Theresa Hush co-founded Roji Health Intelligence in 2002 after decades in leadership roles across government, payer, and provider organizations. Her experience directing Illinois Medicaid, leading strategic transformation of Blue Cross Blue Shield of Illinois regulation, and building clinically integrated hospital networks showed her how payment systems and data could be used to optimize health care and control costs. That perspective drives her commitment to helping health systems, ACOs, and physician groups succeed in value-based care through technology and strategies that put better patient results at the center.

What led you to start Roji Health Intelligence, and how did your background influence the company’s mission?

My career has touched almost every part of healthcare. I’ve been on the government side running Illinois Medicaid, on the payer side with a major insurer, and on the provider side leading joint efforts for an academic hospital system and building clinically integrated networks. No matter where I sat, I saw the same pattern—payment systems and operations often drove patient care because the clinical data was not aggregated to reveal Value, the nexus of patient care quality and cost, at that time. Early Value-Based Care efforts were born around that time, but the IPAs and PHOs then didn’t have any analytics–or any digitized clinical and cost data, in fact.

My experience in the academic health system made me realize that data-driven performance on these two concerns, quality and cost, would be the future of health care. My physician business partner and I formed Roji Health Intelligence out of that fortunate prediction. Our company helps healthcare organizations succeed in Value-Based Care by giving them actionable data and strategies to improve patient outcomes and reduce costs. Our mission is simple: help providers understand the story of their patients’ health and support them in value-based payment models. If you furnish trusted data, they are inspired to improve.

What’s the biggest challenge healthcare organizations face in improving care today and how is Roji helping solve it?

One of the toughest challenges is that providers are drowning in documentation and are pummeled by patient volume. They don’t often see real performance data, nor do they have the opportunity to investigate the “scores” they do see. That can feel like a judgment instead of a tool for improvement, because there is often lack of support for patient improvement programs. Although some ACOs are beginning to make gains by providing population health and patient improvement programs, these exist mostly in the primary care. Specialty care is a different ball game, and Value-Based Care models for specialty treatments and procedures are just beginning. The lynchpin for these efforts has sharply turned to putting providers at financial risk, which is very new for specialists and hospitals.

We do the heavy lifting of aggregating sources of data, like various EHRs, and then create the technology to help them visualize and resolve issues for patient outcomes and cost. One of the most important tools we bring to the table is the use of comparative “episodes of care” to evaluate both costs and quality outcomes for any type of care for every patient. We show these patient episodes for chronic conditions and measure the trend of improvement in their outcomes over time, highlighting progression of disease and any interventions which have–or haven’t–been used for patients in the highest risk categories. If the patient does not come in, or follow through on plans, we see that in the data. Then we create registries to identify patients for their review for a change in the clinical plan.

For specialists, we facilitate similar analytics for surgeries, specialty conditions, and high cost treatments like chemotherapy. We capture surgical procedure costs in episodes with their ancillary costs and show the cost variation in each procedure, together with what is driving the cost up. Because most of the time these cost fluctuations are caused by complications, it makes a very clear case for creating plans to avoid or reduce complications, especially those which are created by unknown risk factors prior to surgery. It means arrangements to ensure full patient records, conversations with primary care physicians, and especially a good patient risk assessment prior to surgery, with pre-treatment of known problems that can cause complications. It is also clear through this process that the burden cannot involve more than one practitioner, for example the surgeon. It must include the hospital, the surgeon, anesthesiologist and other parts of the care team, as well as the primary care physician. And there must be technology to support communication between all of that team, regardless of whether they are in the same health system.

The process is collaborative, so we build trust and get people engaged. Once teams see the link between what they do, the results for patients, and the financial outcomes, they’re much more willing to take on change.

How is Roji helping providers deliver better care while managing rising costs and limited resources?

It’s tempting for organizations to try to control costs by cutting services or staff, but that’s not a long-term solution. Those are one-time savings and do nothing to meet the goal of Value-Based Care, which is to reduce the total cost of care. Our focus is on helping providers find the spots where improving care saves money, like preventing complications, keeping chronic conditions under control, and focusing resources on patients who need the most attention.

We bring together all the different pieces of patient information so providers can see the full picture. That makes it easier to spot trends and risks early, and to act before problems turn into cost increases across the board. We also work alongside the organization to make sure these insights turn into practical steps that fit their workflow. The end result is care that’s better for patients and more sustainable financially.

How do you use data to help healthcare organizations make smarter decisions for their patients?

We start by pulling together all the data, including claims, medical records and registry information, into one place so it tells a complete story about each patient. That means providers can see how a patient’s health has changed over time, what care they’ve received and where there may be gaps.

From there, we look for patterns and trends. We highlight what’s going well so teams can repeat it, and we identify risks so they can intervene earlier. The goal is not just to measure performance for a report or a performance measure that is taken once a year, but to give providers the kind of information they can use in real time to improve patient status.

What are some ways healthcare providers can close gaps in care and make sure no one is left behind?

You can’t fix what you can’t see. Many patients fall through the cracks because their care is spread across different providers or they face barriers that keep them from following through on treatment. Without clear visibility into who is at risk, those patients can be overlooked.

We help organizations pinpoint exactly where those gaps are and which patients are most affected. From there, we focus on strategies that combine practical support with shared medical decision-making between patients and their physicians. That might mean scheduling timely follow-up visits, connecting patients to community resources, or rethinking care processes so they work for the patient’s life and goals. When patients are active participants in choosing their care path, and understand the trade-offs and benefits, the solutions are more personal, more realistic, and far more likely to last.

There’s a lot of hype around AI in healthcare. How do you see it being used in a meaningful way, and where does Roji fit in?

AI can be a powerful tool, but only if it’s fed accurate data. If the data is incomplete or biased, the AI will provide the wrong answers. Where it works well is in spotting risks sooner, finding patterns that aren’t obvious, and helping providers personalize care for patients.

At Roji, look forward to using AI to build episode models more quickly and capture more insights. From our standpoint, it will be a year or more for the data to be complete enough to produce completely reliable results. But we expect it to be a powerful way of identifying risks earlier for providers, and for testing interventions for efficacy.

What’s your vision for the future of healthcare, and how do you see Roji helping shape that future?

I see a future where payment systems, care delivery, and patients themselves are all working toward the same goal: better health outcomes. That means patients have clear information to make choices about their care, and providers have the tools and incentives to give the best possible care without driving up costs.

Roji’s role is to make that possible. We fit into a health care ecosystem that is fragmented. It doesn’t matter how much consolidation goes on in health care, there are boundaries between systems and providers, between specialties, and between facilities of care. We bridge that gap with data, so that providers in any part of the ecosystem can participate in Value-Based Care to understand their patient populations, improve results, and prove their value to both patients and payers. If we can align better care with sustainable costs, everyone benefits—and that’s the kind of system we’re working to build.

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