Population healthiness INDEX℠ (PHI, Φ)

For Payers


A Game Changer In Healthcare


Transform Healthcare - Scenario

Situation

Ron, the CEO of one of the leading health plans in his state, wishes there was a better way to manage his business.  He feels a constant squeeze from all directions and is left to react to situations that seem out of his control.

Major employers who form the majority of his member base are demanding cost transparency and control.  Recently, he had to make significant premium reductions to retain customers as the fierce competition is driving customer decision making purely on cost while other value adding services built with huge internal investments to improve member health are being ignored.  His challenges include:


  • Network payment models are a mess and he feels less in control of his costs.  
  • Large systems are demanding and getting away with better payment terms and there is myriad of payment structures to manage his current provider network.
  • With increasing complexity of payment models, the transactional, fee for service model is more opaque, making cost management challenging.
  • Efforts to apply value-based payment models touted in the industry have been failure as there was no common measure and many ways to game the system.
  • Large national plans are aggressively encroaching on his market and customers with huge marketing budgets, competitive pricing and provider networks.
  • Increasing complexity in product design is resulting into greater member confusion and complaints.
  • Efforts to engage members and have them manage their health and vitality proactively are stagnant, questioning the validity of significant investments made in member engagement and wellness efforts.


 Insight

The lack of a holistic SINGLE measure is the core to Ron’s and his industry’s problems.  The measurement of the Whole Person with both clinical and non-clinical dimensions and factors would provide an elegantly simple yet powerful tool to cut through the complexity and waste perpetuated by the current volume driven healthcare system.

 PHI (Φ) Difference

Understanding the Whole Person view with ΦScore℠ - the SINGLE number that includes both clinical and non-clinical dimensions and factors influencing employee health, vitality, productivity and cost would help Ron and his peers dramatically simplify their business models and transform healthcare by impacting major stakeholders:

 Customers 

  • Significantly reduce cost and increase productivity in real dollars for the employers using fine-tuned population based strategies.
  • Forge deeper collaborative relationships with customers by leveraging and optimizing joint resources.
  • Build sustaining partnerships with customers by delivering long-term superior value.
  • Change narrative from cost to productivity, health, vitality and innovation.


 Members

  •  Build deeper and sustaining engagement with the members.


 Physicians 

  • Offer a true performance based payment model.
  • Share gains and improve population healthiness.
  • Deliver reimbursements faster.
  • Help improve quality of care.
  • Provide outstanding service and experience.

Hospitals/Systems

  • Offer a true performance based payment model.
  • Share gains and deliver reimbursements faster through a simplified reimbursement system.
  • Help improve quality of care.
  • Help reduce relapses, readmissions and reworks.
  • Collaborate for targeted population based strategies for better outcomes.
  • Assess and provide faster feedback on the effectiveness of new and existing care delivery models, systems, technologies etc.
  • Provide outstanding service and experience.


 Pharmaceuticals & Bio-techs

  • Provide faster and more effective feedback on the drug efficacy.
  • Build collaborative models to address critical compliance and cost issues.
  • Transform drug development by offering real life data for faster, precise, less expensive and effective therapies.


 Ancillary Service Providers

  • Provide a clear basis for measuring the effectiveness of services, devices, delivery systems etc.
  • Offer real life data for research, development and innovation in product and services.


 Researchers

  •  Real life data on finely-tuned populations for insight and innovation in helping develop and deliver the next generation of medicine.



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