Optum’s Market Performance Partnerships lend viable non-clinical operational options to providers

The Bottom Line: Optum’s Market Performance Partnerships provide a model for health systems and health practices to remain financially independent while maintaining a focus on the health of their communities.

Managed services are an essential part of the healthcare ecosystem, helping alleviate the burdens associated with non-clinical functions. Health systems and physician practices must consider leveraging such options so they can concentrate on their mission…keeping us healthy!

Health systems, specialty and primary care practices have been under financial pressure for an extended period due to lower reimbursement rates, uncompensated care, changes in contract mechanisms, and overall increasing operational costs. COVID-19 made it worse as revenues declined significantly due to canceled non-emergency and elective procedures and costs escalated due to the need for more enhanced personal protection equipment (PPE) and supply chain-related inflation.

The uninsured population steadily increased during the Trump administration due to the lack of support for the Affordable Care Act (ACA), significantly impacting health systems that must treat COVID-19 patients but don’t expect compensation for it. The Kaiser Family Foundation estimates that the cost of treating a patient from diagnosis to health with COVID-19 could be between $20,000 (hospitalization) and $88,000 (ventilator support).

In the context of such headwinds, health systems suffer, and population health takes a huge hit while regressing on all attributes of the Triple Aim (cost, health outcomes, and experience). Optum’s Market Performance Partnership has attributes that could help alleviate non-clinical challenges by leveraging their scale, experience, and financial muscle.

Ecosystem plays are a key element of meaningfully impacting the Triple Aim

Health and healthcare require an entire village to contribute, and we have seen that in the recent pandemic times. Fights over lockdowns, masks, vaccines, and more are indicators that when the village won’t lean in, it will stay sick.

That concept is at the heart of ecosystem plays. Health systems and physician practices need technologies (EHR [electronic health record], analytics for evidence-based medicine, medical devices) and services (RCM, [revenue cycle management] patient experience, compliance). However, they often don’t have the capabilities and resources to identify needs, select the best of breed, and source them.

Developing an ecosystem of trusted partners who are experts in their areas helps create an environment of predictability for results and trust of delivery. This approach, while logical, is not often adopted because it can take effort and resources that healthcare providers don’t have. So, which came first, the chicken or the egg?

Managed services vs. outsourcing vs. partnership; it’s all happening here

Optum, the $136 billion United Health Group company, created a Market Performance Partnership framework some two and half years ago to help health systems and physician practices operate efficiently, remain financially viable, and create capabilities that will sustain them.

The Optum partnerships allow health systems to accelerate their mission and maintain their culture while driving digital transformation, core performance efficiency, growth, and innovation without capital burden or staff rationalization. These long-term partnerships typically allow Optum to leverage the broader UnitedHealth Group assets and bring to bear capabilities such as RCM, IT, clinical operations, analytics, and assorted digital features that enhance the health system’s ability to deliver the best clinical care and remain financially independent.

Several examples of these partnerships appear to be meeting the needs and objectives of health systems, such as with John Muir Health, where Optum provides managed services across a broad set of non-clinical functions, including revenue cycle, IT, analytics, and clinical operations. Boulder Community Health offers another example; one year into the partnership, Optum is delivering essential functions spanning revenue cycle, analytics, and clinical operations. At Bassett Health in central rural New York, Optum is delivering revenue cycle, IT, and analytics. Most recently in October 2021, SSM Health partnered with Optum and UnitedHealth Group to focus on revenue cycle, inpatient clinical operations, innovation, and digital transformation. The partnerships align toward modernizing systems and processes, simplifying patient access, improving local community care, and addressing the health equity gap.