Sustainable Solutions for Health Plans
It is clear the past and present models of coordinated care are not sustainable. Health plans have failed to engage physicians or patients and instead focus on “unit price” strategies. Optimus Healthcare Partners believes a collaborative patient-centered approach between health plans and providers can provide more sustainable solutions.
The key will be integrating the resources and competencies of each entity within new compensation models that align financial incentives. The fragmented silo approach to healthcare can be replaced with a coordinated accountable direction. The results will be improved quality, affordable premiums, true value and a sustainable solution for the purchasers and consumers of healthcare.
Accountable Physicians,
Hospitals & Health Plans
Prior years have seen negative relationships develop between health plans, physicians and hospitals due to recurring “price-based” negotiations. Each entity strives to squeeze the maximum amount of dollars from the other, with minimal attention to the needs of patients or purchasers.
Optimus Healthcare Partners returns “clarity of purpose” to these relationships by holding all entities accountable for patient quality, utilization and experience. This accountability is driven by the Optimus performance management framework that closely follows specific metrics, communicates real-time performance, and outlines needs for improvement over specific time periods. Physicians not willing to improve can be decredentialed from the Optimus network while transparent hospital report cards guides referral patterns to high performing facilities. Health plans are rewarded with superior HEDIS, CAHPS and STAR ratings while maintaining affordable health care premiums.
A Collaborative Patient-Centered Approach
The physicians in Optimus have agreed to redesign daily workflows and incorporate
the value-driving elements of a successful accountable care organization.
PRIMARY CARE PHYSICIANS
For primary care physicians, these elements include the joint principles of the Patient-Centered Medical Home:
- A personal physician that is willing to takes responsibility for their Medicare Fee-for- Service patients and Commercial patients and is willing to rebuild the physician-patient relationship
- Enhanced access to care for Medicare Fee-for- Service patients and Commercial patients including same day / off-hours / weekends and electronic access
- A physician directed medical practice that utilizes all personnel to the level of their licensure in a team approach
- Whole person orientation replaces the fragmented silo approach. The physician and team look to understand and support not just the patient's physical needs but their emotional, social, cultural, mental and spiritual needs.
- Care coordination is provided through the use of Optimus clinical coordinators, patient registries and health information exchanges
- Quality and safety are improved through compliance with evidence-based guidelines, clinical decision support tools, electronic health records and E-prescribing
- Physician payment model that recognizes value rather than volume of services
SPECIALTY CARE PHYSICIANS
For Optimus specialists, the value-driving elements involve adhering to the Optimus PCP-Specialist Care Coordination Agreement. This document is signed by both primary care physicians and the specialists they utilize. The agreement outlines the care coordination responsibilities of each party, including:
- Methods of communication for patient referrals
- Timeliness of consultations & availability
- Level of co-management requested by the PCP
- Contents of the ideal transaction record to accompany the patient to the specialist
- Contents of the consultation to be communicated with the PCP
- Consideration of the patient and family during all transitions in care
Together the Optimus PCP's and specialists utilize the Optimus patient registry, health information exchange, analytics and decision support to proactively manage patient populations.
The Optimus Physician Network
The Optimus organization looks to partner with health plans to redesign the current system of care.
For primary care physicians, these elements include the joint principles of the Patient-Centered Medical Home:
- A personal physician that is willing to takes responsibility for their Medicare Fee-for- Service patients and Commercial patients and is willing to rebuild the physician-patient relationship
- Enhanced access to care for Medicare Fee-for- Service patients and Commercial patients including same day / off-hours / weekends and electronic access
- A physician directed medical practice that utilizes all personnel to the level of their licensure in a team approach
- Whole person orientation replaces the fragmented silo approach. The physician and team look to understand and support not just the patient's physical needs but their emotional, social, cultural, mental and spiritual needs.
- Care coordination is provided through the use of Optimus clinical coordinators, patient registries and health information exchanges
- Quality and safety are improved through compliance with evidence-based guidelines, clinical decision support tools, electronic health records and E-prescribing
- Physician payment model that recognizes value rather than volume of services
Together the Optimus PCP's and specialists utilize the Optimus patient registry, health information exchange, analytics and decision support to proactively manage patient populations.