Cracking the code with new approaches to care delivery and operations

Perspectives

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Eric MurphyPresident, Payer Solutions, Optum

2

Perspectives

In recent months, we have all been witness to the introduction of ACA and, along with it, a spectrum of competitive, socioeconomic, demographic and government-mandated changes that impact growth, quality and performance strategies. It’s clear that in our current environment, tackling the complexities of our health care system can feel daunting at times, which is why I find it intriguing — and fitting — that we’ve entitled this edition of Perspectives, “Cracking the code with new approaches to care delivery and operations.”

Through this continuum of change, each of us has before us an extraordinary opportunity to make decisions that positively affect the health of our communities and our organizations.

At Optum, we recognize the challenges and new market realities that health plans face. We remain committed to understanding the implications of these changes, and bringing together the brightest minds in health care to discuss how we can meet these challenges head-on and turn strategies into concrete, tactical initiatives.

Enjoy this issue of Perspectives and the insights provided. We hope it serves as a valuable resource to you and your colleagues.

Best regards,

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Health plans need to transform back office to achieve consumer engagement goals4

3

Plans must provide population health incentives to promote provider risk sharing 9

4

Health plans need to transform back office to achieve consumer engagement goals

5

M any health plans recognize

that their future growth will come

from participating in health care

exchanges and adopting new

business models, but what they

may not have considered is that streamlining their current

back-office operations is essential to realizing that growth

faster and in a manner that builds their relationships

with consumers.

“As the health care market changes in a dynamic fashion,

plans need to focus their attention on their back-office

strategy, on levers that can be pulled by payers to optimize

costs, and on metrics, such as auto-adjudication rates, in

order to fund new initiatives and transformation,” according

to Jim Mapes, senior vice president, Optum, who spoke

Oct. 29 in an Optum webinar, “Transform the Back Office

to Better Engage Consumers on the Front Line.”

Shifting resources from claims to communication

Plans need to find a new paradigm “so that the investments

we make, which include the true time that we spend and

the capital we have on an annualized basis, are focused on

the consumer and on those growth drivers,” Mapes said.

Without a big-picture strategy for the business, he explained,

plans are not going to be able to move forward during

post-health care reform changes, which include accountable

care organizations, value-based delivery and compensation

models, consumer- and individual-based customized care,

and state exchanges. Under this new paradigm, plans must

reexamine the market dynamics that are at play:

• Focus on clinical quality

• Medicaid privatization

• Market consolidation

• Consumer health revolution

• Operational efficiency

• Health benefit exchanges

• Aligning network and incentives

• Payer/provider convergence

These market factors are pushing plans toward three

key areas: 1) population and consumer management;

2) acceleration of automation; and 3) operations and

administrative results. If plans do not move in these

directions, Mapes asserted, they are unlikely to survive in

future market models.

Population and consumer management

Payers need to focus on ensuring growth and financial

success in a consumer-driven marketplace, according to

Mapes. “Consumer engagement is key to moving forward.

When competing in an exchange, plans need to ensure

that the consumer’s first experience is a great experience,”

he said. Plans must focus on sales and retention solutions,

innovatively retool benefits administration and product

management as well as financial risk management, and

communicate with consumers in a clear manner.

Acceleration of automation

“Delivering on goals takes a lot of hard work, but focusing

on automation and data integration will allow plans to

do real-time claims adjudication, provide benefit design

flexibility and facilitate clinical quality/accountable care

integration,” Mapes stated. “Plans need to be able to

turn on a dime when regulatory changes are made, and

automation and technology are the foundation for that

ability. These are becoming the table stakes — the pipes and

wires for building a house.”

Expert presenters

Jim Mapes, Senior Vice

President, Optum

Clay Heinz, Vice President,

Optum

When competing in an exchange, plans

need to ensure that the consumer’s first

experience is a great experience.

— Jim Mapes Senior Vice President, Optum

6

Operations and administration results

Plans also need “a laser-like focus on cost and deployment

strategies, with benefits delivered at a price that keeps them

in business,” Mapes said. Core administration and business

services, payment integrity and claims accuracy, and ICD-10

support solutions can create cost reductions and drive efficiencies,

he noted. “In the past, prompt payment and delivering and

responding accurately to claim inquiries were enough, but now

the stakes are going up. Transparent models make timeliness and

accuracy apparent to everyone and being able to deliver is critically

important,” he said, noting that the results — “true, bottom-line

unit costs and unit price results” — are what need attention.

