to tackle the biggest challenges in health ......aurora health care results together, optum and...

TO TACKLE THE BIGGEST CHALLENGES IN HEALTH CARE, YOU HAVE TO THINK BIG.

Together with our partners, we’re doing just that.

Explore case studies and stories of success.

with

P AT I E N T H E A LT H

C A S E S T U D I E S A N D S U C C E S S S T O R I E S

PREMIER MEDICAL

AURORA HEALTH CARE

PRECHECK MYSCRIPT

LEHIGH VALLEY HEALTH NETWORK

NYUPN


G OA L S

Identify out-of-network utilization and share key performance metrics with providers to identify referral trends and thereby improve in-network utilization

NYUPN

R ESU LT S

Within weeks, NYUPN was able to build reports needed to have successful, data driven conversations with their physicians. Education on out-of-network utilization trends led to an increase in in-network utilization by 5% within one year.

Increasing in-network utilization results in millions of dollars for health system risk contracts and a more coordinated, high quality care team experience for patients.

SO LU T I O N S USE D

• Identify drivers of out-of-network utilization such as types of conditions, and particular providers whose patients are most often treated out of network

• Share performance reports with physicians highlighting referral trends and performance metrics in order to improve in-network utilization with

Premier Medical


G OA L S

Premier was looking to expand on their data-driven approach to improving quality and cost.

R ESU LT S

Premier saw care management improvements such as a 27% readmission reduction for high-risk patients.


Used Optum analytics to improve Population Health Management (PHM) by adopting a proactive approach to care. This included identifying patients at high risk for admission or readmission, then reaching out to help those patients better manage their chronic conditions.

REDUCE READMISSIONS

HEART FAILURE READMISSIONS

DOWN

27%

with


Lehigh Valley Health Network

G OA L S

Address the top 5% highest-risk patients by turning data into actionable information

R ESU LT S

Together, Optum® and LVHN achieved:Robust data and credible outcome metrics … “and it’s beginning to have a viral effect within our medical staff.”


• Define high-risk patients using a combination of HCC, utilization, predictive models, and high risk/low spend patient identification criteria

• Collaborate with care teams to define critical clinical values to view in registries

• Create multiple registries to standardize workflow

• Set targeted PMPM as a network goal tied to employee incentives

ACHIEVE SAVINGS OF

$3.1M

REDUCED COSTS BY

$6M

Tap above to view videowith

http://go.optum.com/HIMSS/lehigh.mp4


G OA L S

• Identify patients likely to be admitted for a CHF-related hospitalization

• Implement operational processes to support proactive management

Aurora Health Care

R ESU LT S

Together, Optum and Aurora achieved:


• Isolate patients 80%+ likely of admission for CHF or COPD

• Validate patient inclusions with local providers and disseminate lists to health coach RNs

• Implement a new approach to provide additional care, through an initial co-visit with Health Coach RN and provider to develop a comprehensive care plan

with

65% REDUCTION in heart failure admissions

DECREASE in all-cause readmissions from 2012–13

DECREASE in ED utilization

ABILITY TO CARE for larger panel sizes

30%


G OA L S

Empower prescribers to reduce drug spend and administrative pain points for the patient and themselves

PreCheck MyScript

R ESU LT S

Early data indicates tens of thousands of prescribers have used PreCheck MyScript over 1.5 million times to potentially avoid a negative patient experience at the pharmacy counter, impacting hundreds of thousands of patients.


Within the prescriber’s Electronic Medical Record e-prescribing workflow, display the same real-time patient pharmacy benefit coverage and cost information that would be available at a retail pharmacy. It will:

• Alert the prescriber of drugs that require prior authorization, are not covered, or are non-preferred

• Provide alternate, lower-cost medications that do not require prior authorization before a patient is sent to the pharmacy

• If needed, allow the physician to submit the electronic prior authorization online, many of which receive instant approval

with

of transactions resulted in an alternative drug1

prior authorizations avoided or initiated1

>20% >30%

1. May-Mid-Oct 2017, UnitedHealthcare data

Physician

TRANSPAREN

T

COLLABORATIO

N

REAL-TIME DATA

ADMIN

ISTRATIV

E

SIM

PLIF

ICATIO

N

SPEED, COST

TRANSPARENCY

PreCheck MyScript

Pharmacy

Patient


UNIVERSITY OF VERMONT MEDICAL CENTER–BURLINGTON

DIGNITY HEALTH HALLMARK HEALTH

MISSION HEALTH

R E V E N U E C Y C L E S E R V I C E S

Dignity Health trusted Optum to take over its revenue cycle operations, and formed Optum360® for that purpose.


