NEW COLLABORATIONS AND INNOVATIONS DRIVE HEALTH CARE

TRANSFORMATION.Through strong partnerships, Optum continues to

accelerate the evolution of health care.

Explore case studies and success stories.

F I N A N C I A L S U S TA I N A B I L I T Y S U C C E S S S T O R I E S

HARTFORD HEALTHCARE

F I N A N C I A L S U S TA I N A B I L I T Y

NEWTON HEALTH CARE*

AVERA HEALTH

Hartford Healthcare

C H A L L E N G EHartford Healthcare system leadership wanted to develop strategy for advancing and sustaining high-reliability care. Existing clinical improvement initiatives were underway but were yielding only modest, isolated gains.

ENHANCED RECOVERY AFTER CARDIAC SURGERY (ERACS)

• Optum consultants combined ERAS principles from colorectal surgery initiative with national best practices for cardiac surgery to create a new-in-kind ERACS clinical pathway.

• Yielded $235K+ in savings from opioid sparing regimen and limiting care variation.

ACUTE KIDNEY INJURY (AKI) IN PCI

• Developed clinical guidelines to decrease AKI in PCI from twice the national benchmark to the median by calculating contrast dose and hydrating, communicating at-risk patients to the care team during Time Out.

• $296K+ in savings from level of care, lab testing, potential dialysis.

COMPLETE REVASCULARIZATION FOR HIGHER-RISK INDICATED PATIENTS (CHIP)

• Nurse clinician leveraged Optum toolkit to help develop a programmatic heart team approach to care for high-risk patients.

• New programmatic approach generated $532K+ in new revenue and referral sources.

M E A N I N G FU L R ESU LT SFROM CARE TEAMS ACROSS HARTFORD HEALTHCARE SYSTEM

COMPREHENSIVE CLINICAL CARE

REDESIGN TARGETS HIGH IMPACT CARE

VARIATION

F I N A N C I A L S U S TA I N A B I L I T Y

$10M+in excess clinical costs eliminated in year one

SO LU T I O N S DRILLING DOWN ON OPPORTUNITIES AT HARTFORD HOSPITAL

Newton Health Care*

G OA L SNewton Health Care wanted to reduce initial and final denials and increase revenue capture.

F I N A N C I A L S U S TA I N A B I L I T Y

I M PAC T

Annualized reduction in final denial write-offs

Reduction in final denial write-offs

SO LU T I O N

• Optum consultants performed a full diagnostic across Newton Health Care’s entire system, including a current-state gap assessment. They also built an implementation plan to manage the engagement to completion.

• Optum developed work teams to address clinical denials, technical denials and consistent reporting and underpayments.

• Key deliverables included new policies and procedures, custom data and reporting tools, launch of monthly denials committees, workflow redesign and implementation, and underpayment analysis and opportunity identification.

$9M 34%

*Pseudonym

Avera Health

F I N A N C I A L S U S TA I N A B I L I T Y

I M PAC T

Estimated return on investment

5:1

Yearly achievable return on investment through standardization, automation and deeper collaboration

$8.5–$12.2M

C H A L L E N G EAvera Health had many regional financial services groups, operating primarily independently from one another. Each group was inadvertently creating operational and cash flow management inefficiencies.

SOLUTION

• Optum consultants partnered with system leadership to assess the current state of financial services at the various facilities and provided recommendations on how to centralize all areas in scope.

• The assessment uncovered significant opportunities in key areas, including:

– 10 days cash on hand - If days operating cash were reduced to an industry best practice of 10 days, the system would benefit from an additional $4.9M in return on invested cash.

– Expanded electronic invoice program — Electronic invoicing could save the system $1.5M due to the decreased time and cost associated with processing electronic vs. manual invoices and the ability to “enter” large numbers of invoices in a matter of seconds.

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

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

DIGNITY HEALTH

HALLMARK HEALTH

MISSION HEALTH

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

Dignity HealthEnd-to-End Revenue Cycle Management

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 MedicareManaged Services

+15M +10.4%

+49.6M+26%

with

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

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.

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

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

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

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

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

CLEVELAND CLINIC

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

WILMINGTON HEALTH

BUCKS MEDICAL CENTER

Cleveland Clinic

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

“ With this process, we were able to better understand the full continuum of care that is happening and pull in the parties from the various areas that may not work with one another but all touch the same patient”

M O N I C A D E A DW I L E RSenior Director, Payment Innovation, Market

& Network Services Cleveland Clinic

Cleveland Clinic is one of the nation’s largest and most respected. A multi-specialty academic hospital located in Cleveland, Ohio, that is owned and operated by the Cleveland Clinic Foundation. When Cleveland Clinic sought to develop a way to automate bundled payments around their Centers of Excellence and specialty care procedures, they knew the need to identify and build the right bundles. Then, to maintain cost-effective success and scale over the long term, a bundled payment solution was necessary to ensure consistent and accurate administration of the bundling.

R ESU LT S

By developing bundled payments for common conditions, Cleveland Clinic implemented a program supporting 300 cases per quarter at eight hospitals. By applying bundled payments, the team has identified a total savings of 7–10% on these cases. The program is now evolving to custom and prospective bundling.

7–10%SAVINGS OF

with

Bucks Medical Center*

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

I M PAC T

Optum consultants helped to elevate employed physicians’ overall productivity, performance and alignment through:

• Aligning FTEs by assessing variance to expected patient-facing clinic time and developing a sustained process of monitoring FTE expectations going forward

• Standardizing scheduling by defining session expectations to meet community access needs and standardizing appointment types across 45+ providers in primary care

• Designing and implementing an innovative access reporting dashboard to communicate

average wRVUs per cFTE improvement

+48

no-show rate improvement

17%

projected revenue increase

$3.63M

*pseudonym

C H A L L E N G EBucks Medical Center suffered from unsustainable financial margins relative to medical group operations and physician productivity and access.

Wilmington Health

R ESU LT S

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

SO LU T I O N S USE D

Using Optum Analytics 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 Analytics 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.

READMISSIONS

21%LOWER

Tap above to view video

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

with

G OA L S

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

LOWER READMISSION

RATE