He further explained that the “truth is in the numbers” when

it comes to claims adjudication. Plans need to reduce their

current operational and administrative costs to less than $10 per

member, per month (PMPM), which can only be achieved through

automation, because auto-adjudication is eight to 10 times less

expensive than manual adjudication. Failing to pursue automation

in this area “leaves a lot of costs on the table and leaves a lot

of dollars on the table from a health care standpoint,”

Mapes emphasized.

He cited an American Medical Association statistic stating that

if claims are paid accurately, an estimated $43 billion1 in cost

savings can be achieved by the industry, and noted that anti-fraud

programs can save 1 percent of medical expense and increase

profitability by roughly 16.7 percent.2 He also remarked that

payment integrity and payment accuracy “can fund a lot of

the initiatives that are needed for a consumer approach”

(see Figure 1).

Payment Accuracy

ProcessAutomation

Consumerismand Population

Health

Your members wantto know::

How do I manage by plan?

How do I manage by health?

How do I manage my money?

Onboarding conciergeprovides:

• Proactive member services

• Designated navigator for your member

• Channels of communication members prefer

• Provider directory

• Completion of health risk assessment

• Appointment scheduling

• Follow-up after doctor visits

• Prescription monitoring

• Microsites specific to member care

• Assistance with bills and claims • EFT payment option• Ways to save solutions

Figure 1Transformation levers

Part of cracking the code to achieving consumer engagement is

understanding what the back office needs to look like, how to set

the transformational drivers in motion — such as payment accuracy

and process automation — and what the strategy will be for

taking the cost and accuracy of delivering health plan benefits to a

new level, according to Jim Mapes, senior vice president, Optum.

“Without the first two, you cannot tackle consumer engagement

and population health,” he said.

Plans need to reduce their current operational and administrative costs to less than

$10 per member, per month (PMPM), which can only be achieved through automation,

because auto-adjudication is eight to 10 times less expensive than manual adjudication.

— Jim Mapes Senior Vice President, Optum

7

Payment Accuracy

ProcessAutomation

Consumerismand Population

Health

Your members wantto know::

How do I manage by plan?

How do I manage by health?

How do I manage my money?

Onboarding conciergeprovides:

• Proactive member services

• Designated navigator for your member

• Channels of communication members prefer

• Provider directory

• Completion of health risk assessment

• Appointment scheduling

• Follow-up after doctor visits

• Prescription monitoring

• Microsites specific to member care

• Assistance with bills and claims • EFT payment option• Ways to save solutions

Figure 2Proactive member onboarding and retention

Case study: Regional health plan attacks first-year attrition

Clay Heinz, vice president, Optum, shared a case study that focused

on a regional health plan that offered individual products (both

Medicare and underwritten) for consumers who are both over 65

and under 65. Before meeting with Optum, the client was not

building loyalty within the first 90 days of members’ terms and had

trouble retaining members past the first year.

“The plan utilized common tools in the marketplace, but interacted

with all members in the same manner, using a generic welcome

letter, the same messaging regardless of plan, region or needs,

and with a reactive service model,” Heinz said. “If an individual

had questions about the directory, online tools or a delinquent

payment, the plan was in reactive mode and had no online tools for

self-service. All of these factors are ingredients for a disaster for a

health plan, and as a result, this plan had high member turnover.”

The plan needed to establish a meaningful relationship with

consumers within the critical first 90 days of membership,

and Optum developed an onboarding strategy for the plan —

including the creation of microsites designed to specifically for each

consumer — that “bucketed the messaging for consumers into

three main components,” Heinz explained (see Figure 2).

By helping members to manage 1) their plan, 2) their health and

3) their money, the regional plan’s members were more satisfied,

and the approach established by Optum allowed the plan to cut

first-year attrition by 48 percent, according to Heinz. By combining

initial outreach, follow-up contact, and appropriate and varied

outreach tools, “plans can leverage every possible communication

channel to deliver the right message at the right time to the right

person,” he stated.

