TO TACKLE THE BIGGEST CHALLENGES IN HEALTH CARE, YOU HAVE TO THINK BIG.

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1 TO TACKLE THE BIGGEST CHALLENGES IN HEALTH CARE, YOU HAVE TO THINK BIG. Together our partners, we re doing just that. Explore case studies and stories of success.

2 PATIENT HEALTH CASE STUDIES AND SUCCESS STORIES NYUPN PREMIER MEDICAL LEHIGH VALLEY HEALTH NETWORK AURORA HEALTH CARE PRECHECK MYSCRIPT

3 PATIENT HEALTH NYUPN Identify out-of-network utilization and share key performance metrics providers to identify referral trends and thereby improve in-network utilization SOLUTIONS USED Identify drivers of out-of-network utilization such as types of conditions, and particular providers whose patients are most often treated out of network Share performance reports physicians highlighting referral trends and performance metrics in order to improve in-network utilization Within weeks, NYUPN was able to build reports needed to have successful, data driven conversations their physicians. Education on out-of-network utilization trends led to an increase in in-network utilization by 5% in one year. Increasing in-network utilization results in millions of dollars for health system risk contracts and a more coordinated, high quality care team experience for patients.

4 PATIENT HEALTH Premier Medical REDUCE READMISSIONS Premier was looking to expand on their data-driven approach to improving quality and cost. SOLUTIONS USED Used Optum analytics to improve Population Health Management (PHM) by adopting a proactive approach to care. This included identifying patients at high risk for admission or readmission, then reaching out to help those patients better manage their chronic conditions. HEART FAILURE READMISSIONS DOWN 27% Premier saw care management improvements such as a 27% readmission reduction for high-risk patients.

5 PATIENT HEALTH Lehigh Valley Health Network ACHIEVE SAVINGS OF $3.1M Address the top 5% highest-risk patients by turning data into actionable information SOLUTIONS USED Define high-risk patients using a combination of HCC, utilization, predictive models, and high risk/low spend patient identification criteria Collaborate care teams to define critical clinical values to view in registries Create multiple registries to standardize workflow Set targeted PMPM as a network goal tied to employee incentives Tap above to view video REDUCED COSTS BY $6M Together, Optum and LVHN achieved: Robust data and credible outcome metrics and it s beginning to have a viral effect in our medical staff.

6 PATIENT HEALTH Aurora Health Care Identify patients likely to be admitted for a CHF-related hospitalization Implement operational processes to support proactive management SOLUTIONS USED Isolate patients 80%+ likely of admission for CHF or COPD Validate patient inclusions local providers and disseminate lists to health coach RNs Implement a new approach to provide additional care, through an initial co-visit Health Coach RN and provider to develop a comprehensive care plan Together, Optum and Aurora achieved: 65% 30% REDUCTION in heart failure admissions DECREASE in all-cause readmissions from DECREASE in ED utilization ABILITY TO CARE for larger panel sizes

7 PATIENT HEALTH PreCheck MyScript Physician REAL-TIME DATA TRANSPARENT COLLABORATION PreCheck MyScript ADMINISTRATIVE SIMPLIFICATION SPEED, COST TRANSPARENCY Pharmacy Empower prescribers to reduce drug spend and administrative pain points for the patient and themselves Patient SOLUTIONS USED Within the prescriber s Electronic Medical Record e-prescribing workflow, display the same real-time patient pharmacy benefit coverage and cost information that would be available at a retail pharmacy. It will: Alert the prescriber of drugs that require prior authorization, are not covered, or are non-preferred Provide alternate, lower-cost medications that do not require prior authorization before a patient is sent to the pharmacy If needed, allow the physician to submit the electronic prior authorization online, many of which receive instant approval Early data indicates tens of thousands of prescribers have used PreCheck MyScript over 1.5 million times to potentially avoid a negative patient experience at the pharmacy counter, impacting hundreds of thousands of patients. of transactions resulted in an alternative drug 1 >20% >30% prior authorizations avoided or initiated 1 1. May-Mid-Oct 2017, UnitedHealthcare data

