CIOTechOutlook >> Magazine >> June - 2013 issue

ZeOmega: Lowering the Cost of Healthcare in the United States

By

The U.S. healthcare system has arrived at a crossroad of competing priorities—priorities representing issues of unprecedented magnitude. Passed in 2010, the Affordable Care Act (ACA) will add an additional 11 million men, women and children to Medicaid or the Children's Health Insurance Program when it is fully implemented in 2016, according to estimates from the Congressional Budget Office. At the same time, nearly 25 million people will begin to receive healthcare coverage through insurance exchanges administered by individual states or the federal government.

Many of these millions of newly insured will be battling chronic conditions such as diabetes, high blood pressure and obesity, conditions that can be particularly costly to manage if patients aren't fully engaged in their care. Studies indicate that 5 percent of the population accounts for one-half of all healthcare spending in the U.S. and that individuals with multiple chronic conditions will cost seven times as much in healthcare expenditures as a patient with just one chronic condition.

The challenge facing the U.S. medical community is not just helping people to stay healthy in the first place; it's also combatting the high cost to care those who do fall ill. Healthcare spending in the U.S. accounts for 17 percent of the gross domestic product, a figure projected to grow to 20 percent by 2020, according to National Health Expenditure projections.
Recognizing both the desire for a healthy population and the need to reduce the high cost of care, the Institute of Healthcare Improvement developed what it calls the Triple Aim, which seeks to improve not only individual health outcomes but also outcomes in general, while lowering the cost of care. The concept was quickly embraced by the Centers for Medicare and Medicaid Services (CMS), insurance companies, healthcare systems, physician groups and others as a model to tackle the seemingly conflicting goals of improving population health and saving money.

Software to manage population health

Against this backdrop of incredible change, ZeOmega has come into its own as a provider of population healthcare management software and services. Founded in 2001 and based in the Dallas suburb of Frisco, Texas, with operations in Bangalore, ZeOmega provides a powerful platform for health plans, providers and value-based care organizations. In 2012, the company's revenue increased by 60 percent over the previous year, following a similarly impressive 66 percent increase in 2011.
"Our primary mission is to deliver proven healthcare management software solutions to help our clients enhance the value of healthcare and keep a tight rein on costs," says Sathya "Sam" Rangaswamy, Founder and CEO, ZeOmega. "The U.S. healthcare market has been our proving ground. As public and private payers struggle to keep down the rising cost of care, ZeOmega's industry-leading integrated care management solution, Jiva™, is serving dozens of federal and commercial payers and millions of covered lives."

Jiva does more than help care managers track individuals and their treatments. It transforms traditional episodic-based care into an ongoing and collaborative healthcare model that benefits the patient, the provider and the payer. ZeOmega's population healthcare platform enables integrated and shared care management through electronic health record-enabled care plans, point-of-care tools, decision support, user-configurable workflows and portal services. The innovative platform is designed to integrate workflow, analytics, content and communication capabilities.

"We shift the focus from just looking at data and taking isolated and manual actions, to sharing information and taking cooperative, meaningful steps in an automated manner," adds Rangaswamy. "As a result, we help health plans improve the quality and cost of healthcare, streamline operations and facilitate communication among stakeholders."

ZeOmega offers an end-to-end solution, including implementation, custom software development, integration and data migration services, remote administration, enterprise software hosting and administration, end-user training and customer support.

While the ACA expands the number of Americans with insurance, earlier legislation in the form the Health Information Technology for Economic and Clinical Health (HITECH) Act compels healthcare providers to adopt meaningful technology that can be used to track patients and their conditions, reduce the incidence of duplicated tests and procedures, reduce medication errors, and allow providers to share information and collaborate on care.

The adoption of so-called health information exchanges (HIE) that allow this collaboration has accelerated over the past few years, fueling tremendous growth for ZeOmega. The Department of Health and Human Services has approved more than 250 accountable care organizations (ACOs), whose members comprise 8 percent of the U.S. Medicare population. That doesn't count private ACOs, where health plans team up with providers and typically large employers in a local market to coordinate and manage care for that population.
ACOs and related care models such as patient-centered medical homes seek to break the fee-for-service model in the U.S., where providers are paid for the services they perform rather than the outcomes of those services. In their current form, participants in a typical ACO share in any savings that are generated. But other models under consideration or in the pilot phase shift the burden of cost containment to the provider, with health plans or employers paying a set dollar amount to care for a certain population. Manage the health of this population effectively and providers benefit. Do a poor job, and providers are on the hook for any losses.

Phenomenal Growth for Company

In a 90-day period last year, ZeOmega launched five clients on the Jiva platform that manage anywhere from 200,000 to three million lives. Clients include organizations that provide integrated benefits management services and aggregate care management services for self-insured employers, Quality Improvement Organizations (QIOs), managed Medicaid health plans, Integrated Delivery Networks (IDNs), and small and large health plans including Blue Cross Blue Shield plans with commercial and Medicare Advantage plans covering over 20 million lives.

ZeOmega has been honored with several high-profile awards that acknowledge the company's industry reputation, flexible deployment options, company growth strategies and superior offerings. ZeOmega was named by IDC Marketscape as a major player in care management in its "U.S. Care Management Solutions for Healthcare Payers 2012 Vendor Assessment." Jiva was proclaimed the most advanced in the industry in terms of care management capabilities, with its ability to help health plans position themselves strategically to address emerging needs in population healthcare management.
ZeOmega was also named one of the fastest-growing companies in its North Texas home, ranking 13 on the 2012 Fast Tech list of top 35 companies by growth, an impressive feat, given the high number of technology companies in the Dallas area. This marks ZeOmega's second consecutive appearance on this list. The company also ranked 287 on Deloitte's 2012 Technology Fast 500, a compilation of the fastest-growing companies in North America. The ranking recognizes ZeOmega's 254 percent revenue growth from 2007 to 2011.

"Awards provide a nice snapshot of where the company has been, but we remain firmly focused on our future growth," says Rangaswamy, noting that revenues are being reinvested in product development to meet the emerging requirements of healthcare reform and accountable care.
In fact, ZeOmega has invested significantly in expanding the company infrastructure during this period to support the growing client base. The privately held ZeOmega received Series A funding to support increased hiring, product investments and marketing. The company received funding from Sandbox Industries and BlueCross BlueShield Venture Partners LP. This expansion includes the addition of Christopher Mathews, MD, as Senior Vice President & Chief Medical Officer. Christopher, who joined ZeOmega last year, is a board-certified internist and physician executive with more than 25 years' experience in healthcare delivery systems and managed care.

Building Toward the Future

On The Deck

CXO Insights

Data Science & Machine Learning In Fintech

By Jainendra Kumar, Head - Global Delivery Center-India & Senior Director Product Development Software, Diebold NixDorf

A Short Guide for Data-driven and...

By Kapil Makhija, VP - Technology Cloud Business, Oracle India

Facebook