ACO Congress Using Analytics to Improve ACO Performance November 5, 2013
Introductions Deb Davis OPTUM General Manager, West Region Accountable Care Solutions Jay Hazelrigs OPTUM National Lead, ACO Actuary Accountable Care Solutions 2
Analytics for ACO s High Risk Claimants Provider Performance 3
It may feel like you are scaling Mount Everest! You need critical information to help make critical decisions 4
The challenges in transitioning to value-based care Which patients are at high risk? What conditions exist in my population? What s happening to my patients outside of my four walls. Are my patients getting better? Who is managing the patient? What is the optimal treatment plan for the patient? Where am I on the quality standards? What is my bonus? How do I compare with my colleagues? 5
Electronic medical records are only the first step in the evolution, a technology for the fee-for-service model Longitudinal Population Health Management Prediction Stratification Fee for value Technology Analysis Reporting Transactional Monitoring Fee for service Low Health Status High 6
The next evolution is enabling technology that adds value to a fee- for-service and fee-for-value world Longitudinal Population Health Management Prediction Stratification Fee for value Technology Analysis Reporting Transactional Monitoring Fee for service Low Health Status High 7
Key Capabilities Needed Risk/Value-Based Contracts Advanced Clinical Risk Prediction Advanced Care Management Cost/Risk Analytics (Predicted Cost, Total Spend, Leakage, Etc.) HCC RAF/Risk Score Optimization Mobile Patient Education & Remote Monitoring PCMH Clinical Integration (HIE, Registries) Basic Clinical Analytics (Clinical Stratification) Patient Relationship Management Transition Management P4P Patient Registries & Gaps-In-Care Management Tasking and Alerting for Physicians in the EMR Physician Management (Scorecards, Dashboards, etc. Measure Reporting (ACO, PQRS, HEDIS, Etc.) 8
Population Segmentation
Population Segmentation Commercial High Level Example 10
HCC Risk Score Stratification by Beneficiary Member Key Death Date Attributed Physician Paid 7/11 to 6/12 2012 Final Score Total HCC Count HIV/ AIDS Septicemia/ Shock Opportunistic Infections Metastatic Cancer and Acute Leukemia 917 6/25/2012 Deceased $211,250 8.821 15 0 1 0 0 9854 JOHN DOE, MD $143,797 8.738 12 0 0 0 0 25174 11/14/2012 Deceased $171,693 8.607 13 0 1 0 0 4915 JOHN DOE, MD $182,737 8.347 15 0 1 1 0 11386 8/29/2012 Deceased $203,616 8.331 14 0 1 0 0 24530 JANE DOE, MD $231,594 8.117 14 0 1 0 0 19564 JANE DOE, MD $73,990 8.102 12 0 0 0 0 16662 JOHN DOE, MD $82,412 8.084 11 0 0 0 1 21446 JANE DOE, MD $100,917 7.989 11 0 1 0 1 7633 8/30/2012 Deceased $130,027 7.979 10 0 1 0 1 11
Hidden Risk/Low Utilizers All Members Low Utilizers % of Total Living Beneficiaries 29,784 550 1.8% Gender Female 17,486 320 1.8% Male 12,298 230 1.9% Race White 28,757 533 1.9% Black 718 11 1.5% Asian 17 0.0% Hispanic 50 0.0% Native American 17 2 11.8% Unknown 81 1 1.2% Other 144 3 2.1% Age Category <65 3,077 72 2.3% 65 69 5,472 51 0.9% 70 74 6,591 70 1.1% 75 79 5,659 73 1.3% 80 84 4,473 80 1.8% 85 89 2,896 105 3.6% 90 94 1,307 84 6.4% 95+ 309 15 4.9% Risk Score <1.00 21,088 0.0% 1.00 1.15 1,752 248 14.2% 1.15 1.35 1,692 168 9.9% 1.35 1.65 1,685 76 4.5% 1.65 2.00 1,111 34 3.1% 2.00 2.25 526 9 1.7% 2.25 2.60 526 6 1.1% 2.60 3.10 509 7 1.4% 3.10 3.50 277 0.0% 3.50 4.00 236 2 0.8% 4.00+ 382 0.0% Low utilizers are defined as beneficiaries with a risk score greater than 1.000 and less than $1,000 in claims Identifies at risk populations by various categories Beneficiary detail is also provided 12
