Roji Health Intelligence Addresses Value-Based Care Challenges Through Data Integration and Analytics

Theresa Hush, CEO and founder of Roji Health Intelligence, brings decades of healthcare leadership experience to addressing one of the industry's most pressing challenges: implementing effective value-based care models that improve patient outcomes while controlling costs. Her background spanning government, payer, and provider organizations has given her unique insight into how payment systems and operations often drive patient care decisions when clinical data isn't properly aggregated to reveal the relationship between quality and cost.

One of the biggest challenges healthcare organizations face today is that providers are overwhelmed by documentation and patient volume, often lacking access to meaningful performance data that could help them improve care. While some Accountable Care Organizations are making gains with population health programs in primary care, specialty care presents different challenges as value-based models for treatments and procedures are just emerging. The shift toward putting providers at financial risk represents a significant change for specialists and hospitals.

Roji Health Intelligence addresses these challenges by aggregating data from various electronic health record systems and creating technology that helps providers visualize and resolve issues affecting patient outcomes and costs. The company uses comparative episodes of care to evaluate both costs and quality outcomes for every type of patient care. This approach allows providers to track improvement trends over time, highlighting disease progression and interventions used for high-risk patients.

For specialists, Roji facilitates analytics for surgeries, specialty conditions, and high-cost treatments like chemotherapy. The system captures surgical procedure costs along with ancillary expenses, showing cost variations and identifying what drives costs upward. Since complications often cause cost fluctuations, this data makes a clear case for creating plans to avoid or reduce complications through better patient risk assessment, complete medical records, and improved communication among care team members.

The process is fundamentally collaborative, building trust and engagement among healthcare teams. When providers see the connection between their actions, patient results, and financial outcomes, they become more willing to embrace change. Rather than focusing on short-term cost-cutting measures that reduce services or staff, Roji helps organizations find opportunities where improving care actually saves money through complication prevention, chronic condition management, and targeted resource allocation for patients needing the most attention.

Roji's data integration approach brings together claims, medical records, and registry information to create complete patient stories, enabling providers to see health changes over time, care received, and potential gaps. The goal extends beyond annual performance measurement to providing real-time information that clinicians can use to improve patient status immediately. The company also helps organizations identify care gaps and patients at risk of falling through cracks due to fragmented care or barriers to treatment adherence.

Looking toward the future, Hush envisions AI playing a meaningful role in healthcare when fed accurate data, potentially helping to spot risks sooner and identify non-obvious patterns. At Roji, AI may eventually help build episode models more quickly and capture deeper insights, though complete data reliability may take another year or more to achieve. The ultimate vision involves creating a healthcare system where payment systems, care delivery, and patients all work toward the same goal of better health outcomes through aligned incentives and comprehensive data integration.