OptumHealth NYC BHO Provider Training

1. OptumHealth NYC BHO Provider Training

2. Agenda • Introductions • Overview of Optum • Review of Contract between Optum and the Offices • Provider Tools & Submission Process • Initial start up experience • Questions and Answers

3. Optum New York Staff • William Fishbein, Executive Director Optum New York City BHO • Amy Freeman, Behavioral Health Clinical Manager • Margaret “Peggy” Elmer, Behavioral Health Clinical Manager • Joni Richter, Behavioral Health Intake Manager • Erik Geizer, Quality Assurance/Training Manager • Linda West, Reporting & Technology Manager • Michael Silver, Psychiatrist • Marc Minick, Community Liaison • Mark Simmons, Community Liaison

4. Optum Overview

5. Optum Organizational Overview • Optum is a health services business dedicated to making the health system work better for everyone • We are comprised of three market-leading business segments: • OptumHealth • OptumInsight • OptumRx • Optum serves the entire health ecosystem • 250,000 health professionals and physician practices • 6,200 hospitals and facilities • more than 270 state and federal government agencies • over 2,000 health plans; two of every five FORTUNE 500 employers; and one in every five U.S. consumers.

6. Our Business Context UHG UNH=Publicly Traded Registrant (NYSE) UnitedHealthcare-Health Benefits Optum—Health Services • Information and technology-enabled health services platform, encompassing: • Technology solutions • Intelligence and decision support tools • Health management and interventions • Administrative and financial services • Pharmacy solutions • Health care coverage and benefits businesses, unified under a master brand • Employer and Individual • Community and State • Medicare and Retirement Helping to make the health care system work better for everyone Helping people live healthier lives

7. Contract Review

8. NYC BHO – Contracted Region

9. Populations covered under the program • All fee-for-service admissions to OMH-licensed psychiatric units (all ages) in general hospitals (Article 28 hospitals). • Fee-for-service children and youth admitted to OMH licensed private psychiatric hospitals (Article 31 hospitals). • Fee-for-service direct admissions to OMH State-operated children’s psychiatric centers or children’s units of psychiatric centers. • Fee-for-service OASAS Certified Part 816 Inpatient Detoxification Services (Article 28/32). • Fee-for-service OASAS certified hospital (Art 28/32) or freestanding (Article 32 only) Part 818 Chemical Dependence Inpatient Rehabilitation Services. • Each new episode of care initiated by Article 31 OMH designated Specialty Clinics for children/youth (up to 19th birthday) diagnosed as having a Serious Emotional Disturbance (SED) who are covered by Medicaid Managed Care

10. Functions of the BHO include: • Optum will complete initial reviews for applicable services of Fee-For-Service Medicaid members within 72 hours after admission or by 5pm of the next business day following notification of the admission by the provider, whichever is later. Follow-up reviews will be conducted at regular intervals. Concurrent Review Discharge Planning & Tracking • Optum will engage with the inpatient provider with respect to discharge planning for applicable admissions • Enhanced efforts will be employed for inpatients identified as “High Need Individuals” Tracking of Children with SED • Each new episode of care initiated for a Medicaid Managed Care SED child will be tracked for reporting back to the State Provider Profiling /Analytics Community Liaisons • Historical Clinical data will be provided by the Offices to the BHOs • Data elements specific to each inpatient admission and provider will be collected by the BHO and shared with the Provider and the Offices. • Metric Reporting will be provided back to the Offices Facilitation of Cross System Linkages • Optum will work with the Offices and the Providers to determine cross system linkages for adults and children with mental health conditions and substance use disorders Quality Initiative • Optum will devise a quality assurance program to monitor the quality of work performed within the contract

11. Review of Contract Provider Community The Offices Optum Provider Community • Notify Optum of admission • (Portal, Fax or Telephonic) • Notify Optum regarding Children with SED • Performs initial/ concurrent reviews • Monitoring discharge planning & post-discharge services • Tracking of children with SED • Provider profiling • Facilitation of cross system linkage • Quality Initiative • Treatment History Form • Follows concurrent review & discharge monitoring processes • Supplies Optum with guidance to perform tasks • Supplies historical clinical data • Supports access to cross systems

12. What we need from you: Partner with Us • Submit requested information to be used in initial/concurrent reviews, discharge planning/tracking, SED tracking, and cross system facilitation • Use your dedicated Care Advocate and Community Liaison as a part of your team Engage in the Process • Follow the concurrent review & discharge planning/trackingprocesses • Identify Cross System Linkages • Provide data as requested • Use the tools provided • Don’t hesitate to ask us questions • Clinical questions can be directed to the Care Advocate or to: NYCBHO.Clinical@optum.com • General questions can be directed to the Executive Director & Community Liaisons or to NYCBHO.General@optum.com • ProviderConnect technical questions/issues can be directed to: NYCBHO.tech@optum.com. Ask Questions • Let us help you! • We want your feedback. Other

13. Provider Tools & Submission Processes

14. Provider Tool Review- Methods for submission Fax • Individual Information Matrix • - Within 24 hours of admission • - Concurrent Review at established intervals • - Discharge by the date of discharge but no later than within 24 hours post discharge. Fax # • Clinical Fax: (877) 283-0555 Telephonic • Toll-free: (866) 505-3398 • Dedicated Care Advocate assigned by Facility Portal • New provider portal: www.optumhealthnyc.com • ProviderConnect software

15. Submission time frames • Childen with Serious Emotional Disturbance (SED) Report • Submitted for each new episode of care for SED children covered by Medicaid managed care • Providers to complete and submit within 3 business days of initiation of services • Submit via fax, portal, or telephonic • Individual Information Matrix Form (inpatient providers) • Admission • Providers to notify their assigned BHO within 24 hours of admission, except that for admissions which occur on a weekend or holiday such notification would be required by 5 P.M. of the next business day following such week-end or holiday. • Concurrent Review • Optum will complete initial reviews for applicable services of Fee-For-Service Medicaid members within 72 hours after admission or by 5pm of the next business day following notification of the admission by the provider, whichever is later. Follow-up reviews will be conducted at regular intervals. • Discharge Planning • Provider to complete and submit by the date of discharge but no later than within 24 hours post discharge. • Forms located on the Optum NYC BHO Provider Portal : www.optumhealthnyc.com

16. Experience since start up • Volume • 65 admissions per day (average) • 40% portal, 38% fax, 22% telephonic • Major initial activities • Initiating review process • Provider outreach • Provider training • Connecting with stakeholder groups • Completion of staff hiring and training efforts

17. Initial challenges • Different review process • Provider resources • Usage of web portal • Data submission for SED children • Engagement of some inpatient providers

18. Challenges on the near horizon • Working with health homes • Integration of peer support services

19. Questions?