8

Want to learn more?

Visit optum.com

or call 1-800-765-6807.

How Optum can helpPartner with Optum to transform your back office to ensure growth and financial

success in a consumer-driven marketplace with a strategy focused on:

• Improved payment accuracy

• Accelerated administrative automation and real-time data

• Proactive member onboarding and retention

He added that satisfied customers are:

• 87 percent more likely to renew.3

• 83 percent more likely to recommend.4

• 43 percent more likely to purchase other products.5

“There has been a paradigm shift to really engage consumers, so

plans need to change to become trusted advisors and co-navigators

with the members,” he said. “Plans don’t want to just be a card in

the member’s wallet anymore.”

Mapes also noted that the most important factors plans need

to consider to enable migration to a new business model are

leveraging data to focus on cost structure and back-office

automation, looking at where the plan needs or wants to be in

three to five years, and determining where to invest capital.

“Being able to deliver from a PMPM standpoint by initiating

projects that create true cost take-out, such as automation,

eliminating redundancy, working with vendors and looking at

globalization, will be necessary as plans refocus their attention on

getting new members and retaining them,” Mapes concluded.

“These levers have to be pulled to be more forward-thinking and

build relationships with consumers. The time to act is now.”

Plans don’t want to just be a card

in the member’s wallet anymore.

— Clay HeinzVice President, Client Practice, Optum

1. American Medical Association, 2013 National Health Insurer Report Card (NHIRC)

2. Optum estimates based on client experience

3. J.D. Power and Associates 2012 study

4. ibid.

5. ibid.

9

Plans must provide population health incentives to promote provider risk sharing

DDuring the past several years, the delivery

of health care has changed dramatically.

These changes, which stem from

government-mandated health insurance

as well as competitive, socioeconomic and

demographic forces, have a direct impact

on health plans’ growth strategies, care

management approaches, and cost and

quality initiatives. Among these initiatives is risk sharing, which calls

for all health care stakeholders to take on more risk in order to

improve health outcomes.

To encourage physicians and hospitals to participate in integrated

risk-sharing models that advance population health management,

health plans will need to develop incentives that are both significant

enough to ensure stakeholder buy-in and simple enough that they

can be implemented in a reasonable and timely manner, according

to Dr. Scott Howell, senior national medical director, Optum.

“There are hundreds of ways to design population health

management programs, but if risk-adjustment model incentives are

minor and bonuses get paid out 18 months later, providers will not

be interested,” Howell said, adding that regardless of how plans

design their programs, they have to first acknowledge that the

status quo in health care is long gone.

“Over the past three years, we have seen one of the most

transformational periods in medicine. Right now, plans are under

exceptional pressures, which include changes in Medicare risk-

adjustment models, sequestration and performance standards,”

he said, “so models have to be extremely fine-tuned to meet cost,

quality and performance goals while firing on all cylinders.”

Howell noted that various factors — from geography to health

information technology (HIT) adoption rates — contribute to success

or failure in meeting important performance measures. “According

to an analysis of key community benchmarks from Optum,1 health

care today is ‘both local and uneven,’” said Howell.

Geographic differences evident for three key measures

To demonstrate the inconsistencies in care, cost and population

health, Howell turned to Optum data, which tracks certain

health care indicators as a way to identify key enablers of better

performance. To understand certain quality benchmarks, the data

set includes avoidable hospitalizations, hospital readmissions and

medication adherence rates. “From a quality-of-care perspective,

looking at large data sets is crucial for understanding geographic

trends,” comments Howell.

Optum data shows the following:

• Avoidable hospitalizations: Commercial data reveals that

avoidable hospitalization rates are lowest in the West, the

Midwest and the Northeast, while the highest rates can be

found in the South and certain rural and urban regions. These

higher rates are associated with chronic illness, low economic

resources and poor patient health behaviors.

• Hospital readmissions: For 30-day hospital readmissions in

the commercial population, the highest and lowest rates are

less centralized. Among the Medicare population, 18 percent

of patients are readmitted within 30 days, while just 8 percent

of commercial plan patients are readmitted within 30 days

(see Figure 1). The highest rates for readmission for Medicare

patients are concentrated in the Appalachian and Ohio Valley

regions, as well as in the states of Mississippi and Louisiana.

