Roji Health Intelligence CEO Discusses Data-Driven Solutions for Value-Based Healthcare

Theresa Hush, CEO and founder of Roji Health Intelligence, brings decades of experience from government, payer, and provider organizations to address healthcare's most pressing challenges. Her company focuses on helping health systems, ACOs, and physician groups succeed in value-based care through technology and strategies that prioritize patient outcomes. Hush's background includes directing Illinois Medicaid, leading strategic transformation at Blue Cross Blue Shield of Illinois, and building clinically integrated hospital networks, giving her unique insight into how payment systems and data can optimize healthcare while controlling costs.

One of the most significant challenges healthcare organizations face today is that providers are overwhelmed by documentation and patient volume while lacking access to meaningful performance data. Hush explains that providers often receive scores without context or support for improvement programs, making them feel like judgments rather than tools for enhancement. While some ACOs are making gains in primary care through population health programs, specialty care presents different challenges as value-based care models for treatments and procedures are just emerging. The shift toward putting providers at financial risk represents a particularly new development for specialists and hospitals.

Roji Health Intelligence addresses these challenges by aggregating data from various sources, including electronic health records, and creating technology that helps providers visualize and resolve issues affecting patient outcomes and costs. The company's approach includes using comparative episodes of care to evaluate both costs and quality outcomes for every type of patient care. This methodology allows healthcare organizations to track chronic conditions and measure improvement trends over time, highlighting disease progression and interventions used for high-risk patients. When patients miss appointments or fail to follow through on care plans, this information becomes visible in the data, enabling the creation of registries to identify patients needing clinical plan adjustments.

For specialists, Roji facilitates similar analytics for surgeries, specialty conditions, and high-cost treatments like chemotherapy. The company captures surgical procedure costs within episodes along with ancillary costs, revealing cost variations and their drivers. Since most cost fluctuations result from complications, this data makes a compelling case for developing plans to avoid or reduce complications, particularly those stemming from unknown risk factors before surgery. This process requires arrangements ensuring complete patient records, communication with primary care physicians, and thorough patient risk assessments prior to procedures, including pre-treatment of known problems that could cause complications.

The collaborative nature of Roji's approach builds trust and engagement among healthcare teams. When teams see the connection between their actions, patient results, and financial outcomes, they become more willing to embrace change. Rather than focusing on cost-cutting measures that provide only one-time savings, Roji helps providers identify areas where improving care actually saves money, such as preventing complications, managing chronic conditions effectively, and directing resources toward patients needing the most attention. By bringing together all pieces of patient information, providers can see the complete picture, spot trends and risks early, and take action before problems escalate into widespread cost increases.

Roji's data integration approach combines claims, medical records, and registry information to create comprehensive patient stories, enabling providers to track health changes over time, review care received, and identify potential gaps. The company looks for patterns and trends, highlighting successful practices for replication and identifying risks for early intervention. The goal extends beyond annual performance measurement to providing real-time information that providers can use to improve patient status immediately. This approach helps organizations pinpoint care gaps and identify affected patients, leading to strategies combining practical support with shared medical decision-making between patients and physicians.

Regarding artificial intelligence in healthcare, Hush acknowledges its potential but emphasizes the importance of accurate data. AI can effectively spot risks earlier, identify non-obvious patterns, and help personalize patient care when fed complete and unbiased information. Roji anticipates using AI to build episode models more quickly and capture additional insights, though Hush notes it may take a year or more for data to become complete enough to produce completely reliable results. The company expects AI to become a powerful tool for identifying risks earlier and testing intervention efficacy.

Hush envisions a future where payment systems, care delivery, and patients work toward the common goal of better health outcomes. In this vision, patients have clear information to make care choices, and providers have the tools and incentives to deliver optimal care without driving up costs. Roji's role involves bridging gaps in the fragmented healthcare ecosystem, enabling providers across different systems, specialties, and care facilities to participate in value-based care, understand their patient populations, improve results, and demonstrate value to both patients and payers. By aligning better care with sustainable costs, the company works toward building a healthcare system that benefits everyone involved.