Simplifying provider value-based care improves engagement, member experience and outcomes
Health Plans

Engaged providers drive higher quality care at lower costs

April 20, 2021
Simplifying value-based care for providers improves engagement and outcomes.
Senior Clinical Transformational Consultant


Four years into a new value-based care initiative, New Jersey’s largest health plan had a problem. Albeit a good one.

Enrollment in the new initiative surged to more than 450,000 members. Large employers and members alike were attracted to its innovative promise of cost-controlled, high-quality care.

To successfully meet demand and sustain growth, the plan knew it must make value-based care easier for its participating providers.

Making the shift from fee-for-service to value-based care can be a struggle for providers who must develop a proactive, preventive medicine mentality and encourage their patients to do the same. The transition is easier with tools offering decision-support, performance tracking and the identification of patients most in need.

The transitions from fee-for-service to value-based care is easier with tools offering decision-support, performance tracking and the identification of patients most in need.

Recognizing this as the need for a population health platform, the plan saw an opportunity to strengthen provider engagement to improve health outcomes and increase member satisfaction.

For powerful AI-driven data analytics at the population and individual patient levels, the plan chose to collaborate with Geneia. By applying data analytics, patients at high-risk are identified and categorized; and associated future costs are easily understood.

With access to this information, providers know which patients to focus on. This, in turn leads to higher quality care at lower costs, enabling the plan and its provider partners to grow, measure and continue to improve the performance and shared savings of the popular value-based initiative.

Horizon case study value-based car performance and shared savings

Download the case study, Simplifying value-based care with the Theon® Platform, to learn more.