Payer Provider Employer Collaboration and Convergence Improves Lucy's Care | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

Payer Provider Employer Collaboration and Convergence Improves Lucy's Care

February 6, 2018
by Geneia
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Meet Lucy. She's 42 and the mother of two teenagers. A year ago, she was diagnosed with prediabetes.

Supported by her physician and care team, health plan and employer, Lucy is now successfully engaging in her health, adopting a healthier lifestyle and reducing her risk of becoming diabetic. Let me show you how Geneia's Theon® analytics, insights and care management platform makes it easy for them to collaborate and deliver better care to patients like Lucy.

LUCY'S PRIMARY CARE PHYSICIAN

Lucy's primary care physician is Dr. Todd Becker. For the past 10 years, Dr. Becker has been a part of Granite Physicians, a multi-site practice with nearly 250 physicians. The practice has a value-based contract with Allegiant Health that incents Dr. Becker and his colleagues to improve HEDIS® measures such as measuring BMI and ordering fasting blood glucose tests. Two years ago, Granite Physicians was purchased by the Be Well Health System.

As a part of the pre-visit planning, Dr. Becker viewed Lucy's information in the Theon® platform. He saw she was on Allegiant Health's list of members at-risk for metabolic syndrome and ordered the fasting blood glucose test a year ago that showed Lucy, in fact, has metabolic syndrome.

In the year since Lucy's diagnosis, Dr. Becker and his team have used the Theon® platform to monitor her progress on her care plan, including annual measurement of her BMI and nutritional counseling.

PAYER HEDIS® DIRECTOR

Jaime is the HEDIS® director at Allegiant Health Plan. At a population level, Jaime works to cost-effectively improve her plan's HEDIS® performance by simplifying quality measure tracking for network providers including Lucy's physician, Dr. Becker. For the past three years, her plan has focused on closing diabetes-related HEDIS® measures, including testing blood glucose levels.

Three years ago, Allegiant licensed the Theon® platform to, in part, support Jaime's work. Jaime has used the platform to identify subpopulations of members with gaps in care, many of whom also are the plan's rising-risk patients. For example, she reviewed BMI trends to generate lists of members at-risk for or with a metabolic syndrome diagnosis, which were then shared with Allegiant's value-based care practices. Granite Physicians' list from 15 months ago include Lucy.

PAYER POPULATION HEALTH CLINICIAN

Until a year ago, Judy was a disease manager for Lucy's health plan, Allegiant. The plan's increasing emphasis on value-based care means care managers – now called population health clinicians – have an expanded role that includes identifying and engaging rising-risk patients and improving performance on HEDIS® measures in the plan's value-based contracts.

Judy is Lucy's population health clinician. Using the Theon® platform, Judy is able to monitor Lucy's progress on her care plan.

HEALTH SYSTEM QUALITY MANAGER

Janelle is the quality manager for the Be Well Health System. She works directly with the health system's practices including Granite Physicians to help them succeed in their value-based contracts. That means she uses the Theon® platform to monitor the practice's progress towards meeting their HEDIS® quality goals. As the result of her work with Granite Physicians, far fewer patients like Lucy have diabetes-related care gaps, and care gap identification and closure is now better embedded into the patient care workflow.

LUCY'S EMPLOYER

Lucy's employer is Lightning Laser. The vice of human resources, Chase, has been using the Theon® platform for the past three years. His current priority is to identify cohorts of rising-risk employees such as the high percentage of employees with diabetes and an even greater percentage with prediabetes or at-risk for prediabetes. Armed with this information, Chase has been working with Allegiant Health Plan to offer virtual health education and nutritional counseling programs, one of which included Lucy, and semi-annual onsite biometric screenings.
 

For the First Time, Simplified Collaboration and Coordination

Everyone who works in healthcare has always wanted to help Lucy and others like her be one of the 30 percent of prediabetics who do not progress to diabetes. For the first time, all of the people who interact with Lucy and have the opportunity to help her adopt a healthier lifestyle and engage in her health – her physician and his team, the population health clinician and HEDIS® director at her health plan, the quality manager at the health system, and her employer - have a tool that simplifies collaboration and coordination in a way that directly benefits Lucy.

Lucy is fictional and not intended to represent any specific person. This information is provided for illustrative purposes only.

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