Fragmentation is the disease. Consolidation is the precondition.
Before automation, before outreach, before anything else works, health plans need a unified view of the member. Not a better spreadsheet or a smarter query — an actual single source of truth that pulls medical claims, pharmacy records, facility data, and real-time HIE and SDOH feeds into one coherent picture.
This sounds obvious. It's also, for most plans, genuinely hard to achieve — precisely because the vendor landscape has evolved in layers, with each platform solving one piece of the puzzle in isolation. Adam's point is that until that consolidation problem is solved, everything downstream suffers. Clinical teams make decisions on incomplete information. Outreach gets triggered on stale data. And quality metrics reflect the fragmentation of the system rather than the actual health needs of the population.
From fragmentation to action
Once the data problem is addressed, two more things have to work. The rules engine needs to move beyond simple numerator/denominator logic — identifying, for instance, members who are medication non-adherent and lack a current A1c on file, rather than flagging those as separate issues with separate workflows. And the outreach itself needs to happen automatically: EHR messaging to providers, AI-assisted calls and texts to members, triggered the moment the data indicates a need rather than whenever a staff member gets to it.
The practical demonstration in the webinar involves a diabetic care gap sequence — gap identification, home test kit shipment, lab result tracking, member incentive — completed end-to-end without a phone call or fax from a staff member. The estimated impact is roughly $300 PMPM for diabetic members. The broader implication is more important than any single number: when outreach is automated and data is unified, quality teams can stop managing process and start managing strategy.
