OptumHealth NYC BHO Provider Training

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 2 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. 3 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

Optum Overview

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 5 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. 6 Our Business Context Health care coverage and benefits businesses, unified under a master brand –Employer and Individual –Community and State –Medicare and Retirement UnitedHealthcare-Health Benefits Information and technology-enabled health services platform, encompassing: –Technology solutions –Intelligence and decision support tools –Health management and interventions –Administrative and financial services –Pharmacy solutions Optum—Health Services Helping people live healthier lives Helping to make the health care system work better for everyone UHG UNH=Publicly Traded Registrant (NYSE)

Contract Review

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 8 NYC BHO – Contracted Region

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 9 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 19 th 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. 10 Functions of the BHO include: 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. Concurrent Review Discharge Planning & Tracking Each new episode of care initiated for a Medicaid Managed Care SED child will be tracked for reporting back to the State Tracking of Children with SED Provider Profiling /Analytics Community Liaisons Historical Clinical data will be provided by the Offices to the BHOs Data elements specific to each inpatient admission and provider will be collected by the BHO and shared with the Provider and the Offices. Metric Reporting will be provided back to the Offices 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” 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 Facilitation of Cross System Linkages Quality Initiative 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. 11 Review of Contract The OfficesOptumProvider Community Supplies Optum with guidance to perform tasks Supplies historical clinical data Supports access to cross systems Performs initial/ concurrent reviews Monitoring discharge planning & post- discharge services Tracking of children with SED Provider profiling Facilitation of cross system linkage Quality Initiative Treatment History Form Follows concurrent review & discharge monitoring processes Provider Community Notify Optum of admission (Portal, Fax or Telephonic) Notify Optum regarding Children with SED

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 12 What we need from you: 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 Partner with Us Follow the concurrent review & discharge planning/tracking processes Identify Cross System Linkages Provide data as requested Use the tools provided Engage in the Process Don’t hesitate to ask us questions Clinical questions can be directed to the Care Advocate or to: General questions can be directed to the Executive Director & Community Liaisons or to ProviderConnect technical questions/issues can be directed to: Ask Questions Other Let us help you! We want your feedback.

Provider Tools & Submission Processes

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 14 Provider Tool Review- Methods for submission New provider portal: ProviderConnect software Portal Toll-free: (866) Dedicated Care Advocate assigned by Facility Telephonic Clinical Fax: (877) Fax # Fax Individual Information Matrix - 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.

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 15 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 :

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 16 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. 17 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. 18 Challenges on the near horizon Working with health homes Integration of peer support services

Questions?