Dignity HealthEnd-to-end revenue cycle management

G OA L S

• Upgrade revenue cycle tools and operations • Improve financial performance and address revenue leakage • Better manage to changing industry regulations, payment models and technology trends

Point of service collections

in average cash collections

Medicare CMI (case mix index)

in revenue recovery due to additional eligibility screenings on self-pay accounts

R ESU LT S11.9% 2.8%

DECREASE in gross accounts receivable days

INCREASE in CC/MCC capture

rate for Medicare and Medicare Managed

Services

+15M +10.4% +49.6M+26%

with

Hallmark Health System is the premier charitable provider of vital health services to Boston’s northern communities, and includes 6 facilities, 700+ physicians and 324 beds.

Hallmark Health System

SO LU T I O N

Using Optum360 coding service, Enterprise CAC, CDI 3D and on-site consulting, Hallmark Health transitioned smoothly to ICD-10, unified coding and CDI workflow and achieved over 90 percent response rate to physician queries — resulting in impressive financial and operational improvements.

I N T EG R AT I O N SO LU T I O N S Y I E L D SU CC ESS

BOOSTED REVENUE

after 3.5 percent case mix index increase

$1.3M DECREASED INPATIENT CODING BACKLOG BY

from 15 days to 3 days80%

REDUCED UNBILLED A/R BY MORE THAN

$8M

REDUCED OUTPATIENT CODING BACKLOG BY

more than

from 30 days to 14 days50%

INCREASED PHYSICIAN QUERY RESPONSE RATE

from -30 percent to over

90%

IMPROVED SOI RATING

(severity of illness)

from

2 TO 3

IMPROVED ROM RATING

(risk of mortality)

from

1 TO 2

Optum360 solutions get results for Hallmark Health System


with

Mission Health, based in Asheville, NC, operates six hospitals, numerous outpatient and surgery centers, and the region’s only dedicated Level II trauma center. With a medical staff of more than 1,000 physicians, approximately 10,700 employees and 2,000 volunteers, Mission Health is dedicated to improving the health and wellness of the people of western North Carolina.

Mission Health

“ The Optum360 technology is definitely supporting our overall goals .... We’re accurately reflecting the acuity of care we’re providing and capturing accurate documentation, as well as building additional efficiencies. Our results speak for themselves.“

E L I A N A OW E N SExecutive director for coding,

CDI and revenue integrity

C AC & C D I 3 D SO LU T I O N W I T H O B TA I N E D R ESU LT S

Using Enterprise Computer-Assisted Coding integrated with CDI 3D, Mission Health achieved:

INCREASE IN TOTAL reimbursement in the first fiscal year

DECREASE in DNFC

IMPROVEMENT in CDI productivity

INITIAL INCREASE IN case mix index (CMI) due to Enterprise CAC and concurrent coding

INCREASE IN CDI queries per month, and a

$4.8M

30%

26%

2.4%

115%


with

University of Vermont Medical Center–Burlington

“ I think the value of Claims Manager is as a cash accelerator. I am not waiting 30–45 days for a denial before I can fix something. In terms of clean claims, and getting it right before we bill it — that is where the value of Claims Manager shines.”

M I C H A E L BA R E W I C ZDirector of Professional Revenue,

University of Vermont

The University of Vermont Medical Center had a large number of payer denials and rejections returned to the billing staff, requiring them to sort out, research, and correct the errors made by the clinical staff before resubmitting the claims to payers — Medicare, Medicaid, and four commercial carriers — for payment. They needed to correct claims and quality control charges, and improve its financial and administrative performance.

R ESU LT S

ROI HAVING CLAIMS

MANAGER

18.65:1

COST SAVINGS

$3.5M

DECREASED A/R DAYS TO

31.5 DAYS

DENIAL RATE BY PAYERS

REDUCED TO

5.1%


with

VA L U E - B A S E D C A R E S U C C E S S S T O R I E S

VA L U E - B A S E D C A R E

WILMINGTON HEALTH

CARESYNC

STRATEGY FOR REGIONAL HEALTH SYSTEM

CareSync

G OA L S

Our industry-leading technology and service along with evidence-based tools drives better management of chronic conditions and revenue over the long term

1. CareSync client survey; 2015, 2016. 2. Commonwealth Fund, Massachusetts General. 3. Urban Institute Health Policy Center, John Hopkins initiative. 4. CareSync internal tracking of data 2015, 2016, 2017. 5. Varies based upon Medicare patient mix and enrollment rate.

