The Results Are In: How One Health Plan Succeeds With Value-based Care | Geneia

The Results Are In: How One Health Plan Succeeds With Value-based Care

November 10, 2016
Dawn Milstead, BSN, MBA / Vice President, Clinical Innovation, Geneia


Every analytics company will quickly tell you what they can do for their clients. Today, we’d like to tell you what we’ve done.

Five years ago, one health plan foresaw the shift to value-based care and created one of the country’s first accountable care networks.

The project began with clear, measurable goals:

  1. Increase patient access to timely care
  2. Reduce hospital admissions, readmissions and preventable complications
  3. Promote the use of preventive care and wellness
  4. Improve member, provider, employer, and health plan communication and care coordination
  5. Create stronger ties with physician network

The health plan recognized technology was key to measuring, and therefore improving, the multitude of metrics that comprised each goal. Within three years they implemented Geneia’s advanced analytics solution, the Theon® platform.

Believing strongly in transparency, the health plan offered the Theon® platform to its participating physician practices and employer groups. Giving everyone access to the same data and insights enabled everyone to work together for better health, relationship and financial outcomes.

Fast forward to a recent 12-month reporting period and the physicians within the accountable care arrangements are outperforming their peers across critical metrics.

Consider the following:

  • Readmissions are 8 percent lower for employer group customers and 14.8 percent lower for Medicare.
  • Emergency department visits are 8.4 percent lower for employer group customers and 8.2 percent lower for Medicare.
  • The physicians are exceeding the regional average for Healthcare Effectiveness Data and Information Set (HEDIS) measures.

For the full story on how we helped this health plan client reduce claims expense by approximately 2 percent, download our case study.


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