Frequent Flyers Emergency Room Visits People with Emergency Room Visits in November, 2012 Member Key Death Date Primary Diagnosis (highest cost) Paid 7/11 to 11/12 # ER Visits 16142 12/23/2012 5715 Cirrhosis of liver without mention of alcohol $42,231 6 12812 6824 Cellulitis and abscess of hand, except fingers and thumb $20,085 6 14762 7847 Epistaxis $4,176 6 28664 49121 Obstructive chronic bronchitis, with (acute) exacerbation $143,077 5 17239 30000 Anxiety state, unspecified $43,101 5 People with Multiple Emergency Room Visits in October and November, 2012 Member Key Death Date Primary Diagnosis (highest cost) Similar report will be provided for frequent admissions/readmissions Paid 7/11 to 11/12 # ER Visits 17239 34830 Encephalopathy, unspecified $43,101 14 21613 490 Lymphocytic choriomeningitis $35,157 12 13362 78659 Chest pain, other $42,973 9 22084 38014 Malignant otitis externa $13,686 8 13
Frequent Flyers Monthly Summary Diagnosis Member Total ER Specific Key Primary Diagnosis Visits ER Visits 11/1/12 10/1/12 9/1/12 8/1/12 7/1/12 21613 30000 Anxiety state, unspecified 62 10 2 1 2 4 1 Migraine, unspecified without mention 34690 of intractable migraine without mention 21613 of status migrainosus 62 9 1 1 0 0 1 21613 78650 Chest pain, unspecified 62 4 0 1 0 0 0 Sprain and strain of unspecified site of 21613 8479 back 62 4 1 0 0 0 1 21613 920 Early syphilis, latent, serological relapse after treatment 62 3 0 1 0 1 0 21613 8020 Nasal bones, closed fracture 62 2 0 0 0 0 0 21613 7242 Lumbago 62 2 0 0 0 0 1 21613 7840 Headache 62 2 0 0 1 0 0 21613 7245 Unspecified backache 62 2 0 0 0 0 1 21613 78605 Shortness of breath 62 2 0 0 0 0 0 21613 78900 Abdominal pain, unspecified site 62 2 0 0 1 0 0 21613 V681 Issue of repeat prescriptions 62 2 0 0 0 0 1 21613 78609 Other dyspnea and respiratory abnormalities 62 1 0 0 0 0 0 21613 4739 Unspecified sinusitis (chronic) 62 1 0 0 0 0 0 Similar reports provided for frequent admissions/readmissions 14
High Cost Beneficiaries Death Total Paid Total Paid Total Paid Member_KEY Age status Date Hospice? Highest Cost DRG or Condition IN 2011 in 2009 in 2010 in 2011 4624 44 Disabled Factor VIII Recombinant NOS $423,156 $558,483 $467,215 28332 55 ESRD 0907 Other O.R. Procedures for Injuries with MCC 130,950 182,989 449,334 24403 77 Aged 0003 ECMO or Tracheostomy with Mechanical Ventilation 96+ Hou 2,163 10,125 424,532 13294 74 Aged 0003 ECMO or Tracheostomy with Mechanical Ventilation 96+ Hou 1,378 61,514 417,470 29189 65 ESRD 0003 ECMO or Tracheostomy with Mechanical Ventilation 96+ Hou 62,689 73,977 372,023 30613 68 Aged 0003 ECMO or Tracheostomy with Mechanical Ventilation 96+ Hou 34,267 84,167 366,055 15840 60 ESRD 0329 Major Small and Large Bowel Procedures with MCC 132,201 284,447 354,969 3801 82 Aged Oct 11 0004 Tracheostomy with Mechanical Ventilation 96+ Hours or Prin 6,666 2,145 343,700 21451 80 ESRD Dec 11 0166 Other Respiratory System O.R. Procedures with MCC 8,407 9,867 335,575 1279 78 Aged 0003 ECMO or Tracheostomy with Mechanical Ventilation 96+ Hou 1,445 45,276 331,565 20939 84 Aged 0003 ECMO or Tracheostomy with Mechanical Ventilation 96+ Hou 14,571 1,490 327,812 25838 76 ESRD 0252 Other Vascular Procedures with MCC 19,567 18,211 327,439 17944 67 Aged 0005 Liver Transplant with MCC or Intestinal Transplant 7,802 13,788 323,523 8 70 Aged Jan 12 0189 Pulmonary Edema and Respiratory Failure 11,924 30,378 322,757 10914 71 Aged 0003 ECMO or Tracheostomy with Mechanical Ventilation 96+ Hou 7,239 350,037 322,567 2659 57 Disabled 0003 ECMO or Tracheostomy with Mechanical Ventilation 96+ Hou 1,734 1,013 317,394 32258 67 Aged 0001 Heart Transplant or Implant of Heart Assist System with MC 110,126 226,206 313,769 589 78 ESRD 0239 Amputation for Circulatory System Disorders Except Upper Li 349,146 248,794 312,046 17730 46 Disabled 0003 ECMO or Tracheostomy with Mechanical Ventilation 96+ Hou 1,359 37,312 311,089 6547 82 Aged Jan 12 0356 Other Digestive System O.R. Procedures with MCC 22,899 20,449 304,919 30017 84 Aged 0003 ECMO or Tracheostomy with Mechanical Ventilation 96+ Hou 1,385 103,248 303,498 Report will be provided using paid expenses and HCC risk scores as basis for high risk claimants 15
