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By Sarah C. Threnhauser

As the health and human service field shifts towards more integrated models with performance-based reimbursement, can executives of provider organizations find a sustainable strategy by retooling the services they have always provided? Or do they need something totally new? I think of this as patching the leaking hull on a boat, versus building a new model entirely. My colleague, Monica E. Oss, wrote about this strategic dilemma in her recent article, Finding Your Next Cash Cow, and spoke to some of the issues in her closing keynote at The 2018 OPEN MINDS Management Best Practices Institute, Reinventing Your Organization: Key Management Best Practices For A Value-Based World.

Debra Smyers, Plan Product President at Sunshine Health

I got another perspective on this question in a recent conversation with one of our featured speakers at last month’s OPEN MINDS Executive Leadership Retreat: Debra Smyers, Plan Product President at Sunshine Health. Sunshine Health, a wholly-owned subsidiary of Centene Corporation, provides health care coverage through Medicaid, the Health Insurance Marketplace, and Medicare.

As Sunshine Health enhances its approach to better serve consumers, Smyers said, the innovative use of technology with a focus on holistic care management and social determinants of health (SDH) is key.

A focus on SDH requires the advanced use of analytics, she said, and building consumer datasets that aren’t just claims data. She explained:

We have a population algorithm we run with multiple variables that lets us dive down and look at which members have which needs that can be supported by care management. This helps us ensure we are optimizing care for our members.

Additionally, Sunshine Health is looking at expanding its use of digital treatment technologies to improve the consumer experience. Sunshine Health is looking for provider organization partners that can improve consumer engagement and access to care, while improving clinical outcomes. Ms. Smyers noted:

We are looking for provider organizations that leverage technology to engage members and address and influence social determinants. Part of that is building strong community relationships and using more telemedicine, to improve access to care. Currently, we contract with providers who deliver telemedicine, and we are looking to identify other providers in our service area, including behavioral health providers, who are doing telemedicine already.

After considering this perspective on leveraging new technology to increase value, the question for provider organization executive teams is: How do you rebuild or develop case management, care management, and utilization management processes to best address these demands? Can you patch the boat? Or do you need to build a new one?

For more on using data to improve your organization’s performance, check out these resources in the OPEN MINDS Industry Resource Library:

  1. Building & Executing Strategy In A Complex Market-A Three-Phase Best Practice Model For Success
  2. Make Your Data ‘Count’
  3. Getting More From Your EHR
  4. Metrics-Based Management For Value-Based Reimbursement
  5. Structuring (& Budgeting For) Analytics
  6. HIE 3.0?
  7. Go Beyond the Risk Score: How Health Plans Can Use Social Determinants Analytics To Improve Member Quality Of Life
  8. Less Pain, More Gain: Leading A Cost-Saving Plan With Provider-Driven Outcomes
  9. Utah Alliance Launching Medicaid Pilots To Address Social Determinants Of Health
  10. Six Policy Domains To Assure Equity In Value-Based Payment Arrangements

For more on new tech and data usage, join my colleague Joseph Naughton-Travers, Senior Associate, OPEN MINDS on October 24 at The 2018 OPEN MINDS Technology & Informatics Institute for his seminar, “How To Make The Right Tech Investments For Your Organization: An OPEN MINDS Executive Seminar To Technology Budgeting & Planning.”

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