Practice Extend for Providers

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[Text On Screen – Who is Optum?]

[MEGHAN MILLER SPEAKING ON SCREEN]

[Text On Screen – Meghan Miller, Vice President of Payer Market Development, Optum]

MEGHAN MILLER: So as we dive in, let's talk a little bit about who Optum is. We are a subsidiary of United Health Group, and we are the biggest health care services company, serving over 25,000 providers nationwide. We're focused on creating a healthier world, with you at the center of it, a

[Text On Screen – Who is Optum? A leading health solution and care delivery organization.

-          Subsidiary of UnitedHealth Group since2011

-          Fortune 5 company

-          Combines clinical expertise, technology and data to support people, partners and providers with information and tools to achieve better health.

Delivering better health outcomes by:

-          Providing insightful research and consulting to drive action

-          Delivering analytics and technology to put market-leading insights and innovation into a client’s workflows

-          Performing services to drive best practices and optimize financial performance

Our work is complex, but our mission is simple: create a healthier world, with you at the center.

Optum, © 2024 Optum, Inc. All rights reserved.]

and really focused on how we can bring the best health outcomes to our patients and members that we are serving. We do that through a series of investments, as well as technology and analytics, a consulting organization that helps to focus on driving action, as well as services that help us to support our clients, and providers that we are serving, to optimize financial performance.

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[Text On Screen – How do we define value-based care?]

[MEGHAN MILLER SPEAKING ON SCREEN]

[Text On Screen – Meghan Miller, Vice President of Payer Market Development, Optum]

MEGHAN MILLER: So as we think about our investments and looking out into the market and how we can best serve our stakeholders and clients, we want to first focus in on how we define value-based care. And as we think about value-based care, this is a really important part of the industry, as we think about where everybody from CMS is pushing, to your health plan partners that you are working with.

[Text On Screen – How do we define value-based care (VBC)? Rewarding providers for delivering quality of care, not just volume of care.

Health care providers work together and with their patients to:

-          Collaborate on their care to keep patients healthy

-          Deliver proactive, preventative care, not just reactive sick care

-          Avoid unnecessary ER visits and medical costs and prevent hospitalizations

-          Address social determinants of health

According to a recent study among physicians facing burnout, those with little-to-no burnout had 75% or more revenue from VBC arrangements¹ as opposed to those with the most severe symptoms had majority of revenue from fee for service. 1. Family Physicians with Value-Based Payment Models Relieve Burnout, According to Study from AAFP with Elation Health (prnewsire.com),

Benefits of VBC program:

-          Creates additional financial opportunities for practice

-          Rewards them for delivering the kind of care that leads to better patient outcomes

-          Spends more time with sicker patients

-          Addresses preventative care opportunities and holistic patient needs

Optum, ©2024 Optum, Inc. All rights reserved.]

So how do we define value-based care? Value-based care is rewarding providers for delivering quality of care, not just volume of care. Healthcare providers work together, and with their patients, as we think about value-based care to collaborate and keep those patients healthy. Thinking proactively about preventative care, not just reactive sick care, how can providers partner with their patients to avoid unnecessary utilization, medical costs, and hospitalizations, keeping those patients healthier and at home. And, in addition, thinking about the whole person and various social determinants that are impacting the health of that patient.

[Text On Screen – How do we define value-based care (VBC)? Rewarding providers for delivering quality of care, not just volume of care.

Health care providers work together and with their patients to:

-          Collaborate on their care to keep patients healthy

-          Deliver proactive, preventative care, not just reactive sick care

-          Avoid unnecessary ER visits and medical costs and prevent hospitalizations

-          Address social determinants of health

According to a recent study among physicians facing burnout, those with little-to-no burnout had 75% or more revenue from VBC arrangements¹ as opposed to those with the most severe symptoms had majority of revenue from fee for service. 1. Family Physicians with Value-Based Payment Models Relieve Burnout, According to Study from AAFP with Elation Health (prnewsire.com),

Benefits of VBC program:

-          Creates additional financial opportunities for practice

-          Rewards them for delivering the kind of care that leads to better patient outcomes

-          Spends more time with sicker patients

-          Addresses preventative care opportunities and holistic patient needs

Optum, ©2024 Optum, Inc. All rights reserved.]

With that definition of value-based care, there are a number of benefits that we wanted to touch on. First, value based care programs create additional financial opportunities for you and your practice. It helps to bring rewards for improving the care of the patients, and enables you to be able to spend more time with your sicker patients, while also addressing preventative opportunities and holistic patient needs across all of the patients that you are serving. That's really important, because as we think about providers and practices today, we know that burnout is a really important challenge that we need to help to overcome. And one of the things with making this shift to value-based care away from fee-based, activity-based payments, is that we know that providers that have had 75 percent or more of their revenue tied to value-based care arrangements don't experience the same burnout because they're able to focus more on their patients, spend more time with them, again, focusing on those sicker patients, while balancing that with the preventative care to your healthier patients.