Interventions Using Analytics
Ambulatory Care Sensitive Conditions Potentially Avoidable Admissions Data Conditions Number of Admissions Percent of Admits Rate/1000 Members Asthma 114 3.33% 3.19 CHF (non-htn) 838 24.47% 23.45 COPD 681 19.89% 19.06 DiabMel no c 27 0.79% 0.76 DiabMel w/cm 192 5.61% 5.37 Epilepsy/cnv 132 3.86% 3.69 Gastroent 63 1.84% 1.76 HTN 60 1.75% 1.68 PID 4 0.12% 0.11 Pneumonia 724 21.14% 20.26 Tuberculosis 3 0.09% 0.08 UTI 586 17.11% 16.40 Grand Total 3,424 100.00% 95.84 Potentially avoidable admissions or ambulatory care sensitive conditions defined by the Agency for Health Research and Quality. The metrics are based on admissions for conditions that may be avoided through well-managed, coordinated primary care. Additional detail based on attributed provider, servicing provider and facility can be used to identify opportunities to reduce admissions. 17
Preference-Sensitive Conditions: Admissions Acute Inpatient Admits Medicare Paid PMPM Admits per 1,000 unique Admits Paid (for admits State Percentiles of FFS Medicare people per 1,000 per Admit with the condition) Min 20th 40th 60th 80th Hip fracture surgical repair 198 5.8 $15,064 $7.28 3.9 5.2 5.6 6.1 6.5 Total hip replacement 192 5.5 $17,549 $8.11 3.5 5.6 6.1 6.5 7.2 Total knee replacement 256 7.7 $15,344 $9.85 4.2 7.6 8.9 9.9 11.6 Total shoulder replacement 12 0.4 $13,771 $0.45 0.0 0.7 0.8 1.0 1.1 CABG 90 2.5 $48,287 $10.15 1.3 2.1 2.5 3.0 3.4 Back Surgery 70 2.0 $18,251 $3.03 0.3 2.0 2.2 2.8 3.4 Carotid endarterectomy 86 2.8 $15,760 $3.68 0.8 1.8 2.1 2.4 2.7 Lower Extremity Bypass 39 1.3 $24,586 $2.58 0.0 0.7 0.9 1.1 1.3 Angiography 188 5.8 $24,421 $11.75 1.5 4.7 6.0 7.0 7.8 Mastectomy 21 0.6 $5,949 $0.29 0.0 0.3 0.5 0.5 0.7 PCI/PTCA 202 5.9 $21,628 $10.71 2.8 5.5 6.6 7.5 8.6 Colectomy 77 2.3 $28,046 $5.37 1.4 2.0 2.2 2.4 2.6 Cholecystectomy 108 3.0 $17,589 $4.44 0.9 2.7 3.1 3.4 3.9 Prostatectomy 11 0.3 $11,272 $0.29 0.0 0.4 0.6 0.7 0.9 Carotid Endarterectomy, Lower Extremity Bypass, and Mastectomy each appear to have relatively high admit rates, as compared to state percentiles of FFS Medicare 18
ACO System Care Retention by Member, Physician and Hospital Who has attributed patients seeking care within the delivery system? Attributed Physician Physician NPI Name Members Total Inpatient Outpatient -PCP - SPEC DME Deceased Deceased 804 26% 31% 20% 67% 4% 48% 1234567890 JOHN SCOTT MD 431 11% 0% 5% 77% 1% 26% 1234567891 JOHN BECKNER MD 415 8% 3% 1% 68% 1% 35% 1234567892 JOHN MANLEY MD 410 34% 42% 44% 90% 1% 44% 1234567893 JANE LEAHY MD 407 44% 61% 50% 88% 3% 65% 1234567894 JANE AUSTIN MD 401 8% 1% 1% 66% 1% 54% 1234567895 JOHN REESE MD 382 18% 14% 19% 87% 6% 31% 1234567896 JANE AUSTIN MD 338 9% 2% 1% 70% 1% 45% 1234567897 JOHN BRAKEBILL MD 338 35% 52% 36% 89% 4% 56% 1234567898 JOHN THOMAS MD 333 44% 65% 69% 86% 4% 66% 1234567899 JANE MONTGOMERY MD 326 38% 51% 48% 88% 5% 57% Beneficiaries of the largest attributed physician have no innetwork inpatient admits This attributed physician has lowest PCP care retention potential loss of beneficiaries from CMS attribution ACO may have additional opportunities to manage care by expanding their network, formally or informally, to include specialists 19
