How technology enables the data sharing essential to high-performing health plans

This is the 2nd blog of a 3-part series “The Power of Three, a New Model for Quality and Risk Adjustment Provider Engagement”

In today’s health care environment, members are demanding better outcomes at a lower cost. It’s that simple. But it hasn’t been so simple for health plans to achieve. Taking preventative action hinges on the provider’s ability to identify high-risk patients in time to prevent a severe and costly event. To date, providers have had difficulty accessing timely data, which would enable them to assess members in a comprehensive way.

A new operating model created by Optum promises to change that. In this model, three core components work together to empower the provider’s quality and risk adjustment performance. And importantly, it works under multiple payer contracts. Part 1 of this series described how provider engagement experts help providers pinpoint at-risk patients and their gaps in care. Let’s next turn our attention to the technology tools that significantly aid in these efforts.

The shared point-of-care platform

Providers need actionable data, aggregated from multiple sources, to improve patient outcomes. The Optum operating model fulfills this need with a technology solution that effectively facilitates data sharing within each provider’s workflow.

For example, a provider engagement expert is notified by the technology when a Medicare Advantage member may be non-adherent to medication, such as insulin for diabetes. The provider engagement expert then contacts the care provider staff. They work together on a shared platform to identify if the member has a history of non-adherence and then determine the best method to support the member’s needs in the future.

This point-of-care platform enables a provider to:

  • Gain a real-time view of patient status, including during critical transitions
  • Close care gaps to meet quality and risk-based performance metrics
  • Readily share actionable data with any plan
  • Use a single access point to report metrics for multiple payers

Supporting the provider

Providers and their patients welcome responsive, proactive care. But providers need more than a handbook to navigate this new dynamic and optimize their access to shared data. To that end, the point-of-care platform is augmented with support services that include virtual training and 24/7 webchat or call center support.

Optum recently announced a partnership with HealthBI. The collaboration allows care providers to access member gaps-in-care information on a shared platform. This helps further drive adoption of a shift to proactive care to cost-effectively improve outcomes. To learn how providers can document and improve these results, look for details in the third and final post in this series on outcomes management.

Learn more about the quality and risk adjustment provider operating model 


About the author:


Scott McFarland, President, HealthBI

HealthBI and Optum have collaborated to help improve Medicare Advantage health plan performance. Scott McFarland leads HealthBI’s health information technology platforms and contact center solutions for providers, “payviders” and payers. He is a nationally recognized health innovator and positive disruptor. Scott’s executive management experience at leading healthcare organizations includes the Hawaii Health Systems Corporation (HHSC), where he served as CEO. At Cleveland Clinic, he served as president of Wellness and Population Health. And at Healthways, he led innovation, product development, and product management.

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