Health Systems / Health Plans

There is no single agreed-upon definition of a healthcare system; however, it can be broadly understood as an organization of people, institutions, and resources devoted to meeting the health needs of target populations.

The World Health Organization (WHO) identifies healthcare systems’ goals as good health for the citizens, responsiveness to the expectations of the population, and fair means of funding operations. Progress towards them depends on how systems carry out four vital functions: provision of health care services, resource generation, financing, and stewardship.[4] They have also been described in the United States as “the five C’s”: Cost, Coverage, Consistency, Complexity, and Chronic Illness.[5] Health system – Wikipedia.

A health plan is a type of insurance that provides or pays for medical care1234. It can be public or private, individual or group, and vary in the scope and level of coverage24. Some health plans are subject to State insurance regulation, while others are not5.

How HealthFocus Supports Health Systems and Plans

Health system – vital functions

Cost: HealthFocus cleans, condenses, and categorizes insurance claims to highlight the cost of patient care. Risk-adjusted allocation allows for continuous review of targets and categorical expenses. HealthFocus allows you to review financial reports for all your insurance products in one location and identify leakage, high-cost facilities, and other opportunities to reduce the cost of care.

Provision of resources: HealthFocus helps highlight opportunities for allocating resources to programs and interventions that impact health outcomes on a population level.

Consistency: HealthFocus provides consolidated insights within an actionable time frame using a format that is easy to understand. Providing a clear and complete picture of patient care helps reduce administrative burden and allows for more informed, consistent decision-making from the provider.

Chronic illness: HealthFocus helps identify eligible and high-risk patients for proper care management. Risk scores are captured across health systems and calculated within our warehouse. We can also track social needs and internal referrals to community resources.

Health Plan Integration

HealthFocus facilitates the exchange of information between health plans and providers. We work closely with insurance companies and other stakeholders to ensure accurate bi-directional data feeds. HealthFocus directly analyzes claims, membership, risk, diagnosis, and treatment opportunities from insurers. Information gathered from a patient’s medical record can also be securely sent back to incentive programs to close gaps in care.

Michigan Health Information Network
We are proud to support the work of the Michigan Health Information Network. We actively engage in use cases and pilot activities on behalf of all our member organizations. From state-wide ADTs and labs to the PPQC supplemental data exchange, MiHIN is critical in ensuring health information is safely and securely transferred to necessary recipients.