

24. Nuka System: 65,000 Voices

25. NE OHIO
COMMUNITY-OWNED
HEALTH PLAN:
Employer-
Driven Change

26. Barriers to a Healthy Ashtabula: The main barriers keeping the
county from optimal health were deemed to be lack of
healthcare resources and sufficient health insurance, poverty,
and lack of education.

27. 1/3 of Ashtabula County youth live in households under the
federal poverty level, and almost 30% of residents spend
greater than 30% of their monthly income on housing costs.
Over 60% of students are on free or reduced lunch. Under
15% of Ashtabula County residents have a Bachelor’s degree.

28. Medical desert: The ratio of Ashtabula County physicians
(both MDs and DOs) is 1 to every 1,072 Ashtabula County
residents. This is much higher than the 1 to 299 ratio in the
state of Ohio as a whole.

29. - 2019: Learns how to implement high-
performance health plans starting with one
employer.
- 2020: Direct contracts with independent DPC,
pharmacy & ASC.
- 2021: DPC & community pharmacy woven into
growing community-owned health plan.
Appointed to county health dept board.
- 2022: Over 5,000 citizens have access to
superior health plans; new clinics/practices
open in a medical desert.
In 2018, benefits broker transforms his practice from
selling product to serving his community:

30. Impact: Far better care at
$0 cost for members
Navigators program: Assistance for
finding high-quality providers,
removing cost barriers, advocacy for
low healthcare IQ patients, access to
COE 2nd opinions at no cost, improved
Care Coordination
On-site mammography options
for breast cancer screenings
catching multiple undiagnosed
cancers
Diabetes with 50% of HbA1c
below 7%
Introduced local, independent
community pharmacist on both
plans for $0 drugs (all generics)
along with advocacy and
navigation provided to patients
Unlimited concierge style
primary care at no cost
24/7/365 for entire families

31. Impact: Increased access
Fair deals for clinical
leaders delivers increased
access to care
Crystal Clinic is ranked #1 in
Ohio and in the top 1% in the
U.S. by CareChex/Quantros
Analytic’s. The Ashtabula
clinic is Crystal Clinic’s first in
Ashtabula County.
Access previously impaired
due to 1-hour drive time is
now readily available.

32. Impact: Economic
Development 3.0
- “Shop local” means $millions now circulate previously
extracted out of local economy.
- Local school funding previously threatened by out-of-
control healthcare saved by modern health plan.
- First net wage gains in decades for working middle class
allow families to save for college/retirement.
- Reasonable healthcare costs better than any tax break
for local businesses. Jobs once shipped overseas due to
healthcare costs now secure with spending reduced 15-
20% on their 2nd largest expense.

33. Health Rosetta Dividend
impacts have just begun
Service company increased their dependent
contribution from 0% to now 50%.
No premiums increases in 3 years for teachers
meaning pay raises are more meaningful.
Chemical company reduced their premiums to
employees.
Healthcare premium holiday months on the
rise at multiple employers.
Many employers now purchase DPC
memberships for their employees at 100% +
zero cost sharing on the fees as well as any of
the services rendered.

35. STEPS TO MAKE HEALTHCARE LOCAL
Transform health plans from the #1 driver of inflation, debt, poverty and bankruptcy to the
top driver of well-being.
Learn how to
be liberated from
the status quo
Optimize
health plan
infrastructure
Carve out
pharmacy benefit
manager (PBM)
Advanced
primary care
Leave behind
value-extracting
PPO networks
Stop accepting 5%
to 20% annual cost
increases and paying
more to get less.
Work with a
Health Rosetta Advisor
who has your best
interests in mind.
Save by accessing,
understanding and
utilizing pharmacy claims
data.
Reduce downstream costs
and offer a better and
more proactive care
experience.
Average PPO network
pricing is 260% of
Medicare rates — you’re
not saving money.

36. LOCAL Roadmap: Assesses where you are &
where you can go
Informed by the
foremost experts in
high-performance
health plans
stewarding > 5 million
lives, the Plan Grader™️
scores the 40 most
important attributes of
a vibrant health plan.
Health Rosetta model
transforms the
“prescription” into
saved lives & dollars.
Plan Grader™️ First Objective Measure for $2 Trillion of spending

37. Health Rosetta Plan Grader™️
Claims
Risk Management

38. CHANGE CAN HAPPEN QUICKER THAN MOST THINK

39. The Future
We Choose
March 9, 2016
March 9, 2031
“Out of darkness is born the light”
- St. Catherine of Siena

40. Thank you!

41. WHAT’S POSSIBLE WITH COHPs
WORLD CLASS ORGS GAIN COMPETITIVE ADVANTAGE
7
PRIMARY CARE
ACCESS
Employer provides 7x24
primary care access,
access to world class
hospitals with
transparent
quality/price info.
NO DEDUCTIBLES
NO COINSURANCE
Removing financial burdens for wise
decisions means no medical
bankruptcies.
SAVINGS
Savings go to enhanced pay and
profit-sharing
EDUCATION
Funded college & continuing
education for employee AND children
FAMILY LEAVE
FREE, HEALTHY MEALS

42. STATUS QUO PLANS VS. COHPS
STATUS QUO Plans COMMUNITY-OWNED
PLAN DESIGN
ETHOS
One-size-fits-all built for
communicable disease era & acute care
Purpose-built for chronic disease era
where lifestyle drives health outcomes
SUCCESS
DEFINED BY Pleasing Wall Street
Improved health outcomes &
reduced waste
USE OF
PROFITS Taken OUT of communities Reinvested into communities*
IMPACT
Highest costs & worst outcomes in
developed world
Lower costs
Superior outcomes
*Community determines use of Health Rosetta Dividend -- we recommend investing in community assets including better jobs/pay, education, public health, & physical environment (e.g., clean water)

43. Student Debt
• Total US Student Debt 12 (2020): $1.56 trillion
If student debt in the United States was a Gross Domestic Product it would
be the 13th largest economy in the world (Silver, 2020).

46. Median Student Debt

47. Median Student Debt Snapshot: %
Change From 2016-2019
Black:
$21,000 🡪 $30,000
43% Increase
White:
$20,500 🡪 $23,000
12% Increase
Other:
$20,000 🡪 $19,000
5% Decrease
Hispanic:
$19,000 🡪 $18,000
5% Decrease

48. References
• Silver, C. (2020). The Top 20 Economies in the World: Ranking the
Richest Countries in the World. Investopedia. Retrieved from
https://www.investopedia.com/insights/worlds-top-economies/