NYCBHOProviderTraini.. - The Coalition of Behavioral Health

Report
OptumHealth NYC BHO Provider Training
Agenda
• Introductions
• Overview of Optum
• Review of Contract between Optum and the Offices
• Provider Tools & Submission Process
• Initial start up experience
• Questions and Answers
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Optum New York Staff
• William Fishbein, Executive Director Optum New York City BHO
– Amy Freeman, Behavioral Health Clinical Manager
– Margaret “Peggy” Elmer, Behavioral Health Clinical Manager
– Joni Richter, Behavioral Health Intake Manager
– Erik Geizer, Quality Assurance/Training Manager
– Linda West, Reporting & Technology Manager
– Michael Silver, Psychiatrist
– Marc Minick, Community Liaison
– Mark Simmons, Community Liaison
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
3
Optum Overview
Optum Organizational Overview
• Optum is a health services business dedicated to making the health
system work better for everyone
• We are comprised of three market-leading business segments:
– OptumHealth
– OptumInsight
– OptumRx
• Optum serves the entire health ecosystem
– 250,000 health professionals and physician practices
– 6,200 hospitals and facilities
– more than 270 state and federal government agencies
– over 2,000 health plans; two of every five FORTUNE 500 employers;
and one in every five U.S. consumers.
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
5
Our Business Context
UNH=Publicly Traded Registrant
(NYSE)
UHG
UnitedHealthcare-Health Benefits
• Health care coverage and benefits
businesses, unified under a master brand
Optum—Health Services
• Information and technology-enabled
health services platform, encompassing:
– Employer and Individual
– Technology solutions
– Community and State
– Intelligence and decision support tools
– Medicare and Retirement
– Health management and interventions
– Administrative and financial services
– Pharmacy solutions
Helping people live healthier lives
Helping to make the health care system work
better for everyone
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
6
Contract Review
NYC BHO – Contracted Region
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
8
Populations covered under the program
• All fee-for-service admissions to OMH-licensed psychiatric units (all
ages) in general hospitals (Article 28 hospitals).
• Fee-for-service children and youth admitted to OMH licensed private
psychiatric hospitals (Article 31 hospitals).
• Fee-for-service direct admissions to OMH State-operated children’s
psychiatric centers or children’s units of psychiatric centers.
• Fee-for-service OASAS Certified Part 816 Inpatient Detoxification
Services (Article 28/32).
• Fee-for-service OASAS certified hospital (Art 28/32) or freestanding
(Article 32 only) Part 818 Chemical Dependence Inpatient
Rehabilitation Services.
• Each new episode of care initiated by Article 31 OMH designated
Specialty Clinics for children/youth (up to 19th birthday) diagnosed as
having a Serious Emotional Disturbance (SED) who are covered by
Medicaid Managed Care
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Functions of the BHO include:
Concurrent
Review
Discharge
Planning &
Tracking
Tracking of
Children with SED
• Optum will complete initial reviews for applicable services of Fee-For-Service Medicaid
members within 72 hours after admission or by 5pm of the next business day following
notification of the admission by the provider, whichever is later. Follow-up reviews will
be conducted at regular intervals.
• Optum will engage with the inpatient provider with respect to discharge planning for
applicable admissions
• Enhanced efforts will be employed for inpatients identified as “High Need Individuals”
• Each new episode of care initiated for a Medicaid Managed Care SED child will be
tracked for reporting back to the State
Provider Profiling • Historical Clinical data will be provided by the Offices to the BHOs
/Analytics
• Data elements specific to each inpatient admission and provider will be collected by the
BHO and shared with the Provider and the Offices.
Community
• Metric Reporting will be provided back to the Offices
Liaisons
Facilitation of
Cross System
Linkages
Quality Initiative
• Optum will work with the Offices and the Providers to determine cross system linkages
for adults and children with mental health conditions and substance use disorders
• Optum will devise a quality assurance program to monitor the quality of work
performed within the contract
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Review of Contract
The Offices
• Supplies Optum
with guidance to
perform tasks
• Supplies
historical clinical
data
• Supports access
to cross systems
Optum
Provider Community
•Notify Optum of
admission
(Portal, Fax or Telephonic)
•Notify Optum regarding
Children with SED
• Performs initial/
concurrent reviews
• Monitoring discharge
planning & postdischarge services
Provider Community
• Follows concurrent
review & discharge
monitoring processes
• Tracking of children
with SED
• Provider profiling
• Facilitation of cross
system linkage
• Quality Initiative
• Treatment History
Form
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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What we need from you:
Partner with Us
• Submit requested information to be used in initial/concurrent reviews, discharge
planning/tracking, SED tracking, and cross system facilitation
• Use your dedicated Care Advocate and Community Liaison as a part of your team
• Follow the concurrent review & discharge planning/tracking processes
Engage in the
Process
• Identify Cross System Linkages
• Provide data as requested
• Use the tools provided
• Don’t hesitate to ask us questions
• Clinical questions can be directed to the Care Advocate or to:
[email protected]
Ask Questions
• General questions can be directed to the Executive Director & Community Liaisons or to
[email protected]
• ProviderConnect technical questions/issues can be directed to:
[email protected]
Other
• Let us help you!
• We want your feedback.
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Provider Tools & Submission Processes
Provider Tool Review- Methods for submission
• Individual Information Matrix
Fax
- Within 24 hours of admission
- Concurrent Review at established intervals
- Discharge by the date of discharge but no later than within 24 hours post discharge .
Fax #
Telephonic
Portal
• Clinical Fax: (877) 283-0555
• Toll-free: (866) 505-3398
• Dedicated Care Advocate assigned by Facility
• New provider portal: www.optumhealthnyc.com
• ProviderConnect software
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Submission time frames
•
Childen with Serious Emotional Disturbance (SED) Report
– Submitted for each new episode of care for SED children covered by Medicaid managed care
– Providers to complete and submit within 3 business days of initiation of services
– Submit via fax, portal, or telephonic
•
Individual Information Matrix Form (inpatient providers)
•
Admission
– Providers to notify their assigned BHO within 24 hours of admission, except that for
admissions which occur on a weekend or holiday such notification would be required by
5 P.M. of the next business day following such week-end or holiday.
•
Concurrent Review
– Optum will complete initial reviews for applicable services of Fee-For-Service Medicaid
members within 72 hours after admission or by 5pm of the next business day following
notification of the admission by the provider, whichever is later. Follow-up reviews will
be conducted at regular intervals.
•
Discharge Planning
– Provider to complete and submit by the date of discharge but no later than within 24
hours post discharge.
•
Forms located on the Optum NYC BHO Provider Portal : www.optumhealthnyc.com
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Experience since start up
• Volume
– 65 admissions per day (average)
– 40% portal, 38% fax, 22% telephonic
• Major initial activities
– Initiating review process
– Provider outreach
– Provider training
– Connecting with stakeholder groups
– Completion of staff hiring and training efforts
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Initial challenges
• Different review process
• Provider resources
• Usage of web portal
• Data submission for SED children
• Engagement of some inpatient providers
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
17
Challenges on the near horizon
• Working with health homes
• Integration of peer support services
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
18
Questions?

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