SOLUTIONS Overview | For Providers | For Payers

Enabling the Optimization of Risk Contracts

Gennius provides a software platform that supports a robust, fact-based performance improvement framework that allows customers to drive higher healthcare quality while reducing costs:

1. Define Metrics and Objectives

The platform structures measurement algorithms as objects within the matrix.  Measures can be created, adapted, and applied as necessary to understand and characterize performance.  Measures come from two sources:

  • Industry-standard Performance Measures:Gennius maintains more than 400 commonly used Evidence-Based Guideline measures within the system.  These measures are regularly updated with the latest specifications and are available out of the box for all clients.  Measure sets include: HEDIS, Meaningful Use, PQRI, and Hospital Compare. 

  • Contract-specific or Client-specific Measures: These measures might be unique adaptations of industry standard measures, may be specified as part of a contract between a provider and a payer, or may be unique metrics that are important to track for a specific client.  Gennius configures measures for each client and maintains them as a client-specific portfolio. 

    Measures are configured using a decision tree structure that makes measure construction a task that can be executed by analysts without the programming process typically required in other systems. 

2. Define Performance Goals

Payment structures are increasingly requiring that providers simultaneously are managing to specific quality measure goals and to budgets that encompass the care for a population or a patient.  Gennius incorporates the contractual requirements from each provider-payer contract into the system so that the goals can be associated directly with the relevant covered populations and care events. 

Analysis of care can then be compared against goals set by contract or by other benchmarks that management determines to be appropriate (peer averages, prior period performance, national benchmarks, etc.)

3. Evaluate and Score Performance

As Care events are translated and loaded into the system, they are evaluated against the structured measurement algorithms in the system. A series of true/false answers about each patient is built and stored as a result of these evaluations. These evaluations become the most basic unit of analysis and can be aggregated up to view performance results at a patient, population, physician, care team or institutional level.  Results can also be stratified to look at sub-populations by disease groups, by risk score, by cost, or by payer contract. 

4. Prioritize Performance Improvement

Performance management is ultimately about taking action. The Gennius platform provides a rich interface for reviewing results, understanding performance and then zeroing in on the actions that will drive improvement. Results can be ranked , sorted, and filtered on any dimension. Trends can be observed and outliers identified. Typically, clients are able to drive performance improvement with two types of actions:

  • Patient level interventions—The unit of improvement in healthcare is the patient.  The Gennius system identifies patients who are in need of specific care interventions and generates both patient synopsis reports and patient-specific action plans that can guide care planning.  These plans define the actions that will bring a patient into compliance with evidence-based guidelines, change utilization and cost patterns, and ultimately improve outcomes. 

  • Physician pattern interventions—Across patients, physicians make care decisions that have significant variation.   Compliance with Evidence Based Guidelines, utilization of certain tests, procedures or drugs, and referral patterns each drive overall system performance on both cost and quality measures.  The Gennius system profiles physician performance across these dimensions, enabling management to identify behaviors that need to be monitored and intervention actions that need to be prioritized.