driving greater provider engagement · 2020-01-11 · driving greater provider engagement. tiffany...
Post on 11-Aug-2020
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Driving Greater Provider EngagementTiffany Diamond, SVP Integrated Field Operations, Risk Quality & Network Solutions, Optum Steve Eastlack, Executive Vice President, CDAI Operations, Ciox
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• Current State of Affairs
• Chart Collection
• Provider Pain Points
• A New Approach: Partnership between Ciox and Optum
• Built on Core Values
• Results
• Where We’re Heading
• Discussion
Agenda
Current State of Affairs
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What is current state of affairs with chart collection?
• Programs that are dependent on medical charts, including HEDIS, Risk Adjustment and RADV, have continued to grow year over year
• Retrieval programs overlap, creating year-round demand
• Chart collection approach has historically been very transactional and less focused on provider relationships
7,227,956
9,613,626
5,493,646
8,686,599
830,465
1,088,652
1,617,432
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
0
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
14,000,000
16,000,000
2016 2017 2018
Total Charts Collected by Ciox in 2016-18
Retrieved Charts Projected Charts # of Providers
YTD
Projected
Projected
Already submitted charts that Cioxcannot find (fax/mail)
No feedback loop after charts are abstracted back to providers
Lack of clarity around provider payments and invoices
Different time periods drive different request types (retrospective programs like HEDIS audit and RADV) versus prospective programs that collect information for in-year medical services
Concern over PHI
Back and forth exchanges due to rescheduled collections or additional
information needs
No standard medical chart retrieval processes across payer
organizations
Duplicative requests for same patient based on reason for request (HEDIS /
Risk Adjustment)
Disruptive to practices with year round requests through faxes, calls and in-person visits.Existing provider pain points
P A I NP O I N T S
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56
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A New Approach: Optum + Ciox
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Aligned Values and Shared Outcomes
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Going in Position - Aligned Values
Minimize provider disruption and demonstrate respect for provider’s time and priorities.
Invest in robust training of retrieval teams to reduceprovider rework – get it right the first time!
Leverage existing relationships between providers and field staff that work regularly with practice including established remote access through EMRs.
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Develop future state capabilities to enable moreeffective chart reuse and automated data acquisition.
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Managing Performance and Outcomes
Retrieval milestones
Retrieval rates
Retrieval completeness Contract
performance (STAR rating)
Compliance ratesNext best action (minimize CNA)
Traditional KPIs Outcomes
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2018 HEDIS MRR (Payer Engagement)
• Focus on partnership to encourage provider engagement
• Leverage existing provider relationships across Ciox, Optum and Client
• Share inventory visibility and assignment to seamlessly drive retrieval
• Outreach• Field Techs• ROI Sites
• Field Ops Team
• Leadership
Client ABC• Internal
Provider Support
Centralized System & Data Repository
• Improve Provider Engagement
• Reduce Provider Abrasion
• Produce Higher Yield
Goals
• Full visibility to inventory across teams • Leverage relationships to assist each other • Centralized Intake and Delivery • Easily transfer inventory ownership across teams
• 10% Increase in Yield YOYo 2017 Retrieval = 81%o 2018 Retrieval = 91%
• Expedited Retrieval o Significant volume of charts
retrieved early in project o Backlog in Abstraction
• Some retrievals could occur with no “Scheduling” o Ciox ROI, Optum Field Ops,
Target Fax, Client Teamso Minimizes provider impact 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Retrieval By Region
Central West Northeast Southeast
End DateMay 2, 2018
Start DateJanuary 29, 2018
2018 HEDIS Results “Best Chase in History of Organization” – President of Clinical Services
Where We Are Heading
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Designing the future with the provider always in mind
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Disruption to practices with year round requests through faxes, calls and in-person visits
Duplicative requests for same patient based on reason for request (HEDIS / Risk Adjustment)
Providers have expressed frustration about…
HEDIS Chart Collection (MRR) for prior dates of service
Risk Adjustment Charts for prior dates of service to look for additional HCCs
Risk Adjustment Charts for current dates of service to address suspected conditions
HEDIS care opportunities to demonstrate gaps in care addressed
Analytics for retrieval
Centralized display for patient information and data requests
Field and Provider Continuous Partnership
Risk and Quality Integrated Approach
Continuous review and action of patient risk and quality information
EMR ConnectivityDifferent time periods drive
additional requests based on program (risk / quality)
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Relationships have to be the Anchor to the Process
Relationships have to be the anchor to our process along with shared goals and continuous improvement
Provider Profiling
Robust provider information to capture practice preferences and workflow (including EMR)
Sophisticated logic using to determine best approach to retrieval method
Identification of primary relationship owner for engagement
Historical retrieval information to determine potential obstacles
Scalable data repository for storing information for future application
Provider Engagement
Partner with practices to leverage direct access to EMR for retrieval
Plan in advance of retrieval requests to give clear overview of process, timing, methodology and potential volume
Communicate clear expectations around scheduling
Provide insights from charts on care opportunities, documentation and coding
• Provider Relationships & Provider Engagement are key to improving the retrieval process
• Ciox and Optum are partnering to move towards an integrated, continuous retrieval process o Maximize chart reuse o Consolidate requests across
programs and clients o Reduce disruption to provider site o 18 to 24 months away
Summary Continuous Improvement
Current actions underway to address other provider pain points
Leverage historical data to understand provider retrieval preferences and previous retrieval method
Leverage existing ROI and Client relationship to facilitate retrieval without continuously calling
Enable direct, electronic connections with major EMR companies
Encourage adoption of EMR Remote or Provide Portal to reduce risk of “missing” faxed/mailed charts
Improve provider payment process through technology enhancements and negotiations with major HIH companies
Thank You!
Questions?
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