10

Expert presenters

Scott Howell, MD, Senior National Medical Director, Optum

There are hundreds of ways to design population

health management programs, but if risk-adjustment

model incentives are minor and bonuses get paid out

18 months later, providers will not be interested.

— Scott Howell, MD Senior National Medical Director, Optum

11

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3.753.95

4.154.35

4.685.73

6.737.73

8.739.72

HCC Risk Score

ER Visits

Hospital Admits

Member-centric, collaborative approach

Where Population health managements �t

Retrospective Services Prospective ServicesAcuisition & Retention Population Health Management

Population Health Management

Improving member care and quality of life within an itegrated manner using a framework that leverages best practice advanced analytic capabilities to provide a holistic view of your population and provide the right intervention at the right time to drive member and provider behavior.

Operations & Administration

AttributionCMS Payment Projection & Bid Support

Renue Reconciliation

Retrieval & ReviewsHospital Data Capture Chart Reviews

AttestationsRAPS & EDPS Submissions

Population SegmentationRisk & Quality SegmentationStars Measures

Population SegmentationRisk & Quality SegmentationStars Measures

Analytics & Reporting

Retrieval, Review &

Submission

Care Gap Analysis

RADVClaims Verification (CV)Internal Data Validation

OIG Audits

Marketing ConsultationProvider Training & EducationMember Outreach

ComplianceProvider & Member

Engagement

Sales & Marketing

Benefit Design

Pricing & Underwriting

Network Mgmt.

Health Mgmt.

Quality Improvement

Claims & Payments Mgmt.

ConstituentService

Corporate Admin

Percent of Providers Who Have Population Health Initiatives Completed or Underway

Clinical Integration Initiatives

High-Risk PatientManagement Programs

ReadmissionsReduction Programs

31%

57%

28%

50%

33%

73%

0

10

20

30

40

50

60

70

80PhysiciansHospitals

11: Map: Quality: 30-day Readmissions Commercial population(HR R s >4,000 members )

Highest rate, readmissions

Insufficient data

Lowest rate, readmissionsFigure 1Quality of care: 30-day readmissions in the commercial population2

“When you look at the Medicare map, the data are striking,

because they indicate that there are 2,100 hospitals that

essentially forfeited about $280 million in reimbursement for

30-day readmissions last year,” Howell said.

• Medication adherence: Medication adherence is characterized

by the World Health Organization as a leading cause of

preventable morbidity, mortality and high health care costs,

and is a key patient-centered care measure that varies widely

across communities. For example, communities in the South and

mountain regions have lower rates of medication adherence

relative to the rest of the nation. Communities with high

rates of medication adherence often have fewer avoidable

hospitalizations.

Factors that drive performance

Beyond the general observations about the quality and cost of care,

Howell explored other dynamics that may be driving the performance

of health plans in certain geographic areas. Factors that drive

health system performance fall into two categories, he observed:

1) community social and economic capital — defined as wealth,

employment, education, literacy, charitable and volunteer activity;

and 2) community incentives and alignment — defined as value-

based payment and accountable collaborative care.

“There is no single factor that will change performance, but there is a

whole host of factors that drive aspects of differentiation,” according

to Howell. “However, incentive alignment, social capital, economic

resources, technology and health behaviors all contribute to good

outcomes. Some early findings from our data show that adoption

of HIT, value-based incentives and provider alignment — as opposed

to not having those — contribute to higher performance levels,

especially for quality.”

There is no single factor that will change

performance, but there is a whole host of

factors that drive aspects of differentiation.

— Scott Howell, MD Senior National Medical Director, Optum

12

“Looking at how a very large data set maps out, you can see

where health plan performance is, what types of interventions

are sophisticated and where there are good outcomes,” he says,

“and it all points to a high level of HIT adoption and value-based

incentives.”

However, in individual communities and regions that are not high

performers and that do not have some of the high-performance

drivers in place, providers may not be quite ready to take on more

responsibility for the care of populations.