8 REVENUE CYCLE SERVICES CASE STUDIES AND SUCCESS STORIES DIGNITY HEALTH HALLMARK HEALTH MISSION HEALTH UNIVERSITY OF VERMONT MEDICAL CENTER BURLINGTON

9 REVENUE CYCLE SERVICES Dignity Health End-to-end revenue cycle management Dignity Health trusted Optum to take over its revenue cycle operations, and formed Optum360 for that purpose. Upgrade revenue cycle tools and operations Improve financial performance and address revenue leakage Better manage to changing industry regulations, payment models and technology trends 11.9% 2.8% DECREASE in gross accounts receivable days INCREASE in CC/MCC capture rate for Medicare and Medicare Managed Services Point of service collections +15M +10.4% +26% +49.6M Medicare CMI (case mix index) in average cash collections in revenue recovery due to additional eligibility screenings on self-pay accounts

10 REVENUE CYCLE SERVICES Hallmark Health System INTEGRATION SOLUTIONS YIELD SUCCESS Hallmark Health System is the premier charitable provider of vital health services to Boston s northern communities, and includes 6 facilities, 700+ physicians and 324 beds. SOLUTION Using Optum360 coding service, Enterprise CAC, CDI 3D and on-site consulting, Hallmark Health transitioned smoothly to ICD-10, unified coding and CDI workflow and achieved over 90 percent response rate to physician queries resulting in impressive financial and operational improvements. BOOSTED REVENUE $1.3M after 3.5 percent case mix index increase INCREASED PHYSICIAN QUERY RESPONSE RATE IMPROVED SOI RATING from 2 TO 3 (severity of illness) IMPROVED ROM RATING from 1 TO 2 (risk of mortality) from -30 percent to over 90% Optum360 solutions get results for Hallmark Health System DECREASED INPATIENT CODING BACKLOG BY 80% from 15 days to 3 days REDUCED OUTPATIENT CODING BACKLOG BY more than 50% from 30 days to 14 days REDUCED UNBILLED A/R BY MORE THAN $8M

11 REVENUE CYCLE SERVICES Mission Health Mission Health, based in Asheville, NC, operates six hospitals, numerous outpatient and surgery centers, and the region s only dedicated Level II trauma center. With a medical staff of more than 1,000 physicians, approximately 10,700 employees and 2,000 volunteers, Mission Health is dedicated to improving the health and wellness of the people of western North Carolina. CAC & CDI 3D SOLUTION WITH OBTAINED Using Enterprise Computer-Assisted Coding integrated CDI 3D, Mission Health achieved: The Optum360 technology is definitely supporting our overall goals... We re accurately reflecting the acuity of care we re providing and capturing accurate documentation, as well as building additional efficiencies. Our results speak for themselves. ELIANA OWENS Executive director for coding, CDI and revenue integrity $4.8M 2.4% 30% 115% 26% INCREASE IN TOTAL reimbursement in the first fiscal year INITIAL INCREASE IN case mix index (CMI) due to Enterprise CAC and concurrent coding DECREASE in DNFC INCREASE IN CDI queries per month, and a IMPROVEMENT in CDI productivity

12 REVENUE CYCLE SERVICES University of Vermont Medical Center Burlington The University of Vermont Medical Center had a large number of payer denials and rejections returned to the billing staff, requiring them to sort out, research, and correct the errors made by the clinical staff before resubmitting the claims to payers Medicare, Medicaid, and four commercial carriers for payment. They needed to correct claims and quality control charges, and improve its financial and administrative performance. ROI HAVING CLAIMS MANAGER 18.65:1 COST SAVINGS $3.5M DECREASED A/R DAYS TO 31.5 DAYS DENIAL RATE BY PAYERS REDUCED TO 5.1% I think the value of Claims Manager is as a cash accelerator. I am not waiting days for a denial before I can fix something. In terms of clean claims, and getting it right before we bill it that is where the value of Claims Manager shines. MICHAEL BAREWICZ Director of Professional Revenue, University of Vermont