R ESU LT S

PATIENT ENGAGEMENT• 65% of patients are more engaged in their care1

• 84% of patients remembered their follow-up items1

REDUCE UNNECESSARY VISITS• 20% reduction in hospitalizations2

• 21% reduction in 30-day readmissions3

• 68% avoided duplicate tests4

• 49% of cases uncovered a medical error4

REVENUE OPPORTUNITY• $50–150k per physician per year incremental

revenue opportunity5

• The Optum solution generates 4 times more revenue than the industry due to higher billing and retention rates over the life of the program

A TURNKEY SOLUTION WITH

SEAMLESS WORKFLOW

INTEGRATIONEXPERIENCED KNOWLEDGEABLE TEAM

We provide and manage the team to extend your reach

PROGRAM COMPLIANCE

Track patient interventions and provides CMS audit protection

TECHNOLOGY

CMS compliant technology that integrates with your EMR


with

Strategy for regional health system

G OA L S

Develop value-based care contracting strategy to maximize return on population health investments for next seven years

R ESU LT S

Estimated annual cost savings across members with top 4 chronic conditions

Estimated benefits from risk adjustment practices and commercial payer contracts


• Completed an assessment and opportunity analytics to identify opportunities and risks

• Developed plan to maximize returns on population health management platform investments

• Developed road map to maximize returns on population health programs (Medical neighborhood models)

• Developed road map for VBC “at risk” contracting

$4–5M

~$8Mwith


Wilmington Health

G OA L S

Prepare for value-based care (VBC) by analyzing patient data and identifying areas for improvement

R ESU LT S

37.6% lower hospitalization rate, 38.6% reduction in ER visits, 20.5% lower 30-day readmission rate


Using Optum One metrics and analysis, Wilmington deployed VBC innovations like the utilization of clinical research to engage patients in order to reduce per member per month (PMPM) costs. Optum One metrics also helped Wilmington Health convert to VBC at an abnormally low cost. Widely held estimates indicate it costs between $1.5–$4 million to launch an accountable care organization. Wilmington was able to do it for $300,000.

LOWER READMISSION

RATE

READMISSIONS

21%LOWER

Tap above to view videowith


http://go.optum.com/HIMSS/wilmington.m4v

CMS ONE PI (PROGRAM INTEGRITY)


OPM HEALTH CLAIMS DATA WAREHOUSE

F E D E R A L H E A LT H I T S O L U T I O N S

CMS One PI (Program Integrity)

G OA L S

Preserve and protect the integrity of Medicare and Medicaid by creating the One PI system to identify, deter and prevent all fraud, waste and abuse activities across the Centers for Medicare and Medicaid Services (CMS)

R ESU LT S

Helped CMS develop Medicare-Medicaid (Medi-Medi) data analytics to improve PI and fight FWA, and created a mapping tool to identify opioid prescriptions locally to fight the epidemic.


Optum develops, maintains and improves the One PI portal and creates new ways for CMS to analyze data to include training, business intelligence, security and compliance, and continually engages the end-user community.

REDUCE FRAUD WASTE AND ABUSE (FWA)

ACTIVITIES, AND ENSURE PI DATA ARE ACCURATE

AND SECURE

TOTAL USERS SUPPORTED BY ONE PI MONTHLY DATA REQUESTS

2,200 54,000+

with


OPM Health Claims Data Warehouse

We are proud to assist the Office of Personnel Management (OPM) with overseeing the administration of benefits through the Federal Employee Health Benefits Program for approximately 8.2 million federal workers, retirees and their dependents.

HCDW will provide OPM with detailed information on the cost and quality of health care services in different geographic regions, across health plans and specialty types, and for sub-populations.

R ESU LT S

Optum helped establish a system to receive encrypted data from FEHB plans, which enabled the initiation of the HCDW build. We also provide ongoing SME development and program management support.

OPTUM SELECTED TO BUILD HEALTH

CLAIMS DATA WAREHOUSE

(HCDW)

with


to tackle the biggest challenges in health ......aurora health care results together, optum and...

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