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Health Plans

Implementation process should support value-based care success

March 21, 2017
Geneia's implementation process is designed to help our clients and their stakeholders succeed in value-based partnerships in as few as 12 weeks.
Tom Murray

Geneia has a successful track record of helping health plans and their provider partners succeed in value-based care relationships, and we’ve written frequently about those success stories.

To refresh your memory, we’ve shared the stories of a number of health plan leaders who have used our Theon® advanced analytics platform to achieve their organization’s goals for improving the cost and quality of healthcare, including:

  • Val - A health plan leader who trimmed claims cost by two percent
  • Sam - A health plan IT leader who saved $3.1 million by sunsetting legacy software
  • Blair - A Medicare Stars director who increased her plan’s rating to 4.5 stars

We also published a case study about a health plan that improved quality outcomes, utilization trends, and claims costs in its value-based partnerships.

Perhaps it could go without saying that these health plan success stories all begin with a comprehensive and thorough implementation process, but in my 10+ years in the health information technology industry, I’ve learned implementation does not always go as intended. Too often, the process is cheated of sufficient time, resources and leadership, and fails to anticipate the impacts to the people whose work is changed.

At Geneia, our process puts the right emphasis on process, people and technology, and is designed to help our clients and their stakeholders succeed in value-based partnerships and achieve their cost, quality, outcome and engagement goals.

As one of the Geneia implementation leads, I typically work closely with a health plan leader who is directly responsible for the plan’s success in value-based contracts, often the vice president of provider network strategy. In the ideal situation, this person has been very involved in the health plan’s selection of Geneia’s Theon® advanced analytics platform for use by the plan and its value-based partners.

It is quite common for health plans to seek a rapid implementation. After all, they have already come to know the sooner the plan and participating providers begin using the Theon® platform, the sooner they will improve their cost, quality, utilization and outcome trends.

A ‘quick start’ implementation is one of the reasons health plans prefer Geneia’s Theon® solution. Implementation time varies due to the uniqueness of each client, but because it is a cloud-based application, the start of implementation to go-live is at least 50 percent shorter than non-cloud solutions. When we begin our phased implementation process with claims data only, we are able to implement the Theon® platform in as few as 12 weeks.

Health Plans

Geneia Implementation Best Practices

Typically, health plans are choosing the Theon® platform to measure and manage cost, utilization, quality and more within their value-based partnerships, and that means the providers in these partnerships need to find value in any analytics and reporting tool provided by the plan. We have learned health plans that demonstrate the tool to their value-based partners and solicit feedback before making a final decision have an easier time driving provider adoption.

We start with a fundamental and achievable goal that is important to all stakeholders such as gaining new and actionable insights into risk-adjusted cost and utilization within a plan’s value-based relationships.

We create a phased implementation process with meaningful and attainable goals for each phase. For example, typical phase 1 goals include ensuring the following capabilities are deployed, understood and used by all stakeholders:

  • Peer to Peer Benchmarks. Monthly efficiency scores and per-member-per-month cost reports. Compare physician performance in relation to value-based and fee-for-service peers.
  • Cost and Utilization. Provide total and risk-adjusted cost for the value-based partners attributed member population, including insights into the services attributed members use most often.
  • Provide overview of savings opportunities by analyzing cost drivers.
  • Prescribing Pattern. Provide detailed analysis capabilities of provider prescribing patterns from an overall cost perspective to understand generic substitution opportunities.
  • Referral Pattern. Understand efficient use of services and network options that drive high efficiency and value.

Take full advantage of Geneia’s crawl/walk/run approach

We have had much success with iterative or short-phased implementation. It leads to wider and faster adoption among provider partners, and a shorter path to improved cost and quality in value-based relationships. Broadly speaking, our approach includes:

  • Defining goals and targets for improvement
  • Measuring baseline results for cost and utilization after defining shared goals
  • Integrating with existing health plan and provider workflows, and
  • Establishing a path to improving and achieving goals without burdening clinical processes

Our approach is designed to minimize the impact to health plan staff. For example, Geneia data scientists and data analysts are available to perform the necessary data mapping.

  • Prioritize regular communication to key stakeholders throughout the implementation process to effectively manage expectations and ensure acceptance. Moving to the Theon® platform means the health plan and network providers share a single information data set containing clinical and administrative data. This supports the creation and measurement of shared goals within the value-based partnership, ultimately establishing an enhanced level of trust between the health plan and participating providers. 
  • Leverage Geneia’s training resources for health plan staff and value-based provider partners and their office staffs, including scenario-based training specific to business requirements. At Geneia, people train within the Theon® environment rather than relying exclusively on paper and digital manuals. In addition to pre-go-live training, we also provide on-going training to support further adoption of the tool.
  • Meet regularly with your value-based providers and their office staffs in the initial months following implementation, and use those meetings to show them how to use specific functions that will help them achieve their contractual goals, e.g. how to determine how close they are to meeting their breast cancer screening metric and which patients have yet to be screened in this contract year.

The bottom line is that Geneia has created a timely and efficient implementation process that prioritizes quick wins for the health plan and their value-based providers.