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Population Health and Care Management Crossover Solution...

Optima Health Rolls Out Population Health & Care Management Crossover Solution For DSRIP Medicaid and Commercial Populations

Health plan arm of Sentara Healthcare partners with Performance Clinical Systems to address complex needs of Alabama DSRIP Medicaid program.

Additionally, Optima Health is rolling out Symphony for its diverse populations in government and commercial programs over the coming months in order to be best positioned for the requirements of population health management and risk-based contracting. Through the Symphony platform, the Optima Health care teams can more efficiently manage and engage patients in partnership with its provider network by leveraging a common platform which serves various clinical roles and settings, contract parameters and patient environments, including home health.

Significant efficiencies can be obtained through Symphony’s dynamic documents generated “on the fly”—in the form of assessments, protocols, care plans, etc.— which are regulatory-compliant and based upon patient history and needs together with the clinician-user’s skill set and license level required for each encounter.

“Our partnership with Performance Clinical has enabled us to scale our value-based payment models and population health programs in an incredibly efficient manner,” said Tom Lundquist, Senior Vice President and Chief Medical Officer at Optima Health. “Critical to our success with populations this size is empowering our provider networks to connect with patients, in coordination with our care teams, in the most timely, compliant and effective manner. Symphony delivers on all fronts” he added.

Symphony maximizes productivity across existing multi-disciplinary teams by allowing each member— RN, LCSW, LPN, MA, etc.— to work at the top of their license, providing greater staffing flexibility and task allocation.

“The new reality is that healthcare organizations are faced with how they can best affect the care for a wider population of patients using existing resources,” commented Chris Johnson, MD, MPH, Performance Clinical’s co-founder and chief scientist. “We designed Symphony to be lightweight for minimally disruptive deployment, extremely adaptable for a myriad of contract requirements and payment models and highly intuitive for all users, which is consistently identified as one of the most attractive benefits of the platform,” he noted.

“Our partnership with Sentara Healthcare and Optima Health continues to demonstrate how simultaneously improving the patient experience while creating efficiencies in care delivery is quickly attainable,” said Brian O’Neill, CEO of Performance Clinical. “Since Symphony is cloud-based, it is easily configured and rapidly optimized for shifting clinical, contractual and organizational requirements.”

About Optima Health
Optima Health, based in Virginia Beach, Virginia, provides health insurance coverage to approximately 450,000 members. With 30 years of experience in the health insurance arena, Optima Health offers a full suite of commercial products including consumer-directed, employee-owned and employer-sponsored plans, individual health plans, employee assistance programs and plans serving Medicare and Medicaid enrollees. Our provider network features 26,000 providers including specialists, primary care physicians and hospitals. Optima Health offers programs to support members with chronic illnesses, customized wellness programs and integrated clinical and behavioral health services as well as pharmacy management – all to help our members improve their health. Our goal is to provide better health, to be easy to use and offer services that are a great value. To learn more about Optima Health, please visit http://www.optimahealth.com. (1)

About Performance Clinical Systems
Performance Clinical Systems is a privately held healthcare information technology company based in San Francisco, California and Boston, Massachusetts. Founded by two physicians, its cloud-based workflow accelerator platform, Symphony™, efficiently manages patient outreach and encounters across various roles and clinical settings within team-based care models.

Symphony maximizes productivity across existing multi-disciplinary teams by allowing each member to work at the top of their license, providing greater staffing flexibility and task allocation. Additionally, Symphony ensures regulatory-compliant engagement and creates an electronic trail for care and contract compliance reporting.

The company’s solutions are attractive to performance-oriented health care payers and providers because they increase productivity, are quickly embraced by clinicians, can be deployed rapidly and work alongside or as a layer on traditional enterprise HIT systems. Most importantly, Symphony contributes significantly to a provider’s ability to handle shifts in value-based alternative payment models, such as Accountable Care Organizations (ACO’s), Patient-centered Medical Homes (PCMH), Medicare Advantage, DSRIP, LTSS and managed Medicaid, which reward better care at lower cost. For more information, visit http://www.performanceclinical.com.


(1) The membership figure includes total membership in all group and individual insured products, Medicare Managed Care Plans, Medicaid and Famis Plans, and self-funded health plans issued or administered by Optima Health. Total Medical Membership based on Membership History Report, June 2016. Includes members from all Optima Health Licenses, products, Medicare and Medicaid products. Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, and Sentara Health Plans, Inc. Optima PPO plans, and Medicare Managed Care Plans are underwritten or administered by Optima Health Insurance Company. Optima Vantage HMO plans, Medicaid, and Famis products are underwritten or administered by Optima Health Plan. Sentara Health Plans provides administrative services to self-funded plans but does not underwrite benefits. Employee Assistance Programs (EAP) are administered by Optima Behavioral Health Services, Inc. Wellness programs are administered by Sentara Health Plans. Source for provider network is Optima Health, Provider Status Report, February 2016.

