Specialty Care Physicians

Why you as a specialist physician should join us.

When deciding to join an Accountable Care Organization which one will have your interests in mind? A health plan driven and governed model, a hospital system governed model, or a physician governed and focused model?

The choice should be clear. Physicians are the ultimate managers of healthcare delivery and best suited to drive quality, increase efficiency, and decrease costs to put value into the system. We should have the final say regarding the clinical guidelines we will follow and the remuneration we receive for bringing such value. Optimus Healthcare Partners will allow you to remain independent and receive the support you need for Care Transformation and movement towards Patient Centered Medical Home designation. We will remain focused on equitable distribution of value-based shared savings to all the physician members in our network.

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.

As a Specialist what can I expect upon signing up to be a member of Optimus?

Unlike the primary care physicians, specialists are allowed to participate in multiple ACO's. An ACO contract is negotiated for specific patient populations which are identified by which PCP the patient utilizes, therefore PCP's must align with only one ACO. After signing the Optimus participation agreement, the specialist physician will be represented in ACO contract negotiations to obtain defined fee-for-service reimbursement levels, bundled payment arrangements, shared savings, shared risk and other new compensation methodologies for the patient population served by the Optimus ACO.

For patients from different ACO's, the specialist reimbursement will be according to that ACO's contract. For patients with no ACO affiliation or no ACO contract model, Optimus will negotiate an enhanced fee-for-service arrangement for all Optimus physicians. Until these new Optimus contracts are obtained, your existing contracts and reimbursement schedules will remain in place (whether obtained through an IPA or independently).

In preparation for the new insurance contracts, all specialist offices will participate in an "ACO readiness assessment" survey. The survey results will identify what areas of transformation and redesign could be implemented to enhance 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. Optimus will provide care collaboration agreements and referral processes that facilitate better communication and care coordination with Optimus PCP's, other specialists, facilities, VNA's, home health care and other entities. Ongoing education regarding referral guidelines, improved care coordination and care transitions will be provided by Optimus to help maximize your performance and secure your referral base.

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:

  • Quality
  • Finance
  • Medical Management/ Utilization
  • Credentialing

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.