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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4

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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