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[Text On Screen – Why you should care]

[MEGHAN MILLER SPEAKING ON SCREEN]

[Text On Screen – Meghan Miller, Vice President of Payer Market Development, Optum]

MEGHAN MILLER: Building upon that burnout, and ability to avoid burnout by shifting how you can focus on and align your revenue and financial outcomes with the care that you are focused on delivering to your patients, there are a couple other reasons why value-based care is really important. 

[Text On Screen – Why you should care

Insurers, increasingly Medicare, are demanding a move to value-based care

- By 2030, CMS goal is to have 100% of Medicare members (and vast majority of Medicaid beneficiaries) in VBC

- States are imposing targets for value-based reimbursement in managed Medicaid programs

- Growing high-needs senior population and care improvement opportunities

- Incentives to provide care in new ways to meet demands of this high-needs population

- Expansion of Medicare Advantage is going to drive a bigger push to VBC

Patient demand for transformation of care delivery is on the rise

- Rise of high-deductible health plans creating pressure for lower-cost care to the patient

- Patients want changes to enable longer visit times, access to home care and more

- VBC arrangements can support transformation

As VBC capabilities improve, payer demand will increase/provider adoption will increase

- Data and analytics help bring a better understanding of needs to the population, and provider and program performance

- Experienced partners understand difficulties and costs of moving to VBC and are finding creative ways to engage providers

- Record capital investment in care delivery related to value-based assets and services

Optum, © 2024 Optum, Inc. All rights reserved.]

One of them being that insurers, increasingly Medicare, as well as your commercial insurers, are focused on a continued demand to move to value-based care. CMS has a goal to have 100 percent of Medicare members in value-based care arrangements by 2030, just a few years down the road. That, mixed with the growing high needs of senior populations that are often sicker and demand additional time and focus to help keep them healthier, keep them at home and out of the hospital. There is an expanding push for Medicare Advantage, as well, to push into value-based care. And so making sure that we can match these needs of pushing care into value-based care with how you are delivering care is really important and we're seeing that with how payers are coming to the table. 

[Text On Screen – Why you should care

Insurers, increasingly Medicare, are demanding a move to value-based care

- By 2030, CMS goal is to have 100% of Medicare members (and vast majority of Medicaid beneficiaries) in VBC

- States are imposing targets for value-based reimbursement in managed Medicaid programs

- Growing high-needs senior population and care improvement opportunities

- Incentives to provide care in new ways to meet demands of this high-needs population

- Expansion of Medicare Advantage is going to drive a bigger push to VBC

Patient demand for transformation of care delivery is on the rise

- Rise of high-deductible health plans creating pressure for lower-cost care to the patient

- Patients want changes to enable longer visit times, access to home care and more

- VBC arrangements can support transformation

As VBC capabilities improve, payer demand will increase/provider adoption will increase

- Data and analytics help bring a better understanding of needs to the population, and provider and program performance

- Experienced partners understand difficulties and costs of moving to VBC and are finding creative ways to engage providers

- Record capital investment in care delivery related to value-based assets and services

Optum, © 2024 Optum, Inc. All rights reserved.]

The next is that the patient demand for transformation of care delivery is on the rise. Patients are entering into high deductible health plans. They are focused on having longer visit times, more time with you as the provider, as well as getting access to home care, and more. In addition to really having that focus on whole person care and meeting the needs, both socially, behaviorally, as well as medically. 

[Text On Screen – Why you should care

Insurers, increasingly Medicare, are demanding a move to value-based care

- By 2030, CMS goal is to have 100% of Medicare members (and vast majority of Medicaid beneficiaries) in VBC

- States are imposing targets for value-based reimbursement in managed Medicaid programs

- Growing high-needs senior population and care improvement opportunities

- Incentives to provide care in new ways to meet demands of this high-needs population

- Expansion of Medicare Advantage is going to drive a bigger push to VBC

Patient demand for transformation of care delivery is on the rise

- Rise of high-deductible health plans creating pressure for lower-cost care to the patient

- Patients want changes to enable longer visit times, access to home care and more

- VBC arrangements can support transformation

As VBC capabilities improve, payer demand will increase/provider adoption will increase

- Data and analytics help bring a better understanding of needs to the population, and provider and program performance

- Experienced partners understand difficulties and costs of moving to VBC and are finding creative ways to engage providers

- Record capital investment in care delivery related to value-based assets and services

Optum, © 2024 Optum, Inc. All rights reserved.]

