Ayin Health’s proprietary IT helps health plans with SDOH

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Ayin Health Solutions, a startup of Providence St. Joseph Health, is quickly out of the blocks, now managing 1 million lives as the network’s population health management subsidiary.

It has been nearly six months since Renton, Wash.-based Providence St. Joseph Health—the nation’s third largest health system—launched Ayin. Now, the new company is on target to serve some 30 million within its first year, says Rhonda Medows, MD, president of population health management at the PSJH and CEO of Ayin.

PSJH, with its affiliated Providence Health Plan, launched Ayin because “as a provider-sponsored health plan, we know the pain health plans face,” Medows says, adding, “Ayin’s proprietary IT platform is the sweet sauce that makes this work.”

Based in Portland, Ore., Ayin provides pharmacy benefits management service, risk evaluation tools, comprehensive reporting and employee health benefits services.

Ayin has a dozen service items that it can provide in any combination to its clients. “We focus on what is proven, what is core,” Medows says. “We know what works because we’ve been doing this already.”

Onboarding clients begins by asking what a health plan already knows about its populations and then matching Ayin’s tools to fill any gaps, Medows explains. “It goes beyond claims processing and analysis,” she says. Social determinant information is added into the mix. Ayin can incorporate the data into the health plan’s strategy itself. “We have taken what we know, and we work with clinicians,” the community and social determinants of health (SDOH), she says.

Care management has evolved beyond a particular disease state, to include where a person lives and other SDOH, Medows says. Providence has a long history of working with Medicaid populations and has already figured out solutions to some of the SDOH problems, such as home care or transportation. “It doesn’t take higher math to figure out what it takes to stem the consequences of a patient not having transportation,” she says. “For the at-risk and high-risk populations, you have to go even further and find a way to prevent the problem in the first place.”

Most of the company’s clients are payers outside of the Providence delivery system, and include both regional and national-level payers, Medows says. Other clients are employers and large health systems with their own provider-sponsored plans.

“Payers usually want to know that there’s some predictability to medical costs,” Medows says. “They want more efficient operations, strong but selective networks, and they need help figuring out who should be in the networks.” They also want help predicting future needs.

The reason Ayin has the edge is it has been doing this a long time, helping larger insurers, Medows notes. The PSJH launch of Ayin spread by word of mouth, even before it became incorporated, she says.

Medows says Ayin is building on its knowledge as the company grows. That knowledge began as Providence Health Plan learned from its provider system, and vice versa. The original core knowledge led to mentoring other health plans, and eventually to the launch of Ayin. Now the knowledge base is continuing to grow, as Ayin talks with health plans across the country. “We learn from everywhere we go,” she says. “When listening to the team with the initial client visit, we can see them getting excited, and already problem-solving. This gives us a chance to collaborate.”

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