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In this business profile, Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.

Elena WhiteTell us a little bit about your organization.

Optum™ is a health services and innovation company on a mission to help make the health system work better for everyone. When we say "everyone," we mean everyone with a stake in creating a better future: those who provide care, those who pay for care, and—most importantly—those who need care. The company combines data and analytics with technology and expertise to power modern health care, and in collaboration with our partners, focuses on three key drivers of transformative change: modernizing the health system infrastructure, advancing care, and empowering consumers.

Optum actively serves and partners with care providers and health systems—including four out of five hospitals—supporting their focus on driving quality care, creating better patient experiences, and achieving operational efficiency and cost savings. The company also works across the industry, providing services to 300 health plans, approximately 150 global life sciences companies, 67,000 pharmacies, half of the Fortune 500 companies, and 40 state and government agencies. Through these important relationships across the health system, we touch and make a positive impact on more than 76 million individuals.

What are some of the biggest challenges you see affecting healthcare organizations?

In today's environment, one of the biggest challenges is the ongoing—and fast accelerating—shift from fee-for-service (FFS) to value-based payments. While some in health care, particularly providers, may be primarily operating FFS models, recent activity and announcements by the Centers for Medicare & Medicaid Services (CMS) and commercial health plans are spurring the transition to value-based care. As spelled out earlier this year by HHS Secretary Sylvia M. Burwell, CMS intends to tie 85 percent of all traditional Medicare payments to quality by 2016 and push that to 90 percent of all payments by 2018. Private payers, too, are increasingly looking to create alternative payment model contracts that emphasize value while sharing risk with the health provider.

At the same time, healthcare consumers who are taking greater ownership of their healthcare decisions are faced with their own set of challenges as they try to navigate the shifting landscape and search for health networks or plans that will deliver the most value for their increasing out-of-pocket investments. They are more engaged and empowered than ever before as their mindset changes from "my health, your money" to "my health, my money."

How do your solution and service offerings help address these challenges?

Optum partners with provider organizations and hospitals making the transition from volume to value to identify organizational strengths, shore up weaknesses, and find the best opportunities to realize positive change. For example, many new payment models require healthcare providers to think and behave more like health plans as the providers assume greater risk. Optum can analyze and align both the local market landscape and a provider's strengths to map out the best payer contracting and provider network strategy. In-house experts provide added knowledge, such as actuarial guidance, to ensure providers are set-up for success in their risk-sharing arrangements. Similarly, we can deliver outcomes data and analytics to develop an appropriate care delivery and management strategy. Consulting, operational, and IT resources are available for providers for all areas of risk operation, which includes performance acceleration; network and referral management; integrated clinical models, including risk contract and care coordination solutions; and comprehensive analytics technology and services.

Optum has a track record of working with payers, using internal claims data to better understand healthcare providers' performance. This experience benefits our provider clients because we guide them through strategies for engaging in value-based contracting and point to methods on how to work more closely and effectively with payer partners to better ensure success in risk-based contracts.

What are some key considerations for healthcare leaders when choosing this type of solution or service?

Today's healthcare marketplace is complex, and it can be challenging to find experienced vendor partners that have the breadth and depth of resources needed to enable risk. When looking for a partner, provider organizations are better served if they don't simply evaluate companies based on the products and/or services needed right now, but anticipate additional needs that might be required down the road. Single-focus solutions can address an immediate problem, but providers are wise to closely examine their goals and anticipate future needs. Seeking a collaborative partnership is essential. Providers can also benefit from a vendor relationship that offers a comprehensive suite of solutions and services that support organization objectives both today and as the organization evolves.

A strong, full-service vendor will typically offer a wide-range of services, including an experienced team that provides strategic consulting; quality and depth in data resources and analytics; operating resources that bring scale and flexibility; and technology platforms built to meet the changing demands and opportunities of clients. Organization leaders should also check prospective vendors' industry track records to ensure they are selecting a partner that delivers measurable results. Finally, looking for broad expertise in the areas of risk-based payer contracting, network management, care management, and operations is extremely important.

As healthcare providers implement use of your solutions and services into their day-to-day operations, what advice would you offer so they can best set themselves up for success?

Aligning your people with processes and technologies powered by analytic insights is key to successfully managing financial risk. Starting with strong payer and provider network strategies is essential and should guide your investments in solutions and services to deliver and manage care under risk contracts. Strategic operation and governance by an experienced leadership team when transitioning an organization is also critical. At the top of the operational list is taking time to identify which key staff resources will use the tools and solutions and engage these individuals in the implementation process as early as possible. These stakeholders can provide critical insight and ensure the resulting changes deliver operational efficiency and value. Organizations can also develop protocols and processes in advance of deploying risk enablement solutions to hone the business case and make sure employees are fully leveraging any new tools or solutions. Finally, maintaining open communication is imperative because it is the trigger that allows leadership and a partner like Optum to more readily adapt processes and services to meet your organization's needs as the industry and local environment change.

Are there any educational materials you would like to share to help healthcare providers in these efforts?

For more information on the suite of services and solutions Optum offers to providers making the transition to value-based models, visit www.optum.com/risk. Also, we recommend viewing our publication developed specifically for providers taking on financial risk and improving quality, RISKMATTERS.


HFMA is the nation’s leading membership organization for more than 40,000 healthcare financial management professionals. Business Profiles are funded through advertising with leading solution providers. Learn more.

OptumContent for this Business Profile is supplied by Optum. This published piece is provided for advertisement purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions of those profiled are those of the individual and not those of HFMA. References to commercial manufacturers, vendors, products, or services that appear do not constitute endorsement by HFMA.

Publication Date: Sunday, November 01, 2015