Confidential property of Optum. Do not distribute or reproduce
without express permission from Optum. 2 Agenda Introductions
Overview of Optum Review of Contract between Optum and the Offices
Provider Tools & Submission Process Initial start up experience
Questions and Answers
Slide 3
Confidential property of Optum. Do not distribute or reproduce
without express permission from Optum. 3 Optum New York Staff
William Fishbein, Executive Director Optum New York City BHO Amy
Freeman, Behavioral Health Clinical Manager Margaret Peggy Elmer,
Behavioral Health Clinical Manager Joni Richter, Behavioral Health
Intake Manager Erik Geizer, Quality Assurance/Training Manager
Linda West, Reporting & Technology Manager Michael Silver,
Psychiatrist Marc Minick, Community Liaison Mark Simmons, Community
Liaison
Slide 4
Optum Overview
Slide 5
Confidential property of Optum. Do not distribute or reproduce
without express permission from Optum. 5 Optum Organizational
Overview Optum is a health services business dedicated to making
the health system work better for everyone We are comprised of
three market-leading business segments: OptumHealth OptumInsight
OptumRx Optum serves the entire health ecosystem 250,000 health
professionals and physician practices 6,200 hospitals and
facilities more than 270 state and federal government agencies over
2,000 health plans; two of every five FORTUNE 500 employers; and
one in every five U.S. consumers.
Slide 6
Confidential property of Optum. Do not distribute or reproduce
without express permission from Optum. 6 Our Business Context
Health care coverage and benefits businesses, unified under a
master brand Employer and Individual Community and State Medicare
and Retirement UnitedHealthcare-Health Benefits Information and
technology-enabled health services platform, encompassing:
Technology solutions Intelligence and decision support tools Health
management and interventions Administrative and financial services
Pharmacy solutions OptumHealth Services Helping people live
healthier lives Helping to make the health care system work better
for everyone UHG UNH=Publicly Traded Registrant (NYSE)
Slide 7
Contract Review
Slide 8
Confidential property of Optum. Do not distribute or reproduce
without express permission from Optum. 8 NYC BHO Contracted
Region
Slide 9
Confidential property of Optum. Do not distribute or reproduce
without express permission from Optum. 9 Populations covered under
the program All fee-for-service admissions to OMH-licensed
psychiatric units (all ages) in general hospitals (Article 28
hospitals). Fee-for-service children and youth admitted to OMH
licensed private psychiatric hospitals (Article 31 hospitals).
Fee-for-service direct admissions to OMH State-operated childrens
psychiatric centers or childrens units of psychiatric centers.
Fee-for-service OASAS Certified Part 816 Inpatient Detoxification
Services (Article 28/32). Fee-for-service OASAS certified hospital
(Art 28/32) or freestanding (Article 32 only) Part 818 Chemical
Dependence Inpatient Rehabilitation Services. Each new episode of
care initiated by Article 31 OMH designated Specialty Clinics for
children/youth (up to 19 th birthday) diagnosed as having a Serious
Emotional Disturbance (SED) who are covered by Medicaid Managed
Care
Slide 10
Confidential property of Optum. Do not distribute or reproduce
without express permission from Optum. 10 Functions of the BHO
include: Optum will complete initial reviews for applicable
services of Fee-For-Service Medicaid members within 72 hours after
admission or by 5pm of the next business day following notification
of the admission by the provider, whichever is later. Follow-up
reviews will be conducted at regular intervals. Concurrent Review
Discharge Planning & Tracking Each new episode of care
initiated for a Medicaid Managed Care SED child will be tracked for
reporting back to the State Tracking of Children with SED Provider
Profiling /Analytics Community Liaisons Historical Clinical data
will be provided by the Offices to the BHOs Data elements specific
to each inpatient admission and provider will be collected by the
BHO and shared with the Provider and the Offices. Metric Reporting
will be provided back to the Offices Optum will engage with the
inpatient provider with respect to discharge planning for
applicable admissions Enhanced efforts will be employed for
inpatients identified as High Need Individuals Optum will work with
the Offices and the Providers to determine cross system linkages
