Pay-for-value can improve behavioral health care

Deb-Adler_Paying for value not only helps drive improvements in behavioral health care and lower costs. It also inspires innovation in treatment and empowers consumers.

Today at Optum, nearly 20 percent of our total spending on inpatient network-based behavioral health is tied to performance-based contracts. These contracts reward providers for collaboration, better patient outcomes and improved cost efficiencies.

We do this through our Achievements in Clinical Excellence (ACE) program that rewards and acknowledges facilities and individual clinicians who provide superior patient care.

How Achievements in Clinical Excellence works

Facilities are rated for quality and efficiency of care using seven indicators, most of which are based on widely accepted industry standards. Those who meet both quality and efficiency criteria are rewarded with Platinum status. Those who meet only quality standards are rewarded with Gold status.

Platinum facilities receive benefits, including reduced administrative requirements, marketing support and prominence in our provider directories.

ACE includes frequent and productive feedback such as monthly scorecards and meetings between Optum and our network facilities.

Our pay-for-value agreements with facilities include incentives to reward results:

  1. Enhanced reimbursement or shared savings if performance is within targeted range
  2. Additional reimbursement or greater sharing if performance exceeds range (up to a cap)
  3. Enhanced payment for exceeding effectiveness metrics

We are in our second year of our ACE outpatient program for individual clinicians and groups, who can earn higher reimbursement rates and complimentary continuing education courses for achieving Platinum status.

Consumers see the names of clinicians and facilities who are top rated (indicated by two stars for Platinum, one star for Gold) when searching for providers in our online directories.*

Rewarding providers for delivering care more effectively and efficiently are achievable goals that align with the needs of everyone engaged in making our communities healthier — consumers, providers, payers, and Optum alike.

*Except where restricted

 

For more information

Deb Adler

About the author

Deb Adler, Senior Vice President, Specialty Network Services, Optum

Deb Adler is responsible for coordinating all recruitment, credentialing and contracting for a network of 130,000 behavioral health providers — assuring members have access to quality providers and a broad continuum of care. Her staff has facilitated innovative network programs, including tele-psychiatry and operational requirements to incorporate peer- and family-run organizations into network services. She has a master’s degree in educational psychology and evaluation from Catholic University of America and is a certified professional in health care quality (CPHQ). She has been with Optum since 2008.

Leave a Comment

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s