Better outcomes through value-based care

Value-Based Care provides higher quality, more effective and less expensive care because it focuses on the whole person and on prevention,” said Dr. Amar A. Desai, President and CEO of ‘Optum Pacific West. “This is how we are redefining healthcare in America.”

For more than a decade, Optum has been dedicated to helping people live healthier lives and helping the healthcare system work better for everyone. Today, Optum’s California market has become the largest value-based multi-payer healthcare system in the United States, serving more than two million patients and growing.

Unlike traditional fee-for-service models that encourage volume of care, value-based care relies on positive health outcomes and healthy communities as the driver of affordability. Optum succeeds when its patients succeed. With a clinical program based on broad access to high-quality primary care, a strong focus on prevention and intensive chronic disease management, Optum’s value-based model of care produces better outcomes.

PRIMARY CARE AND PREVENTION
Primary care is at the very heart of Optum’s model and is essential to delivering better outcomes. The benefits of having a primary care provider have been well studied, including a recent study published in JAMA Internal Medicine, which found that Americans with primary care reported significantly better health care access and experience, were more likely to fill their prescriptions and have had a routine preventative visit in the past year and were significantly more likely to receive more high-value care.

Because of the importance of having a primary care physician, Optum is committed to ensuring access to primary care for everyone, regardless of insurance type. Today, Optum primary care is accessible in every Southern California community, including historically underserved areas such as South Los Angeles and the rural Inland Empire and even in places without an Optum clinician thanks to the development of its unique multi-payer IPA model.

Due to Broad Access to Primary Care and Emphasis on Prevention, Optum Shows 28% Better Clinical Performance for California Medicare Advantage Patients Compared to Medicare Fee-for-Service for Key Cancer Indicators breast, colorectal cancer and diabetes, as well as a 37% higher medication adherence rate for type 2 diabetes, an 88% higher medication adherence rate for COPD and a hospitalization rate 25% lower than Medicare fee-for-service averages.

COORDINATION OF CARE FOR CHRONIC CONDITIONS
With more than half of the American adult population suffering from a chronic disease and almost 30% suffering from multiple chronic diseases, it is clear that new approaches are needed. Optum has developed an intensive and coordinated chronic disease care system that strives to reduce avoidable hospitalizations by 16% year over year.

Prevention also plays a vital role in chronic disease management. For example, patients who attend just one of Optum’s Living with Diabetes courses have, on average, a one-point drop in their A1C levels. Health education in other areas such as kidney care, weight management and COPD is enjoying similar success – contributing to a 4.5 star quality rating for many years in a row.

Optum achieves better clinical outcomes for high-risk patients and those with chronic conditions by focusing on education, treating the whole person, coordinating care across behavioral, social and medical care teams, and creating global data-driven services to help physicians. For example, Optum’s Care Plus Acute program uses a validated algorithm to identify patients most at risk of hospitalization so that personalized care plans can be developed by a team including a primary care physician, pharmacist, specialists, a behavioral health professional and others. As a result, Optum’s acute readmission rates for seniors range from 11 to 16 percent compared to the Medicare national average of over 20 percent. Similarly, Optum’s Clinical Pharmacist Program reaches out to high-risk patients to perform comprehensive medication reviews, identify, and then resolve any medication-related issues, resulting in a 14% reduction in patient readmissions. .

The success of these programs and the overall coordination of care for chronic disease management means that Optum keeps patients healthy and out of hospital. Optum’s Medicare Advantage and managed care patients spend 30% or more fewer days in hospital compared to traditional fee-for-service arrangements.

AFFORDABILITY AND ACCESS
With nearly half of Americans reporting delaying or skipping medical care due to cost, affordability is a major factor in achieving better outcomes.

Value-based care is also known as affordable care; in Optum’s case, affordability also coincides with better health outcomes. For example, when location of care is considered, outcomes are improved while costs are reduced. One such example is Optum’s use of day surgery centers for 80% of eligible procedures compared to the national average of 50%. Not only does this provide greater convenience for patients than a hospital setting, but it often increases quality and reduces costs. Likewise, Optum’s extensive network of urgent care centers enables the successful treatment and observation of non-life-threatening conditions outside of the emergency department, increasing access beyond normal clinic hours and obviating the need for overcrowded and more expensive care sites.

Optum’s innovative hospitalist triage system has led to more efficient, personalized and affordable care for approximately 3,000 patients a year through programs that provide coordinated care in an optimal setting, whether in hospital, in hospital or at home.

By shifting the focus of health care outside of the hospital setting to primary care, Optum provides care how, when and where patients want it, further increasing access with options such as home visits, video and virtual clinics on the same day.

By focusing on helping people live healthier lives and helping the healthcare system work better for everyone, Optum is redefining healthcare – not just imagining a world where healthcare health work better for everyone – but by creating it.

Learn more about optum.com/california.

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