In a Harris Interactive multi-stakeholder survey commissioned by

Optum in late 2013, 1,602 physicians and 400 hospitals were

asked questions to determine their readiness to take on more

accountability for managing patient care and dollars, improve

population health management and manage population health

initiatives. Although some physicians (34 percent) and hospitals

(43 percent) said they were adequately prepared to take greater

responsibility for managing patient care, only 16 percent of

physicians and 30 percent of hospitals were similarly prepared to

take greater financial risk for that care, Howell explained.

Further, the survey shows that when you add consumers into the

equation (3,400 consumers were surveyed), their perception of

health care delivery in their communities does not always match

up with the doctors and facilities providing that care. For example,

Howell pointed out that although 38 percent of consumers stated

that health care is coordinated in their communities, only 22 percent

of physicians and 29 percent of hospitals thought that was true.

And when asked whether they thought patients received needed

preventive care, 51 percent of physicians thought they did, while

only 35 percent of consumers thought so.

Integrated risk adjustment drivers must be in place

To drive population health management, which Howell defines as

“improving member care and quality of life in an integrated manner

using a framework that leverages best practice analytic capabilities

to provide a holistic view of your population and provide the

right intervention at the right time to drive member and provider

behavior,” providers need to implement such population health

initiatives as clinical integration, high-risk patient management and

readmission reduction programs.

Surprisingly, the survey results show that only one-third of providers

have implemented population health initiatives or have them

underway (see Figure 2). Hospitals are further along in meeting

those goals. This delta in implementation rates is likely due to

hospitals having greater incentives in place to do so and in providers’

“wait-and-see” approach to developing value-based payment

capabilities, said Howell.

The factors behind this provider reluctance to adopt value-based

opportunities stem from concerns over complexity, administrative

costs and increased risk without adequate reward, according to

Howell. “The marginal aspect of this situation is determining how

much of a reward you need to provide to move forward on the risk

front,” he said. “You can’t add risk without enough reward to keep

the lights on. Also, providers want to keep things simple so they can

understand the targets; plans need to design value-based programs

with this information in mind.”

Although some physicians (34 percent) and hospitals (43 percent) said they were adequately prepared

to take greater responsibility for managing patient care, only 16 percent of physicians and 30 percent

of hospitals were similarly prepared to take greater financial risk for that care.

— Scott Howell, MD Senior National Medical Director, Optum

...In individual communities and regions that are

not high performers and that do not have some

of the high-performance drivers in place,

providers may not be quite ready to take on more

responsibility for the care of populations.

— Scott Howell, MD Senior National Medical Director, Optum

13

4,000

3,500

3,000

2,500

2,000

1,500

1,000

500

0

Rat

e p

er 1

,000

per

yea

r

0.170.35

0.550.75

0.951.15

1.351.55

1.751.95

2.152.35

2.552.75

2.953.15

3.353.35

3.753.95

4.154.35

4.685.73

6.737.73

8.739.72

HCC Risk Score

ER Visits

Hospital Admits

Member-centric, collaborative approach

Where Population health managements �t

Retrospective Services Prospective ServicesAcuisition & Retention Population Health Management

Population Health Management

Improving member care and quality of life within an itegrated manner using a framework that leverages best practice advanced analytic capabilities to provide a holistic view of your population and provide the right intervention at the right time to drive member and provider behavior.

Operations & Administration

AttributionCMS Payment Projection & Bid Support

Renue Reconciliation

Retrieval & ReviewsHospital Data Capture Chart Reviews

AttestationsRAPS & EDPS Submissions

Population SegmentationRisk & Quality SegmentationStars Measures

Population SegmentationRisk & Quality SegmentationStars Measures

Analytics & Reporting

Retrieval, Review &

Submission

Care Gap Analysis

RADVClaims Verification (CV)Internal Data Validation

OIG Audits

Marketing ConsultationProvider Training & EducationMember Outreach

ComplianceProvider & Member

Engagement

Sales & Marketing

Benefit Design

Pricing & Underwriting

Network Mgmt.

Health Mgmt.

Quality Improvement

Claims & Payments Mgmt.

