Quality
Optum Tri-State team that engages patients aligned with value-based arrangements via campaigns against priority quality and patient experience measures
Who is the patient engagement team?
If a patient has transportation barriers preventing them from traveling to an annual care visit, this vendor will provide round trip rides to patients
Who is Lyft?
A workflow for gaps in care initiatives in which a wellness coordinator will connect a patient with an IPA practice directly for scheduling an appointment or screening
What is a warm transfer?
A Medicare covered yearly assessment of a patient’s overall health and well-being with the primary focus being prevention
What is an annual care visit?
The parent company of United Healthcare and Optum
What is UnitedHealth Group (UHG)?
Optum Tri-State VP, Quality & Physician Enablement
Who is Jessica Klarl?
A health insurance plan that covers an annual care visit or physical exam once every calendar year
What is Medicare Advantage?
Patients aged 18-75 with Type 1 or Type 2 diabetes should have this exam performed yearly.
What is a diabetic eye exam?
A health insurance that combines hospital coverage (Part A), medical coverage (Part B), drug coverage (Part D), and additional health benefits under one plan. This plan is provided by private insurance companies with varying benefits, costs, coverage options and providers based on location.
What is Medicare Advantage?
Riverside Medical Group, ProHealth New York, and CareMount Medical
What are the employed groups of Optum Tri-State?
A process in which Gap in Care Reports are reviewed and records are abstracted and submitted
What is supplemental data submission?
An annual exam that focuses on the assessment of a patient’s body. The primary purpose is to look for health problems
What is a physical exam?
A test that measures the levels of blood glucose which is designed to determine how well a patient is managing their diabetes
What is an A1c test?
A health insurance that includes hospital coverage (Part A) and medical coverage (Part B). This plan is provided by the federal government and does not include additional health benefits or prescription drug coverage
What is original medicare?
Name 2 EMRs used across our team: _____ & ______
NextGen, Athena, Epic, eCW, Cerner,
When insurance plan have a financial relationship with Optum in which both entities share the financial “risk” associated with providing healthcare to the mutual members
What is medicare risk?
Vendor that completes at home annual care visits for UHC MA patients
Who is HouseCalls?
A stool DNA-based colorectal cancer screening test for individuals at average-risk. This should be completed every three years. This test is used for individuals 45 years and over that are at average risk for colorectal cancer.
What is Cologuard?
A CRM platform in which the Optum Tri-State "Patient 360" Dashboard will be housed
What is Salesforce?
Name any three Optum Tri-State IPAs: ______, _______, & ______.
Cornerstone, Crystal Run, Northern Medical, Premier, Hudson Valley, Virtua Health, St. Joseph's, Nuvance, etc.
When providers are paid a fee per patient (capitation) and are then responsible for treating the patient within this budget.
The goal is to provide quality care while remaining below budget to maximize profit. If the budget is not achieved, the provider is responsible for paying excess expenses
What is a risk contract?
A patient engagement program providing education on Optum programs and ACV scheduling or reminders for new UHC MA members
A mammogram allows doctors to have a closer look for changes in breast tissue that cannot be felt during a breast exam and should be completed by all women aged ___ to ____.
What is 50-74 years old?
Accountable Care Organization Realizing Equity, Access, and Community Health Model
What is ACO Reach?
Kevin Conroy
Who is the Optum Tri-State CEO?