Optum, the healthcare business services arm of UnitedHealth Group, is making data available to healthcare providers working under at-risk contracts with health insurers to help doctors identify at-risk patients and engage them to improve health outcomes.
The initiative also is intended to give providers help to improve their quality of care and outcomes.
The data given to primary care and high-volume specialty physicians will be made available on a platform from HealthBI that supports workflows, coordination and collaboration to execute patient care across specialties and settings, says Benton Davis, senior vice president and general manager of networks and population health at Optum.
Some of the doctors have at-risk contracts that vary in the amount of risk, while others may be working under the fee-for-service model. “We have massive data stores and can provide actionable analytics to providers on a timely basis in near real-time,” Davis adds.
The data can show physicians where they need to close clinical care gaps and inform doctors of patients with potential morbidities so they can more deeply engage with those patients.
Use of claims and clinical data along with risk adjustment services rendered by Optum and HealthBI can identify patients with suspected medical conditions.
Davis gives an example of a patient who has not been formally diagnosed by a doctor, although laboratory data shows the patient likely has a medical condition that needs to be assessed.
“We’ll inform the physician and help get the patient scheduled for an assessment,” he adds. “We have a facilitated process of what we see in the data.”
Physicians will be encouraged to participate in part because they want better outcomes for their patients, and also would like to do well on HEDIS scores that measure care performance and can affect reimbursement rates, Optum executives say.
Many physicians know they need assistance in rendering better care, but a lot of their day is consumed with transactional experiences with patients and they can’t get to all of the conditions of each patient, and they also until now have not been equipped to know the medical history of patients who have been treated by other physicians.
Consequently, “We create a holistic view of the patient to help the physician decide the highest priority during a 20-minute visit,” Davis explains.
To enhance physician workflows, Optum’s data given to physicians is matched with analytics on the HealthBI platform, which extracts data from the EHR to find workflow gaps, says Scott McFarland of HealthBI. “We extract data elements to document the closing of gaps and send that data to the insurer. We document the evidence of quality care being given.”
As for the prospects of success with the Optum/HealthBI joint initiative, McFarland is bullish on the future. “This is the first time a multi-payer solution actually has a chance in the marketplace,” he contends.
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