The last piece is that the investment in value-based care delivery and capabilities is making it easier to adjust and adapt and move into value-based care arrangements. From the data and analytics that help you to be informed in the care that makes the most sense for your patients, as well as giving you that whole person view on everything that is going on in the care continuum for that patient, even outside of your office, to having partners that can come to the table with the experience to support you on your journey and moving towards those financial arrangements that help you to reach that balance that we mentioned previously.

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[Text On Screen – A successful value-based care partnership requires collaboration]

[EVAN WEISS SPEAKING ON SCREEN]

[Text On Screen – Evan Weiss, Vice President of Provider Enablement, Optum]

EVAN WEISS: So what does it take to be successful in a value-based care arrangement? For one thing, you need to have access to good value-based contracts with payers that have good financial incentive opportunities for you as the provider. 

[Text On Screen – A successful VBC partnership requires collaboration.

VBC challenges

- Financial:

o Lack of access to investment capital

o Reliance on existing Fee-for-Service revenue and moving to less reliable revenue stream

o Complex and variable reimbursement models across health plans

- Process: 

o Reliance on data-driven insights to support more efficient workflows

- Technology:

o Comprehensive data across patient’s healthcare continuum (interoperability)

- People:

o Navigation of operational change management (provider resistance)

What to look for in a VBC partner

- Flexible approach that supports multiple payers and lines of business

- Financial model that is sustainable and mutually beneficial for both the provider and VBC partner

- VBC partner offers the resources to enable care delivery transformation and improvements (i.e., technology, administrative support, etc.)

- Trusted relationships between provider and VBC partner built around shared visions and subject matter expertise

Optum, © 2024 Optum, Inc. All rights reserved.]

You will need to be able to implement new processes in your practice to address proactive patient care opportunities, and you'll need information to inform those new processes that are not existent in your EMR today, helping you understand what's happening with your patients when they're outside the four walls of your practice. Additionally, you're going to need the resources, the people resources, to help act on those opportunities that the data is telling you are there. Patients who proactively need to address gaps in care, patients who need follow up after discharge, and need outreach and med reconciliation or the like, patients who are likely to land in the hospital and being able to understand who they are and what their proactive care needs are. All of that suggests needing investment in new capabilities in order to be successful, which suggests that you're going to want a partner who's willing to help make those investments, with you on your behalf, and enable you to be successful. 

[Text On Screen – A successful VBC partnership requires collaboration.

VBC challenges

- Financial:

o Lack of access to investment capital

o Reliance on existing Fee-for-Service revenue and moving to less reliable revenue stream

o Complex and variable reimbursement models across health plans

- Process: 

o Reliance on data-driven insights to support more efficient workflows

- Technology:

o Comprehensive data across patient’s healthcare continuum (interoperability)

- People:

o Navigation of operational change management (provider resistance)

What to look for in a VBC partner

- Flexible approach that supports multiple payers and lines of business

- Financial model that is sustainable and mutually beneficial for both the provider and VBC partner

- VBC partner offers the resources to enable care delivery transformation and improvements (i.e., technology, administrative support, etc.)

- Trusted relationships between provider and VBC partner built around shared visions and subject matter expertise

Optum, © 2024 Optum, Inc. All rights reserved.]

So what should you be looking for in a partner? One, is having a partner that will be able to get you good access to good contracts. A partner who is invested in your success and helping do right by you and your patients. A partner who has credible, practical solutions and good capabilities to help drive the performance and help you earn those incentives. And it needs to be a partner who you feel aligned with, culturally, and from a trust perspective, that your interests are aligned and you're working towards each other's mutual benefit.

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[Text On Screen – Doing your due diligence]

[EVAN WEISS SPEAKING ON SCREEN]

[Text On Screen – Evan Weiss, Vice President of Provider Enablement, Optum]

EVAN WEISS:  As you start to look for opportunities to get into value-based care and begin looking for who you might partner with to do that, there are several questions that are important for you to ask yourself, and be aware of for yourself, as you go through that process.

[Text On Screen – Doing your due diligence, Your answers to these questions will give you insight into what you need from a VBC partner.

As you think about moving toward a VBC model, what are you biggest hesitations?

-          For example, look for a VBC partner that can help by removing financial, clinical, administrative and staffing constraints while adding revenue opportunities for your practice and protecting you from downside risk.

What are your biggest administrative burdens?

-          For example, look for a VBC partner that can help with patient outreach, contracting, coding and documentation to help remove those administrative burdens from you and your staff.

