Total Solutions for Health Care

Aligning Purchasers & Optimus Healthcare Partners

It is time for employers, unions, and all purchasers of healthcare to recognize their role in transforming how health care is delivered and paid for. The Optimus Healthcare Partners team has delivered the platform and operational expertise to provide your employees and family members with a new level of health care quality and experience. This is coupled with the financial accountability levers driving affordability. Your next step is arranging an introductory meeting with the Optimus Healthcare Partners management team.

Our discussions and follow-up meetings will involve:

  • Overview of the Optimus Healthcare Partners accountable care organization and provider network
  • Identification of your present health care quality, cost, and experience trends along with existing employer-based or health plan-based programs
  • Designing an Optimus-based program for your employees and family members (including retirees)
  • Recruitment of non-Optimus physicians that care for your employees and family members
  • Value-based benefit design analysis and recommendations
  • Agreement on accountable performance metrics and compensation models rewarding value instead of volume
  • On-going proactive population and performance management

Accountable Care

Employers and Optimus Healthcare Partners Transforming Healthcare Delivery

The choice should be clear. The basis for alignment between employers and Optimus is simple: "clarity of purpose". As noted in the Optimus "Mission, Vision and Values" statements, our clarity of purpose is doing the right thing for the patient. The same goes for employers looking to protect their greatest asset - human capital. Intermediaries with private agendas, large overheads and legacy systems are replaced by a partnership focused on outcomes and results. Together we can truly transform the financing and delivery of health care.

The Optimus-Employer alignment includes:

  • Redesign the delivery of primary care by supporting and establishing a foundation of Patient-Centered Medical Homes. Compelling research reveals better care and lower costs can be achieved through Medical Homes delivering care that is more accessible, promotes prevention, proactively manages patients with chronic disease, and engages patients in self-management and shared-decision making. Optimus can identify the primary care physicians utilized by your employees and family members, enroll them in the Optimus network, and help them implement the PCMH model of care.
  • Create health insurance product design and performance requirements that align incentives with the goals of improved quality and efficiency. Optimus can work closely with your benefits and human resource departments to implement value-based designs and performance management frameworks.
  • Integrating employer-based wellness and care management programs with Optimus physician offices, providing a multitude of interventions to drive improved outcomes while leveraging the physician-patient relationship to drive employee engagement.
  • Optimus physician offices utilizing customized “goal-directed” patient care plans to direct patient self-management, engagement in patient interventions, compliance with treatment programs, and selection of healthy lifestyle choices. The Optimus patient care plan and dashboard can be coordinated with on-site clinics, plan case managers, telephonic disease management, and other vendors utilized by the employer.

Providing the scale, experience, tools and support to achieve excellent results

Optimus Healthcare Partners has performed extensive analysis in designing the required infrastructure, processes, incentives, compensation models and performance framework for a truly accountable organization.

Optimus providers are continually measured and provided feedback on evidence-based care compliance, practice variations, gaps-in-care, appropriate utilization and patient satisfaction. We look to incorporate those measures of interest to employers such as absenteeism, present-eeism, and the impact on indirect healthcare costs.

The Optimus compensation model provides the required change in reimbursement linking financial rewards to clinical outcomes rather than volume. Fee-for-service is replaced or modified to incorporate accountability. Reimbursement is aligned with value through various models including:

  • Bundled payments / episodes of care
  • Shared savings
  • Shared risk
  • Global payments

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.