Allen Karp

our business in those markets for this particular product.

So we're able to take these relationships that we have built with the provider community and explain in detail how they're working and why we believe we'll continue to be able to

control costs and improve quality and service as we go forward.

Having those relationships in place for a number of years, we could have very focused conversations with employers about the advantages that we bring to the marketplace.

So initially there is some administrative expense necessary to build the teams to be able to face off with the providers and the technology to support the providers, but over time

it's much more efficient.

We can move some of the functions out to the point of care.

And as we do that, we can lower our administrative costs and be able to have those patients handled by care coordinators, by others within the delivery system to manage that cost.

There are things that we do differently.

around benefit design and ID cards and other ways of communicating with these patients that would be very difficult for a provider to take on, just like it would be difficult for us to get into the hospital or health system business, right?

So I think those complementary skill sets and tools that we bring to the table will allow us to continue to collaborate over time.

From a social determinants of health perspective, it's been very interesting for me to understand how much where you live has to do with your health status versus which health plan you have or the medical care associated with your condition.

The statistics show that 60% of a person's health status has to do with the zip code that they live in because of things like food deserts, transportation, the pollution levels in those areas, crime.

We did a pilot in Newark with Robert Wood Johnson Barnabas Health around one of their hospitals, North Beth Israel.

We looked at four zip codes in that area where the expense was extremely high relative to what we normally see.

And the age cohorts were much younger, between 35 and 50.

We found that the root cause of the problem was that many of them were using the emergency room as their primary care office as opposed to being tied into the delivery system.

They did not know what their conditions were, so many of them had comorbidities, had behavioral health issues.

And so we employed a model called the University of Pennsylvania Impact Model.

It's a model that engages community health workers, who are people who actually live in those communities,