HealthFocus is a population health platform that supports physician and physician hospital organizations through clinical quality measures, identification of patient and population risk, tracking and analysis of patient cost of care, and providing a data interface for engaging with community resources to support care management programs.
Shifting from a fee-for-service model to value-based reimbursement can present a significant challenge for providers as healthcare systems must modify workflows to manage the care of an entire population. Organizations focused on value-based care try hard to provide the best for their patients, increase their HEDIS metrics, and look to bridge gaps in care that individual payers are interested in.
Health Focus can facilitate a shift to value-based care by using aggregated data to highlight health concerns and identify ways providers can use resources to overcome barriers, automate workflows and lessen the burden on providers.
Navigating the presented challenges requires a registry of patients, knowing which services have and have not yet been provided, and which services are covered by the payer. This involves the integration of various sources of data, intelligence to understand what to do with those data sources, and a clear, concise, compelling, and consistent dashboard that the PO staff can access. If reconciliation is required with the payer organization, the solution must be able first to determine that a conflict exists and then provide irrefutable justification that the service that should have been paid for was provided to the patient. HealthFocus does this for POs of all sizes and POs with single or multiple payers.
HealthFocus works with organizations who have an interest in the value-based care business. This includes physician organizations, independent physician associations, accountable care organizations, health systems and health plans. The specific needs of each of these entities may vary slightly, but HealthFocus has developed a solution which serves these multiple needs.
