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optum360.com

Optum360 powers HIM and CDI modernization

Experience matters Since 1999, Optum has expanded its LifeCode NLP technology based on success driven by the performance of its clients. The depth of experience spans across health care settings, medical specialties and varying encounters covering both physician- and hospital-based services.

The only patented NLP technology on the market today Decision-makers are facing the need to transition to value-based care with pressure to move toward metrics around quality, safety and outcomes, in addition to optimizing reimbursement. Reliable and accurate capture of information in these areas is growing the expectations of traditional HIM operations to work in concert with colleagues in CDI, case management and compliance. NLP technology that can accurately capture information at the concept level to refl ect the complete health story of a patient is key to meeting these expectations today in CAC, and tomorrow across settings.

LifeCode NLP technology is uniquely suited to meet this market need through its patented capabilities that allow recognition of precise clinical details along with content, syntax and multiple semantic attributes. It does this through an integration of linguistic analysis with a knowledge base of more than 10 million medical facts.

Better together: A comprehensive solution The Optum Enterprise Computer-Assisted Coding (CAC) and Optum CDI 3D platform bring together the power of LifeCode NLP with the tools needed to streamline operations and the partnership to ensure your ongoing success. Powerful technology combined with a team of experts armed with comprehensive analytics ensures your organization is positioned for success in today’s ever-changing health care environment.

Optum Enterprise CAC leverages LifeCode NLP to identify code-able facts. With Optum Enterprise CAC, coders leverage the encoder, logic, workfl ow and NLP code assignment functionalities to ensure more complete and accurate coding, while providing the traceability and operational tools to ensure cases are coded in a timely manner.

Optum CDI 3D leverages LifeCode NLP to identify gaps in documentation. Optum CDI 3D takes documentation improvement opportunities to the next level, with intuitive, intelligent and clinically based case-fi nding technology that allows CDI specialists to concentrate effort on the right cases at the right time. In addition, the Optum CDI Program offers the education, preparation and support to drive the successful growth in your program.

By the numbers: • Approximately 500 Enterprise CAC clients

sites now using Enterprise CAC, with 100 more scheduled for implementation

• Nearly 200 sites now using CDI 3D, with 100 more scheduled for implementation

• Successful integration with 30+ hospital EHR and revenue cycle systems

• 1 billion unique clinical documents processed by LifeCode annually

• Proprietary NLP approach supported by

fi ve patents and multiple pending patents

Award-winning technology and services

KLAS Enterprise CAC Category Leader 2014 and 2015/16

BlackBook™ Research For the third consecutive year, Optum360® was ranked No. 1 in three categories:

• Computer-Assisted Coding Services and Health Information Management Outsourcing Solutions — Hospitals and Health Systems/Networks

• Revenue Cycle Management Outsourcing for Hospital Managed Systems Corporations/Systems/ Networks and Chains

• Revenue Cycle Management Software/ SaaS/RCM Technology for Health Systems, Corporations, Chains and Integrated Delivery Networks

Appropriate reimbursement

Care management

Compliance

HCC performance

risk adjustment

Accurate clinical picture

Appropriate code capture

Pay-for- performance

The dynamics of health care reimbursement are changing, with an increased focus on population health, risk adjustment and pay-for-performance outcomes. The completeness of clinical documentation and the accuracy of coding have never been more critical to managing all the risks to the fi nancial health of your organization. Optum® Enterprise Computer-Assisted Coding (CAC) and Optum CDI 3D offer both new solutions to historical problems that plague health care organizations today, as well as innovative solutions for the rapidly changing health care reimbursement of tomorrow.

Proven results Health systems across the country have transformed their operations using Optum360 solutions for

impressive results.

Hallmark Health System

Using Enterprise CAC, CDI 3D, consulting and coding services:

• Improved documentation and coding processes, enhancing revenue capture by over $2.2 million

• Improved unbilled accounts receivable (A/R) exceeding $8 million

• Reduced coding backlog by over 85 percent for inpatient and over 50 percent for outpatient

• Achieved a smooth ICD-10 transition with no signifi cant impact on A/R

• Increased physician query response rate from 30–40 percent to ~ 94 percent

• Improved SOI rating from 2 to 3, and ROM rating from 1 to 2

• Expanded CDI review to all payers and

encounters

Mission Health System Enterprise CAC and CDI 3D

Using Enterprise CAC and CDI 3D:

• Achieved $4.8 million increase in total reimbursement in the fi rst fi scal year

• Increased CMI initially 2.4 percent due to CAC and concurrent coding

• Achieved an additional 0.4 percent CMI increase due to CDI

• Decreased discharged not fi nal coded (DNFC) inpatient and observation cases greater than fi ve days 30 percent — which has held steady under ICD-10, going from $6.9 million to $4.3 million

• Saw a $297,000 average monthly increase in DRG reimbursement

• Increased query volume 115 percent and CDI team productivity by 26 percent, thanks to automated case-fi nding technology

• Improved case reviews by CDI specialists 43 percent

Trinity Health

Using Enterprise CAC:

• Reduced accounts receivable days by 15 percent

• Decreased DNFB days by 22 percent

• Improved DNFC by 46 percent

• Increased inpatient coding productivity by 21 percent

• Increased outpatient coding productivity by 72 percent

Optum360 powers HIM and CDI modernization

optum360.com

11000 Optum Circle, Eden Prairie, MN 55344

Property of Optum360, LLC. Optum360 and the Optum360 logo are trademarks of Optum360, LLC. All other brand or product names are trademarks or registered trademarks of their respective owner.

© 2017 Optum360, LLC. All rights reserved. WF435262 10/17

With the Enterprise CAC platform, we’ve eliminated a lot of rework and unnecessary touches, so we’re now getting better, more accurate bills out the door faster. The system has paid for itself pretty quickly.

— Trent Chastain, Vice President, Revenue Cycle, Trinity Health

I’m so proud of where we are today. Partnering with Optum360 was defi nitely the right choice for Hallmark Health System. Not only are we seeing results that exceeded our expectations, but we are now in a position to be able to focus on the future.

— Nancy Cloutier, System Director, Health Information Management, Hallmark Health System

The Optum360 technology is defi nitely supporting our overall goals .... We’re accurately

refl ecting the acuity of care we’re providing and capturing accurate documentation, as well

as building additional effi ciencies. Our results speak for themselves.

— Eliana Owens, Executive director for coding, CDI and revenue integrity, Mission Health System

84% RECALL

86% PRECISION

Delivering value in ICD-10

Inpatient diagnosis code accuracy — fi rst month under ICD-10

Production users | 335,000 codes | Oct. 2015

These numbers represent top 20% tier of code frequency.

84% RECALL

86% PRECISION