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FOR MORE INFORMATION:
Robert Murphy
Performance Clinical Systems
rmurphy@performanceclinical.com
415-830-3435

DOWNLOAD THE PDF: Optima Press Release

Contract-driven Interactive Workflow Platform...

Optima Health Selects Performance Clinical Systems’ Platform with Contract-driven Interactive Checklists to meet its Population Health Goals

Symphony™ Drives Patient-specific, Role-based Activities to Simultaneously Comply with Clinical Protocols and Payer Contract Requirements

San Francisco, January 13, 2015— Optima Health, a Virginia based health plan with over 451,000 members and over 20,000 participating healthcare providers, today announced a phased rollout of the Symphony workflow management platform from Performance Clinical Systems to select primary care practices within their network. Symphony provides a tool that standardizes robust outreach protocols while allowing for detailed data capture of clinical, social and environmental factors relevant to care management success. Symphony allows for proactive management of patient outreach across various roles and clinical settings within team-based care models. Algorithms tailor “on the fly” checklists based on case-specific care needs, prior patient encounters, payer contract requirements, and the specific role of a care team member.  Additionally, Symphony creates an electronic trail for care and contract compliance reporting.

“One of our key population health initiatives is improving outcomes by intensifying care management for our members with chronic conditions while simultaneously improving care delivery efficiency and standardization among the care team delivering that care,” said Tom Lundquist, Senior Vice President and Chief Medical Officer at Optima Health. “We want the care teams not only to be able to improve the clinical care and impact of the outreach, but also to work more effectively in improving care quality and cost efficiency. The Symphony platform enables a systematic approach for our provider teams to efficiently focus on delivering high-quality care without requiring them to be experts on each patient’s specific payer contract,” he added.

The cloud-based Symphony is accessible across clinical settings and locations and works in unison with traditional electronic medical records. It is highly configurable and rapidly optimized for shifting clinical, contractual, and organizational requirements.

“Optima Health is on the forefront of building infrastructure to support new chronic
condition management programs and payment models that enables them to better partner with physicians in their network. We’re very excited to be part of their vision,” said Performance Clinical Systems co-founder, Jeremy Nobel, MD, MPH.

Through Symphony, Optima Health can enable their provider network to take advantage of Medicare’s new Chronic Care Management (CCM) code, which allows for billing of non-face-to-face chronic care management services as of January 1.

“The new CCM code relies heavily on electronic data capture and documentation by physicians and non-physician clinicians for things such as physical, mental, cognitive, psychosocial, functional, and environmental assessments. This is a core capability of our Symphony workflow platform,” Dr. Nobel noted. “Being able to take advantage these new value-based payer opportunities is critical to a provider practice’s economic success and survival,” he added.

About Optima Health

Optima Health, based in Virginia Beach, Virginia, provides health insurance coverage to more than 451,000 members. With 30 years of experience in the health insurance arena, Optima Health offers a full suite of commercial products including consumer-directed, employee-owned and employer- sponsored plans, individual health plans, employee assistance programs and plans serving Medicare and Medicaid enrollees. Our provider network features 20,000 providers including specialists, primary care physicians, and hospitals. Optima Health offers programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services as well as pharmacy management – all to help our members improve their health. Our goal is to provide better health, to be easy to use and offer services that are a great value. To learn more about Optima Health, please visit www.optimahealth.com.

About Performance Clinical Systems

Performance Clinical Systems is a privately held healthcare information technology company based in San Francisco, California and Boston, Massachusetts.   Founded by two physicians, its cloud-based workflow management platform, Symphony™, proactively manages patient outreach and encounters across various roles and clinical settings within team-based care models. Algorithms tailor “on the fly” checklists based on case-specific care needs, prior patient encounters, payer contract requirements, and the specific role of a care team member.  This approach enables efficient and scalable patient engagement models which are highly personalized.  Additionally, Symphony creates an electronic trail for care and contract compliance reporting.

The company’s solutions are attractive to performance-oriented health care providers and payers because they are quickly embraced by clinicians, deployed rapidly (within 60 days) and work alongside or as a layer on traditional enterprise HIT systems. Most importantly, Symphony contributes significantly to a provider’s ability to handle shifts in payment models, such as Accountable Care Organizations (ACO’s) and Patient-centered Medical Homes (PCMH), which reward better care at lower cost. For more information, visit www.performanceclinical.com

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FOR MORE INFORMATION:
Robert Murphy
Performance Clinical Systems
rmurphy@performanceclinical.com
415-830-3435