Provider Detail Tool Provider Summaries Provider NPI/Site Number 1234567895 ACO Average Attributed Members 401 101 Attributed Member Months 7,217 223,475 Average HCC Risk Score 1.0208 0.9456 Average PMPY $ 7,904.14 $ 7,614.22 Average PMPM $ 658.68 $ 634.52 Member Utilization ACO Average No. of Low Utilizers 8 1.6 No. of Top 100 Frequent Flyer ER Members 0 0.3 No. of Top 100 Frequent Flyer IP Members 1 0.3 No. of High Cost Beneficiary Members 11 2.5 No. of Readmits 32 5.5 No. of Avoidable Admits 20 4.7 No. of Preference Sensitive Conditions 72 18.3 IP Admits/1,000 359.2 276.5 ER Visits/1,000 396.6 405.2 Provides comparison for ACO average or ACO- provided benchmarks Chronic Conditions Member Count % of Total ACO Average Diabetics 121 30.2% 27.5% CHF 48 12.0% 8.8% COPD 44 11.0% 11.4% CAD 39 9.7% 6.0% AMI 5 1.2% 1.0% Vascular Disease 43 10.7% 9.2% Dialysis or Renal Failure 33 8.2% 9.9% Mental Health/Psych 5 1.2% 4.1% 20
Provider Detail Tool Assigned Beneficiaries Characteristics Member Summary ACO Assigned Record Attributed Member Key Number Risk Score Paid 12590 64565 6.658 $ 185,754 1336 456456 2.903 $ 105,392 2613 654645 4.824 $ 84,632 26326 789746 2.437 $ 80,273 1303 969877 5.167 $ 74,069 29126 459094 3.464 $ 70,957 5154 459465 4.111 $ 68,292 Utilization Summary By Member Key Low Utilizers ER Frequent Flier IP Frequent Flier High Cost Beneficiary 4016 29126 1336 10102 5154 17189 7159 17580 10635 18649 12590 20025 15361 20068 21091 26092 23749 25433 25684 Report also includes detailed claims of attributed beneficiaries 21
Provider Detail Tool Chronic Disease Registries NPI: 1234567890 Provider: JOHN DOE, MD Beneficiaries: 401 Members with Specific Chronic Condition by Member Key Vascular Disease Diabetics CHF COPD CAD AMI Dialysis or Renal Failure Mental Health/Psych 121 48 44 39 5 43 33 5 257 121 121 121 121 1303 1303 4120 807 416 1505 257 3826 1336 2613 7040 1356 2198 2613 596 15274 1750 3826 11510 1505 2279 3320 2005 27132 2613 5154 13846 1520 2613 3490 2538 27984 2794 5851 21091 1750 3826 3555 2613 3555 5949 1775 4718 3826 2831 3951 7036 1952 5154 6366 3826 4807 7159 Over 30% of this physician s beneficiaries have diabetes Shows members with multiple chronic conditions 22
Provider Detail Tool Physician Performance Avoidable Admits Preference Sensitive Conditions Summary Summary Avoidable Admits Count Paid Preference Sensitive Condition Count Paid Bacterial pneumonia 10 $ 39,045 ER visit for abdominal pain 12 $ 4,647 Cellulitis 1 3,352 ER visit for acute bronchitis 3 1,035 CHF 3 21,328 ER visit for asthma 2 730 COPD 2 10,465 ER visit for back pain 4 1,036 Diabetes 3 11,588 ER visit for fever 1 637 Kidney/urinary infection 1 3,047 ER visit for head ache 4 909 ER visit for nausea/vomiting 3 1,021 ER visit for UTI 16 9,325 ER visit pharyngitis 1 44 IP visit for Angiography 4 65,569 IP visit for Back Surgery 2 9,246 IP visit for CABG 1 35,390 Indicates opportunity for physician education to Indicates opportunity for increase savings physicians to educate beneficiaries on appropriate healthcare choices Report also includes detail of which beneficiaries are having avoidable or preference sensitive admits 23
Project Potential Impact of Interventions 24
Operational and Programmatic Strategies
Care Management Programs Care Management Deployment Services Avoid the cost, time and risk to develop, design and delivery population health management services independently Referral Management Avoid revenue losses as a result of patient engagement outside the health system Primary Care Clinic Patient Eme rgency Room Emergency Department Redirection Avoid costly delivery of services in the ER that are more appropriately delivered by PCP Care Access Services Readmission Prevention Reduce medical costs driven by redundant or inappropriate utilization Specialty Care Clinic Inpatient Hospital Avoid revenue losses as a result of non-payment for readmissions within 30 days Home Complex & Chronic Patient Management Drive quality compliance with EBM, improve patient outcomes and generate medical cost savings to improve pay for performance or risk bearing opportunities 26
