Primary Care Physicians
What is a PCMH?
The Patient-Centered Medical Home (PCMH) model is a redesign of patient care at the primary care level. Instead of the usual “reactive” patient workflow, the PCMH involves “proactive” evaluation of patient populations. The PCMH office uses a team approach and patient registry software tools to identify Medicare Fee-for-Service patients and Commercial patients with “gaps in care”, develop goal-directed care plans, and work together so all appropriate screenings are performed, chronic diseases are effectively treated, care is coordinated and patients are engaged in self-improvement. More information can be found at www.pcpcc.net.
Primary Care & Specialist
Working in Collaboration
To achieve this goal Optimus brings the tools to the primary care and specialists office to form a greater collaboration and team concept around the delivery of care, utilizing the recommendations of the American College of Physicians, Specialist-PCP collaboration agreements.
Primary care physicians may contact specialists for a pre-consultation exchange of information about the Medicare Fee-for-Service patient and Commercial patient, decide on coordinated treatment arrangements, and send pertinent information prior to the consultation. In return specialists will communicate the results of the consultation in a timely fashion either by secure e-mail, letter, fax, or telephone communication, and advise if further testing is required or if other specialty consultation is requested. The patient will also be informed of these decisions.
By bringing more focused care coordination between the primary care physicians and specialists to bear, it will result in optimized clinical outcomes, decreased overall episode of care costs, reduced variance from best clinical practices, and the development of the foundation for shared savings in our agreements. Our goal is to form a high quality network of physicians that patients will want to access for all of their care.
A fully transparent performance system combined with the Optimus Quality Improvement and Medical Management committees allows peer review, sharing of best practices, and early identification of provider outliers. When needed, providers may be de-credentialed for failing to comply with Optimus protocols.
What can I expect upon signing up to participate in Optimus?
You will be added to the Optimus physician directory and represented in contract discussions. Whether you have utilized an IPA to obtain your present payor agreements or are independently participating with specific insurance companies, your existing agreements and reimbursement schedules will remain in place until an Optimus ACO agreement is obtained. Once a new Optimus ACO agreement is negotiated, you will be notified of the activation date when your existing agreement will be replaced.
In preparation for the new insurance agreements, your office will participate in an "ACO readiness assessment" survey. The survey results will identify what areas of transformation and redesign could be implemented to enhance Medicare Fee-for-Service patient and Commercial patient outcomes and maximize your financial performance. This process will involve identification of a clinical coordinator within your staff or Optimus providing such a person. You will be provided a patient registry tool along with patient care plans and other tools that will integrate into your workflow. Instead of disrupting office workflows these tools can improve productivity while driving better patient outcomes.
In addition to improved care coordination processes within your office, Optimus will provide care collaboration agreements and referral processes that facilitate improved communication and care coordination with Optimus specialists, facilities, VNA's, home health care and other entities.
How can I get involved in Optimus?
To achieve this goal Optimus brings the tools to the primary care and specialists office to form an improved collaboration and team concept around the delivery of care, utilizing the recommendations of the American College of Physicians, Specialist-PCP collaboration agreements.
The Optimus ACO is physician-driven and will involve a “culture of change” including an overall commitment to the organization. All physicians will be participating at some level in the Optimus organization at some time.
For those that wish to express their interest, we have 4 committees:
- Medical Management/ Utilization
They will each meet 10-12 times per year. Physicians can serve on an annual “standing member” basis and receive a stipend. The remaining committee members will be chosen by lottery and serve a six month “selected member” term.
In addition to the above committees, Optimus will be implementing multiple programs involving clinical integration, office transformation, care coordination, care transitions, medication reconciliation, behavioral integration, and end-of-life care. You are welcome to become involved in the design and implementation of these programs. If you are interested in developing additional Optimus-based programs, we welcome your innovation and participation.