Glenridge Healthcare Solutions: Payer-Provider Convergence with Data-Driven Analytics

Terry Spoleti, President
The healthcare landscape is rapidly moving from a system of fragmentation to a fully integrated, risk-bearing, coordinated care structure. In this environment, payers and providers must maintain extensive resources and subject matter expertise in an effort to comply, let alone excel in the performancebased landscape. As that transformative change occurs, care co-ordination programs are having a significant impact on the roles of providers and payers, especially collaborating in Medicaid and Medicare- Medicaid dual eligible populations.

Founded in 1997 as a boutique consulting firm, Glenridge Healthcare Solutions is a premier provider of technology-enabled network development and provider engagement solutions to health plans and health systems. They also offer an analytics platform for additional monitoring, network performance, clinical integration, and for better outcome of network engagement.

Glenridge realizes that the integration of analytics and electronic medical record platforms decreases the burden for the payer-andprovider network while increasing quality outcomes. “From a network standpoint, we optimize access, create network category to perform specific promotion of a product, and help to clinically integrate a network into either provider’s system or a healthcare contractor to have providers engaged in a meaningful way so that there are value-based outcomes versus the feefor- service orientation,” says Terry Spoleti, President, Glenridge Healthcare Solutions. The firm’s services include supplying tools and methodologies that perform analytics to drive the network strategy to optimize resourcing and allocation, creating proforma for business plans, and articulating highly interactive and customizable services to the clients.

Glenridge also beefs up its arsenal of services with a proprietary platform WebTrack, a project and data-management tool that inputs, prioritizes, and allocates provider priorities for network development and educates providers with network scorecard to develop strategies. “Integrated with our clients, we can feed into their credentialing and control their management systems to load provider data at different stages of contracting activation,” remarks Terry.

Glenridge was instrumental in the rollout of a PCMH (Patient Centered Medical Home) program with a Health Plan company having a network of 4000-4200 primary care physicians.
The client intended to build a PCMH program and the challenge was not only to engage and develop contact with 80 percent of that network, but also an orientation to value-proposition. Glenridge's expertise in managed care program design, physician practice operations and technology, and provider engagement campaigns enabled the client to achieve its program objectives. In particular, provider engagement was improved, while generating improvements in cost and quality indicators, and primary care network providers were enrolled in the sophisticated PCMH program.

We optimize access, create network category to perform specific promotion of a product, and help to clinically integrate a network into either provider’s system or a healthcare contractor

In another engagement, Glenridge was called on by a regional Health Plan company to assist in a large scale network expansion and provider relations initiative. The need was for better technology tools and project management expertise, enabling the client to analyze and measure effectiveness. Many years of successful network development experience was implemented into developing systems, applications, methodologies which facilitated the client to ‘industrialize’ network builds, and customize analytics and real-time reporting on status and network information.

Looking forward, Glenridge, acquired by WhiteGloves—a leading mobile healthcare provider—intends to help payers and providers improve patient care while containing costs. They also want to enhance the analytics platform to maximize the capabilities for in-depth analysis and advising, and monitoring of clients to ensure care is being well-delivered and outcomes rise up to benchmarks. Alongside, they want to focus on actionable insights to evaluate engagements with clients on all stages, focusing on data and integration. Spoleti concludes: “Network development is the core area of our expertise. We're really refining our offerings around cost, cloud transparency, consumer engagement, and retailization of healthcare, which is where the market is heading to.”

Glenridge Healthcare Solutions

Columbia, MD

Terry Spoleti, President

A boutique consulting firm to regional healthplans and health systems.