The Holy Grail of Population Health Management for Payers and Providers | Geneia

The Holy Grail of Population Health Management for Payers and Providers

November 07, 2016
Mark A. Caron, CHCIO, FACHE / Chief Executive Officer, Geneia


In the words of Gartner, Inc. Research Director Jeff Cribbs,

“Payers understand the value of analytics. They have learned that analytics to identify gaps in care is easy to develop and ubiquitous. Analytics to efficiently and effectively close them is a premium and illusive capability.”

At Geneia, we couldn’t agree more

Closing care gaps efficiently and effectively is as much the Holy Grail in population health management as meaningful patient engagement that leads to sustained behavior change is.

I recently participated in a HealthsystemCIO.com webinar, Learning from Payers about Population Health Management. Cribbs, Howard Underwood, MD, FSA, vice president and actuary enterprise clinical analytics of Health Care Service Corporation (HCSC), the parent company of five Blue Cross and Blue Shield plans, and I discussed the lessons payers have learned about population health PopulationHealthcareMngmntTestPic2management and how they apply to providers, many of whom are just beginning to embrace risk- and value-based contracts.

In short, payers have learned much about population health management that can benefit providers. (To listen to our discussion about the lessons, click here.)

For me, one of the most important lessons I’ve learned in more than 30 years working in healthcare is that payers and providers need each other, each other’s data, each  other’s complementary but different skill sets, and even each other’s resources. Only by leveraging their respective strengths and effectively collaborating will we be able to meet the significant challenges of achieving true member engagement and closing care gaps.

Reasons to be hopeful

I strongly believe today’s advanced analytics solutions like Geneia's Theon® platform have given us reason to be hopeful about succeeding at both challenges.

Let’s return to Jeff Cribb’s quote about using advanced analytics to effectively and efficiently close gaps in care. Some payers are already doing this successfully. They are using a trifecta of best practices, including:

  • Educating and engaging providers,
  • Keeping the member at the center of care, cost and coding, and
  • Just as importantly, providing analytic and technology solutions like the Theon® platform for continuous, complete and accurate coding, which in turn saves providers’ time and enables earlier detection of suspect conditions and co-morbidities to the benefit of the member, the provider and the payer.

The relationship between payer and provider is of utmost importance. Each has a critical role in the successful coding of conditions, detection of coding gaps, and efficient closing of gaps. The right technology facilitates this important collaboration, leading directly to better population outcomes.PopulationHealthMngmntTextInsert1

For example, the Theon® technology platform that’s used by payers and providers creates a quick and simple communication path for providers to complete and submit condition codes and for payers to share real-time, accurate gap information that incorporates clinical and claims data. Increased accuracy in coding means everyone gets a more complete picture of each person’s health and the complexity of their conditions. Shared knowledge leads directly to better care, coordinated services, appropriately higher reimbursement, and ultimately true population health.

We recently published a white paper How Health Plans Can Use Analytics to Close Coding Gaps to Improve Care and Boost Revenue that details the path from “a premium and illusive capability” to reality. I encourage you to download it today.


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