for adults and children with mental health conditions and substance
use disorders Facilitation of Cross System Linkages Quality
Initiative Optum will devise a quality assurance program to monitor
the quality of work performed within the contract
Slide 11
Confidential property of Optum. Do not distribute or reproduce
without express permission from Optum. 11 Review of Contract The
OfficesOptumProvider Community Supplies Optum with guidance to
perform tasks Supplies historical clinical data Supports access to
cross systems Performs initial/ concurrent reviews Monitoring
discharge planning & post- discharge services Tracking of
children with SED Provider profiling Facilitation of cross system
linkage Quality Initiative Treatment History Form Follows
concurrent review & discharge monitoring processes Provider
Community Notify Optum of admission (Portal, Fax or Telephonic)
Notify Optum regarding Children with SED
Slide 12
Confidential property of Optum. Do not distribute or reproduce
without express permission from Optum. 12 What we need from you:
Submit requested information to be used in initial/concurrent
reviews, discharge planning/tracking, SED tracking, and cross
system facilitation Use your dedicated Care Advocate and Community
Liaison as a part of your team Partner with Us Follow the
concurrent review & discharge planning/tracking processes
Identify Cross System Linkages Provide data as requested Use the
tools provided Engage in the Process Dont hesitate to ask us
questions Clinical questions can be directed to the Care Advocate
or to: [email protected][email protected] General
questions can be directed to the Executive Director & Community
Liaisons or to [email protected][email protected]
ProviderConnect technical questions/issues can be directed to:
[email protected]. [email protected] Ask Questions Other
Let us help you! We want your feedback.
Slide 13
Provider Tools & Submission Processes
Slide 14
Confidential property of Optum. Do not distribute or reproduce
without express permission from Optum. 14 Provider Tool Review-
Methods for submission New provider portal: www.optumhealthnyc.com
ProviderConnect software Portal Toll-free: (866) 505-3398 Dedicated
Care Advocate assigned by Facility Telephonic Clinical Fax: (877)
283-0555 Fax # Fax Individual Information Matrix - Within 24 hours
of admission - Concurrent Review at established intervals -
Discharge by the date of discharge but no later than within 24
hours post discharge.
Slide 15
Confidential property of Optum. Do not distribute or reproduce
without express permission from Optum. 15 Submission time frames
Childen with Serious Emotional Disturbance (SED) Report Submitted
for each new episode of care for SED children covered by Medicaid
managed care Providers to complete and submit within 3 business
days of initiation of services Submit via fax, portal, or
telephonic Individual Information Matrix Form (inpatient providers)
Admission Providers to notify their assigned BHO within 24 hours of
admission, except that for admissions which occur on a weekend or
holiday such notification would be required by 5 P.M. of the next
business day following such week-end or holiday. Concurrent Review
Optum will complete initial reviews for applicable services of
Fee-For-Service Medicaid members within 72 hours after admission or
by 5pm of the next business day following notification of the
admission by the provider, whichever is later. Follow-up reviews
will be conducted at regular intervals. Discharge Planning Provider
to complete and submit by the date of discharge but no later than
within 24 hours post discharge. Forms located on the Optum NYC BHO
Provider Portal : www.optumhealthnyc.com
Slide 16
Confidential property of Optum. Do not distribute or reproduce
without express permission from Optum. 16 Experience since start up
Volume 65 admissions per day (average) 40% portal, 38% fax, 22%
telephonic Major initial activities Initiating review process
Provider outreach Provider training Connecting with stakeholder
groups Completion of staff hiring and training efforts
Slide 17
Confidential property of Optum. Do not distribute or reproduce
without express permission from Optum. 17 Initial challenges
Different review process Provider resources Usage of web portal
Data submission for SED children Engagement of some inpatient
providers
Slide 18
Confidential property of Optum. Do not distribute or reproduce
without express permission from Optum. 18 Challenges on the near
horizon Working with health homes Integration of peer support
services