Case Study Steward Health Care Network Steward Health Care Network Client Overview: Steward Health Care Network (SHCN) is the second largest physician network in Massachusetts with over 1,100 member physicians comprised of both primary care physicians and a full range of specialists. Steward participates in the CMS Pioneer ACO Program where they are responsible for managing the health their attributed Medicare fee for service beneficiaries. 27
2013 Pioneer Covered Lives Local Chapter by Month by Covered Lives 2013 Pioneer Jan 2013 Pioneer Feb 2013 Pioneer Mar 2013 Pioneer April 2013 Pioneer May Cape Cod 10 10 10 10 10 2013 Pioneer June Greater Boston West 5,320 5,268 5,223 5,195 5,149 Greater Brockton 11,136 11,085 11,040 11,001 10,945 Greater Dorchester 2,316 2,303 2,291 2,276 2,267 Greater Fall River 3,124 3,096 3,078 3,064 3,044 Greater Haverhill 107 107 107 107 107 Greater Methuen 5,712 5,681 5,663 5,634 5,605 Greater Nashoba 2,489 2,475 2,466 2,449 2,442 Greater Norwood 4,386 4,353 4,339 4,321 4,296 Greater Quincy 2,010 1,996 1,986 1,973 1,964 Greater Taunton 8,270 8,229 8,196 8,165 8,131 Out of Area 20 20 20 20 20 Data Opt-Outs* 2,261 2,261 2,261 2,261 2,261 2,261 Total 47,161 46,884 46,680 46,476 46,241 46,002 28
Develop Interventions: Complex & Chronic Patient Management Value Proposition: 1-2% cost savings for the managed population with primary drivers of admit reduction and ER visit reduction Targeted Population: High Cost = Healthcare cost >/= $10,000; High Risk = No PCP/multiple physicians, 4 or more ER visits in 12 months, 2 or more unscheduled inpatient admissions in 6 months, Inpatient length of stay >/= 10 days, Readmission within 30 days, Coordination of multiple services (PT, OT, ST, HH, and high risk DME), Poly Pharmacy >/= 10 prescriptions, Co-morbid mental health condition, and multiple trauma Focused Interventions: Medication reconciliation Compliance with EBM and treatment plan Reduction in total cost of care for targeted population Method of Engagement: Local telephonic RN s aligned to System Provider organizations with optional face to face engagement in home/physician office Assumptions: Savings valid for Optum defined program with no variation to targeted population, method of engagement, focused interventions, staffing or workflow/processes Physician communication, engagement and participation in support of program and patient participation is expected and should be facilitated by client IP admit and ER visit reductions serve as a prospective proxy for the achievement of 1 2 % cost savings for the managed population Retrospective measurement of program effectiveness is calculated by comparing medical costs across 2 time periods prior to program implementation (baseline group) and after the program is initiated (intervention group). A 24-12 identification approach is used, whereby individuals are identified for the baseline and intervention periods using 24 months of data but claim costs are calculated using the most recent 12 months of experience (with 3 months of claim run out) Value/Savings Model: Complex and Chronic Patient Management: 2% Assumptions Value Overall Membership 26,000 Outreach 2% 520 Engagement 70% 364 Driver #1 ER Reduction ER visits per 1,000 897 327 ER Visit Reduction of Engaged 20% 65 Average cost per ER visit for CCPM patients $ 1,000 Driver #1 Savings $ 65,302 Driver #2 Admit Reduction Admits per 1,000 1,440 524 Admit Reduction of engaged 30% 157.25 Average cost per admit for CCPM patients $ 15,000 Driver 2 Savings $ 2,358,720 Total Gross Savings $ 2,424,022 Utilization Adjustment Factor 15% $ (363,603) Net Savings $ 2,060,418 % Gain Sharing to System 50% $ 1,030,209 CCPM 2% Total $ 1,030,209 29