ConstituentService

Corporate Admin

Percent of Providers Who Have Population Health Initiatives Completed or Underway

Clinical Integration Initiatives

High-Risk PatientManagement Programs

ReadmissionsReduction Programs

31%

57%

28%

50%

33%

73%

0

10

20

30

40

50

60

70

80PhysiciansHospitals

11: Map: Quality: 30-day Readmissions Commercial population(HR R s >4,000 members )

Highest rate, readmissions

Insufficient data

Lowest rate, readmissionsFigure 2Population health management: Are providers ready to manage population health initiatives?3

A member-centric, collaborative approach is ideal, he noted. “Plans

need to surround the member in an interactive and integrative

manner,” he said, adding that Optum collaborates with a health

plan’s quality and clinical teams and works with its disease

management and other program staff to drive programs toward a

prospective service model. Prospective services include:

• Analytics and reporting (population segmentation, risk and

quality segmentation, Stars measures implementation)

• Care gap analysis (HEDIS/Stars, HQPAF, chronic condition

management, in-home assessments)

• Provider and member engagement (market consultation,

provider training and education, member outreach)

“Looking at the current state of the nation, it is important to

integrate population health, cost measures and quality initiatives

to drive change moving forward,” Howell says. “As seen in these

data, we are not there yet, but we need to start heading in that

direction…to move the needle on risk management, he advises. “It

is going to be important to ramp up from where we are today, so

that five years from now, the whole industry will be willing to take

more risks based on outcomes and performance.”

Surprisingly, the survey results show that only

one-third of providers have implemented population

health initiatives or have them underway.

— Scott Howell, MD Senior National Medical Director, Optum

14

Want to learn more?

Visit optum.com

or call 1-800-765-6807.

How Optum can helpOptum helps health plans improve care by the accuracy, thoroughness and

timeliness of their reporting through outsourced services that include a clinical

orientation. Our solution set helps you:

• Implement an integrated risk and quality program.

• Review and collect information through retrospective data capture.

• Submit and manage data transactions.

• Manage risk adjustment analytics and reporting.

• Prospectively engage with providers and members.

1 The Optum Labs Community Measures Project provides new data and analyses on the performance of the health care system in 306

communities across the United States; its results underscore that health care today is both local and uneven. The Optum Labs Community

Measures Project evaluates the local cost of care for commercially-insured and Medicare populations, utilization of health care services

(including analyses that pinpoint potentially avoidable care and excessive use), and quality of care. It uses a portfolio of measures that are

well validated and capture a range of outcomes across points of care and health care conditions. Performance measures include readmission

rates, physician compliance with chronic care guidelines and patient medication adherence. Population health is captured in measures of life

expectancy and prevalence of disease.

2 Commercial claims as analyzed by Optum

3 Multi-stakeholder Study, October 2013 conducted for The Optum Institute by Harris Interactive

15

Clay Heinz, Vice President, Client Practice, Optum

Heinz is responsible for developing new business concepts at Optum. As vice president of Client Practice, he lends his expertise and innovation to payers, providers, employers and government entities in the health care marketplace. His mission is to empower consumers to make better health care decisions. Prior to joining Optum, Heinz worked for Extend Health, where he developed work force readiness, ranging from the development of training to licensing and appointments. He also managed relationships with several health plan payer partners, ensuring compliance, policy reconciliation and systems integration.

Scott Howell, MD, Senior National Medical Director, Optum

Howell is responsible for risk adjustment, quality performance and predictive modeling. Prior to Optum, he was the regional chief medical officer (RCMO) for the Northeast Region of AmeriChoice, Inc., focusing on the Medicaid and Dual SNPs populations. He also served as the medical director for managed care at the AIDS Healthcare Foundation along with having responsibility for international consulting in Russia, Ukraine, Guatemala, Honduras and Haiti.

Jim Mapes, Senior Vice President, Optum

Mapes is focused on delivering technology and services-based solutions to hospitals, payers, physicians, life sciences companies and other key players in health care. He is responsible for all facets of the business including global strategy, finance, executive leadership, operations and business development. He has more than 25 years of experience in developing client relationships and deploying a unique combination of business, clinical and technology solutions for the health care industry. Mapes has worked in various Fortune 50 firms as a technology executive and business leader.

Perspectives

Expert presenters

Fall 2013

Biographies

optum.com

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Cracking the code with new approaches to care delivery and operations

Perspectives

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Visit optum.com

or call 1-800-765-6807.