Jeff Palmer has created a way to finance and deliver healthcare for poor, uninsured, and semi-insured populations in the United States–a group estimated at 40 million nationally–without relying on the public tax base or traditional philanthropy. In the process, he generates health outcomes better than national averages.
The New Idea
In 2000 Jeff created an innovative system specifically tailored for poor and underserved populations that identifies high-risk patients and gets them into preventive care before their situations end in tragedy or needless suffering. As a result, Jeff is generating large, system-wide cost savings that are reallocated for the care of the uninsured.
Jeff's Coordinated Care Network (CCN) model ensures that low-income citizens receive preventive healthcare through local institutions that the community already knows. Then, citizens' health needs are diagnosed and addressed early on. With this intervention, significant savings accrue for public and private health service providers and HMOs.
Through proprietary claims surveillance and health risk assessment techniques, CCN prospectively identifies patients who are at greatest risk for expensive health problems. CCN then preemptively enrolls them in its management program, envelops the clients in preventive services, thus avoiding the health complications that would have otherwise occurred. In so doing, it reduces costs to the "system" by 20 to 40 percent. In consideration of these services, the HMO pays CCN a fee and 50 percent of the savings created, plus improved health outcomes for uninsured and semi-insured.
Jeff's CCN also enables a proprietary physician dispensing system, a central pharmacy/mail order facility, and the 340B drug discount program. Jeff sells these services to the region's six major health insurance carriers and 44 regional health centers. The value to the carriers is paying 20 to 30 percent less for medications and members get their prescriptions filled more conveniently. Health centers can capture a new profitable revenue stream from prescription reimbursements, and patients regain health faster.
Jeff's revenue-generating activity supports the services of the nonprofit health care providers in his network. Jeff's idea has already spread across Pennsylvania; and now other states like New Mexico have asked him to implement his model.
Jeff is trying to solve the problem of how to finance and deliver healthcare to the uninsured without relying on the tax base or philanthropy. The impact of this problem is significant, given the fact that the U.S. Government estimates that approximately 40 million Americans have no health coverage. In Allegheny County, Pennsylvania (with a population of 1.4 million, including the Pittsburgh metropolitan area), local health officials estimate that approximately 15 percent of the population lack basic health coverage.
Exacerbating the problem is the fact that individuals who have no health coverage tend to delay getting care until their conditions are "serious." This results in above-average costs overall for a small share of the population. Jeff estimates that 2 percent of the population drive 40 percent of the healthcare costs. Furthermore, delays in care and worsening conditions result in care significantly more expensive than if patients had acted sooner. This is a critical insight to Jeff's solution: early intervention saves costs and improves outcomes. In many cases, individuals act too late, and after exhaustive and expensive interventions, they never fully regain their health and may die prematurely. Jeff is accumulating the data to show that life expectancy increases with his approach.
The general problem has been particularly difficult to solve because it is expensive to provide health coverage for uninsured individuals. Adequate sources of local or regional financing are not equitably available across the country and any government-sponsored "national" solution poses significant political opposition based on the perceived tax and business consequences.
CCN is currently developing a strategy to spread beyond local impact. Local, regional, and national demand for the pharmacy program dramatically exceeds present capacity and requires more capacity building. A powerful value proposition is extremely compelling from all stakeholders' perspectives. The clear results in both health and income enable fast spread.
During the next 18 months, CCN plans to implement the physician dispensing/mail order services; increase the number of members enrolled in prescription case management to 10,000 per Medicaid HMO (for a total of 20,000); and finance healthcare for the uninsured, at a base level, using earned income. CCN intends to eliminate dependence on private charitable and government support over the next year and generate sufficient earned income to sustain the organization over the long term.
Since CCN's launch, more than 10,000 members have enrolled in the preventative case management program, and actual "claims paid" data from Gateway Health Plan show reductions in emergency room visits and hospital bed days by 18 and 24 percent respectively (per 1,000 population), compared to the health plan's overall population. With the success in the Allegheny region, Jeff will continue to spread statewide within Pennsylvania; he has signed 44 contracts in 2003, three times the expected amount half-way through the year. His for-profit subsidiary will continue to finance the expansion of the model and growth in the network.
With powerful health outcomes, income-generating programs, and win-win solutions for partner organizations, Jeff has a compelling, self-sustaining strategy that can spread nationwide swiftly and scale to statewide networks.
Jeff grew up on a cattle farm and learned to be independent at a young age with discipline, hard work, and tenacity. His mother died when he was 14. With Jeff's father acting as disciplinarian, teacher, and motivator, values and instincts were set.
Jeff's self-sufficiency stretched through college; working full-time and after graduating from college, Jeff successfully launched a surgical software company and began forming a vision of how his work could have a deeper impact on the Pittsburgh community.
While executive director of a healthcare center in an urban, underserved, and high-crime neighborhood of Pittsburgh, Jeff was not prepared for what he would see in the shadows of the region's premiere health institution: death, disease, abuse, and neglect. Infants starving to death from poverty and families torn apart by cancer, stroke, and heart disease seemed intractably ingrained in the community.
Jeff began building a coalition targeting each of the nonprofit organizations in the region that aimed their programs and services toward at-risk populations. What emerged became Coordinated Care Network–a loose affiliation of 13 organizations that shared common values and principle, and, above all else, wanted to create better outcomes for the city's poorest citizens.
Jeff sees the integration of income-generation streams under the umbrella of a nonprofit institution as the only sustainable type of organization for long-term success. "Improving lives and saving money for the most needy of society" is Jeff's mantra.