In October 2019, Medecision acquired health delivery system transformation pioneer GSI Health. GSI Health has been an innovator in driving change in the industry since 2003. The GSI Health population health platform, HealthCoordinator, will become part of Medecision’s Aerial solution.
By LeRoy Jones, Senior Vice President, Care Delivery System Transformation, Medecision
Sustaining effective, value-based care across a broad base of programs is challenging. Organizations at risk in the healthcare payment system are using Medecision’s Aerial solution to manage clinical and financial risk and compliance and to help them define, build and sustain efficiencies through more effective population health management. Medecision clients engage in the types of health management that align with the value-based care movement and the changing risk balance felt by payers, providers and consumers.
As the industry evolves, the value-based care model is expanding to incorporate more patient segments and services. With risk shifting to providers, Medecision saw an opportunity to empower the provider community in a different way—by delivering the same caliber of tools used for maximizing revenue and improving utilization management to providers so they can manage patient populations more directly and on the ground.
The acquisition of GSI Health has extended Medecision’s reach into the community and the world of care delivery to empower non-traditional providers such as behavioral health, human services and community-based organizations. This creates a new level of versatility to address a wider range of client needs, including social determinants of health (SDOH). GSI Health brings a decade of experience and innovative technology for exactly those types of use cases, enabling Medecision to offer solutions for MCO partners and payers along the front line of the care delivery system that is administered by non-medical providers.
True value-based care requires more than just features and functions—it requires a fundamental change of both the care delivery model and business model for an organization, with an integration of systems beyond what other solutions can accomplish. Medecision’s integrated health management solutions enable objectives to be harmonized across segments in ways that cannot be achieved with point solutions or electronic health records.
Expanding the flow of information to include rich claims information—available from the payer network, SDOH data, assessment information, clinical data, and treatment and intervention information from on-the-ground providers—will do more than simply enrich both payer and provider worlds with new types of data. An integrated system cuts down on the sprawl of point solutions, minimizing seams between the types of work being done. It also creates a new level of care delivery system efficiency and yields improvements in utilization, appropriate levels of care, post-hospitalization follow-up and more. It also enables richer analytics that can drive more insights about the member and patient populations to make programs more effective and holistic. This enables value-based contracts to set the appropriate balance of risk and reward and for provider networks to distribute reimbursement services in a fair and balanced manner.
As increasingly robust models go outside the four walls of an individual organization, providers are brought into the same world with payers and MCOs to create a hybrid “payvider” care model. In this model, payers and providers collaborate to achieve their joint goals—whether the provider takes both roles or partners with their payers to more effectively manage populations. Healthcare organizations should seek partners who understand the complexity of value-based care, have the tools to provide advanced data analytics, and have experience integrating across the continuum of care.