If time and resources weren’t a barrier to success, what could a VBC partner do to help you to improve outcomes for your patients? For example, look for a VBC partner that can help:

-          Augment your staff and support clinical transformation

-          Educate on appropriate sites of service rather than defaulting to the emergency room

-          Offer community services to ensure health equity, alleviate social insecurities (food, shelter, transportation, etc.)

-          Monitor health patterns continuously to understand current state of health

Optum, © 2024 Optum, Inc. All rights reserved.]

For example, what are the things that you are most concerned about in this process, from a financial perspective, resourcing perspective, and is the partner who you're talking to able to speak to those concerns and give you an approach that will address those concerns? Are they responsive to those concerns and does what they're telling you make sense, as to why you should feel comfortable moving into their model. Another opportunity to ensure that you're getting the right partner is to be thinking about what resources that partner is bringing to the table relative to what resources you already have or do not have.

[Text On Screen – Doing your due diligence, Your answers to these questions will give you insight into what you need from a VBC partner.

As you think about moving toward a VBC model, what are you biggest hesitations?

-          For example, look for a VBC partner that can help by removing financial, clinical, administrative and staffing constraints while adding revenue opportunities for your practice and protecting you from downside risk.

What are your biggest administrative burdens?

-          For example, look for a VBC partner that can help with patient outreach, contracting, coding and documentation to help remove those administrative burdens from you and your staff.

If time and resources weren’t a barrier to success, what could a VBC partner do to help you to improve outcomes for your patients? For example, look for a VBC partner that can help:

-          Augment your staff and support clinical transformation

-          Educate on appropriate sites of service rather than defaulting to the emergency room

-          Offer community services to ensure health equity, alleviate social insecurities (food, shelter, transportation, etc.)

-          Monitor health patterns continuously to understand current state of health

Optum, © 2024 Optum, Inc. All rights reserved.]

If you have a lot of resources on hand to be able to do patient outreach, but you lack the technology and analytics, you can look for a partner who is going to push the right reporting and information to you in the practice and then your team can take it from there, in order to act on the opportunities for the patients. On the other hand, if your practice is resource constrained, you might want to find a partner who is going to bring additional clinical and administrative staff to help you accomplish what you need to, in order to be successful in the contract.

[Text On Screen – Doing your due diligence, Your answers to these questions will give you insight into what you need from a VBC partner.

As you think about moving toward a VBC model, what are you biggest hesitations?

-          For example, look for a VBC partner that can help by removing financial, clinical, administrative and staffing constraints while adding revenue opportunities for your practice and protecting you from downside risk.

What are your biggest administrative burdens?

-          For example, look for a VBC partner that can help with patient outreach, contracting, coding and documentation to help remove those administrative burdens from you and your staff.

If time and resources weren’t a barrier to success, what could a VBC partner do to help you to improve outcomes for your patients? For example, look for a VBC partner that can help:

-          Augment your staff and support clinical transformation

-          Educate on appropriate sites of service rather than defaulting to the emergency room

-          Offer community services to ensure health equity, alleviate social insecurities (food, shelter, transportation, etc.)

-          Monitor health patterns continuously to understand current state of health

Optum, © 2024 Optum, Inc. All rights reserved.]

And the last thing is how administratively burdensome is the program that the partner is asking you to participate in and how much capacity do you have to actually undertake those administrative changes. Are they asking you to expand greatly the number of workflows in your practice? Are they asking you to do an end to end workflow? Or are they teeing things up for you and then working it into your existing workflows so that it is easy for you to address those opportunities without having to take on a whole bunch of new work? All of that is important for you to consider, in terms of whether or not the incentives that they're offering you are commensurate with the level of effort that they're asking you to put in, and can you expect to get the right return on your investment.

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[Text On Screen – Thank you]

[EVAN WEISS SPEAKING ON SCREEN]

[Text On Screen – Evan Weiss, Vice President of Provider Enablement, Optum]

EVAN WEISS: We hope that this addressed a lot of your questions and was helpful to you in helping make a decision about whether to pursue value-based care, and if so, whom you want to do that with. Thank you for your time and for your consideration.

[MEGHAN MILLER SPEAKING ON SCREEN]

[Text On Screen – Meghan Miller, Vice President of Payer Market Development, Optum]

MEGHAN MILLER: Hopefully that was helpful to address your questions that you might have around value-based care, understanding whether it is right for you, how you might be able to choose a partner or a path to go down this road towards value-based care and the financial outcomes. If you have any questions, we are here to help. Happy to answer those via email, phone calls, et cetera. Look forward to hearing from you and how we might be able to help you on your journey.

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[Text On Screen – To learn about Optum Practice Extend, send your questions to: oi_providerrecruitment@optum.com]

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