13 VALUE-BASED CARE VALUE-BASED CARE SUCCESS STORIES CARESYNC STRATEGY FOR REGIONAL HEALTH SYSTEM WILMINGTON HEALTH

14 VALUE-BASED CARE A TURNKEY SOLUTION WITH SEAMLESS WORKFLOW INTEGRATION Our industry-leading technology and service along evidence-based tools drives better management of chronic conditions and revenue over the long term PATIENT ENGAGEMENT CareSync 65% of patients are more engaged in their care 1 84% of patients remembered their follow-up items 1 REDUCE UNNECESSARY VISITS 20% reduction in hospitalizations 2 21% reduction in 30-day readmissions 3 68% avoided duplicate tests 4 49% of cases uncovered a medical error 4 PROGRAM COMPLIANCE Track patient interventions and provides CMS audit protection EXPERIENCED KNOWLEDGEABLE TEAM We provide and manage the team to extend your reach TECHNOLOGY 1. CareSync client survey; 2015, Commonwealth Fund, Massachusetts General. 3. Urban Institute Health Policy Center, John Hopkins initiative. 4. CareSync internal tracking of data 2015, 2016, Varies based upon Medicare patient mix and enrollment rate. REVENUE OPPORTUNITY $50 150k per physician per year incremental revenue opportunity 5 The Optum solution generates 4 times more revenue than the industry due to higher billing and retention rates over the life of the program CMS compliant technology that integrates your EMR

15 VALUE-BASED CARE Strategy for regional health system Develop value-based care contracting strategy to maximize return on population health investments for next seven years SOLUTIONS USED Completed an assessment and opportunity analytics to identify opportunities and risks Developed plan to maximize returns on population health management platform investments Developed road map to maximize returns on population health programs (Medical neighborhood models) Developed road map for VBC at risk contracting $4 5M ~$8M Estimated annual cost savings across members top 4 chronic conditions Estimated benefits from risk adjustment practices and commercial payer contracts

16 VALUE-BASED CARE Wilmington Health LOWER READMISSION RATE Prepare for value-based care (VBC) by analyzing patient data and identifying areas for improvement SOLUTIONS USED Using Optum One metrics and analysis, Wilmington deployed VBC innovations like the utilization of clinical research to engage patients in order to reduce per member per month (PMPM) costs. Optum One metrics also helped Wilmington Health convert to VBC at an abnormally low cost. Widely held estimates indicate it costs between $1.5 $4 million to launch an accountable care organization. Wilmington was able to do it for $300,000. READMISSIONS 21% LOWER 37.6% lower hospitalization rate, 38.6% reduction in ER visits, 20.5% lower 30-day readmission rate Tap above to view video

17 FEDERAL HEALTH IT SOLUTIONS CASE STUDIES AND SUCCESS STORIES CMS ONE PI (PROGRAM INTEGRITY) OPM HEALTH CLAIMS DATA WAREHOUSE

18 FEDERAL HEALTH IT SOLUTIONS CMS One PI (Program Integrity) REDUCE FRAUD WASTE AND ABUSE (FWA) ACTIVITIES, AND ENSURE PI DATA ARE ACCURATE AND SECURE Preserve and protect the integrity of Medicare and Medicaid by creating the One PI system to identify, deter and prevent all fraud, waste and abuse activities across the Centers for Medicare and Medicaid Services (CMS) SOLUTIONS USED Optum develops, maintains and improves the One PI portal and creates new ways for CMS to analyze data to include training, business intelligence, security and compliance, and continually engages the end-user community. TOTAL USERS SUPPORTED BY ONE PI MONTHLY DATA REQUESTS 2,200 54,000+ Helped CMS develop Medicare-Medicaid (Medi-Medi) data analytics to improve PI and fight FWA, and created a mapping tool to identify opioid prescriptions locally to fight the epidemic.

19 FEDERAL HEALTH IT SOLUTIONS OPM Health Claims Data Warehouse OPTUM SELECTED TO BUILD HEALTH CLAIMS DATA WAREHOUSE (HCDW) We are proud to assist the Office of Personnel Management (OPM) overseeing the administration of benefits through the Federal Employee Health Benefits Program for approximately 8.2 million federal workers, retirees and their dependents. HCDW will provide OPM detailed information on the cost and quality of health care services in different geographic regions, across health plans and specialty types, and for sub-populations. Optum helped establish a system to receive encrypted data from FEHB plans, which enabled the initiation of the HCDW build. We also provide ongoing SME development and program management support.