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

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

We improve health every day.

We improve health every day.

Our partnership with Performance Clinical has enabled us to scale our value-based payment models and population health programs in an incredibly efficient manner.

Optima Health, a Virginia-based health plan with approximately 450,000 members and 26,000 participating healthcare providers across four states, will be rolling out Symphony, the cloud-based workflow accelerator platform from Performance Clinical Systems, to efficiently manage and document care for Medicaid populations in the Alabama Health Home program. Optima Health, a division of Sentara Healthcare, is a partner in a risk-bearing joint venture in Alabama. Operating as a Regional Care Organization, the company is ready to meet the requirements of Alabama’s shift to a managed Medicaid model under a Centers for Medicare & Medicaid Services waiver.

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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Pamela Walters
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