Case Study: CHI

How a Leading Health System Grew Their Subscription Care Program and Reduced Time Spent on Manual Invoicing by 75% with Accresa


CHI Health is based in Omaha, Nebraska with 14 hospitals, two stand-alone behavioral health facilities, more than 150 employed physician practice locations, and more than 12,000 employees in Nebraska and southwestern Iowa. 

Currently, CHI has a comprehensive subscription-based primary care program supporting 5,000 employees, small groups and individual members. 

CHI implemented the subscription care model in 2018 with the intent to primarily serve its own employee population in the Midwest market, and saw the model as a way to see savings within its own employee and dependent population.


Approximately one year into the model, CHI found as outside membership was increasing (members that were not employees), that they did not have an efficient way of collecting membership fees, selection of the provider, and accurate tracking of panel sizes.  

This helped CHI realize that hospital systems moving forward will need to implement new strategies, ones not rooted in historic payment methodologies. 

In 2019, CHI began to collaborate with Accresa, utilizing its platform to help accomplish these important efficiencies. Accresa brought connections with other organizations and resulted in an organization in this market utilizing our subscription care services.

This need for evolution is also due to new market entrants such as Walmart, Whole Foods, Optum, and others creating onsite clinics that threaten market share. Local health systems have a distinct advantage with existing primary care networks, brand awareness, and existing patient volumes.


Early on in their program, CHI realized they needed to automate the management of eligibility, enrollment, network and financial management of their program. This would create a seamless experience from all sides, which is critical to adoption. 

Employee concerns were more around understanding the model. It is a change of mindset and culture to contact your primary care provider for non-urgent, but acute needs versus just heading to an urgent care,” said April Butterfield, Market Director, CHI Health Clinic. 

CHI works hard continually to educate the employee base about the subscription care model. 

Once an employee fully understands and experiences this model they absolutely love it! As more employees understand the model they spread it to their peers. We continue to increase year over year the number of employees that opt for the benefit product that revolves around this model,” she said.

Year by year, the steps CHI took to implement the program were:

2018: Initiation of subscription-based primary care program

  • 1 location in the Omaha Market with 1 physician and 1 ARNP
  • Approximately 1,200 members

2019: Add 2 locations

  • 1 in the Omaha Market and 1 in the Lincoln Market
  • Add an additional 2 MDs and 1 ARNP
  • Approximately 2,600 members

2020: Add 3 locations, introduce the hybrid subscription care model, established relationship with Accresa

  • 1 in the Council Bluffs, IA market, 1 in Grand Island, NE and 1 in Kearney, NE
  • Add an additional 2 MDs, 1 ARNP & 1 PA-C
  • Approximately 4,600 members


I feel very blessed to work for a very forward thinking healthcare organization that at the heart of decisions made is what is best for our patients and communities,” said Butterfield. “This type of primary care model is what is best for our employees, patients, and communities” 

  • Started in 2018 with 1 location, 1 physician and 1 ARNP, and in 2021 have 6 locations and 10 providers
  • 3 years into the model, CHI continues to see a total cost of care that is lower than employees that are within the PPO plan, along with superior quality and service metrics.
  • Once Accresa was implemented, CHI was able to reduce the time they were spending each month producing manual invoices and following up with members for payment by 75%
  • One-year post implementation with Accresa, all external groups and individual members enrolled.
  • CHI has cultivated several hundred new members through a new direct to individual marketing channel.
  • CHI has a single platform to manage all future subscription based, primary care contractual arrangements regardless of size and complexity all supported and maintained on their unique yet connected instance of Accresa.

This model has aided our employee group to move more into a value based world where the providers are able to develop meaningful relationships that have led to healthier employees. Healthier employees has and will lead to a reduction in our overall healthcare spend on our employees,” said Butterfield.

Employee Stats

83% of employees in the subscription care plan saw their provider at least once during 2020 as compared to an average of 67% for employees in our other two medical plans offered

Total Cost of Care PMPM (risk adjusted data) was the lowest of the three plans offered to their employees

    • 12% lower than those employees and dependents on the high deductible plan
    • 24% lower than those employees and dependents on our PPO plan

Inpatient PMPM (risk adjusted data) was the lowest of the three plans offered to their employees

    • 20% lower than those employees and dependents on the high deductible plan
    • 33% lower than those employees and dependents on the PPO plan

Accresa allowed us to grow and improve our existing subscription care program by automating many of the tasks we were doing manually before. We wouldn’t have been able to scale the program like we have without them. Accresa is a great partner and has allowed us to focus on delivering great care to our patients instead of being bound by administrative tasks,” said Butterfield.

For health systems that are interested in direct to employer contracting, Accresa can provide the technological infrastructure to create an efficient and cost effective direct to employer program. Accresa leverages a large national distribution channel of over 50,000 employers, brokers, and consultants across all 50 states. 

To learn more, contact Accresa today