Steward Program Components Complex & Chronic Patient Management Covers 6 provider organizations approximately 100 PCPs Includes 9 Optum nurses with varied clinical backgrounds and 1 nurse with psychiatric nursing subspecialty; meets language needs of beneficiaries (Russian and Portuguese) Community-based program with geographical considerations in beneficiary/provider organization assignment allows for home- and office-based contract Beneficiary identification and stratification uses a combination of predictive modeling and real-time data Physician community makes direct referrals 30
Complex and Chronic Patient Management - ER visits declined 16% All Chapters Total Member Population Engagement Summary since Program Inception (July 23 2012) Count % Target Total High Risk Prospect in CCPM Program Identified High Risk through Algorithm Other Referral Total Member Population Outreached Enrolled (currently enrolled or discharged) Members: 378 798 2,500 31
Steward Program Components Readmission Prevention Program Deployed at SNF level of care (versus IP acute) Provides coverage for 7 markets (aligned with major IP acute care facilities) consisting of 43 SNFs Jointly staffed with 6 Steward nurses and 2 Optum nurses Makes initial contact face-to-face while beneficiary is in SNF Conducts post-discharge followup care via phone call 32
Readmission Prevention (RAP)- Readmission rates declined 25% All Chapters Total Members Discharged From Steward Hospital to SNF (Estimated for Period Nov 2012 Mar 2013) 1,237 Engagement Summary Since November 2012 Patients referred to RAP (from Pioneer Patient Tracker) Count % 468 38% N= 964 N= 676 N= 370 N= 702 N= 491 N= 250 1 Readmissions for beneficiaries with an acute discharge to a SNF 33
Financial Analysis
Basic Business Model Historic Benchmarks, Performance Year Targets and Actual Expenditures Are we making any money? Updated Benchmark/Performance Year Targets Gross Shared Savings 35
Financial Modeling Considerations One step at a time.. need to understand and quantify Medicare Benefit Cost Sharing Impacts ACO Program Definition Impacts (i.e. paid through dates, interim billing, etc.) Duplicate Claims IBNR / Speed of Payments Truncation Local and National Trends by Eligibility Type Medicare Unit Cost Fee Schedule Changes Local and National (i.e. AWI & GPCI) Excluded Beneficiaries and Medical Expense Impact Opt-out Beneficiary Claims Substance Abuse Claims Beneficiary Churn Risk Adjustment Impacts 36
ACO Average Claims Cost Projection vs. Updated Benchmark Base projection almost 3% below updated benchmark ACO claims net increase 3.7% from base projection once all adjustments considered Initial estimate showed ACO revenues, final projection does not Updated Benchmark / Target = $10,300 37
Conclusions
Conclusions Segment Population: Leverage Payer Data Understand Your Risk - Strong Actuarial Analysis Quantify Interventions: By Condition By Physicians Care Network Location Develop Care Management Programs: Condition-Based Use Dynamic Registries Measure Impacts Maintain Financial Discipline: Understand Your Contracts and Targets Understand & Update Financial Results Constantly 39
Contact Information Deb Davis Jay Hazelrigs 970.560.3027 303.619.2442 deb.davis@optum.com jay.hazelrigs@optum.com