Establishing trust to improve value-based care outcomes

This is the perpetual question occupying the mind of Shadina John, an Optum Health Care Advocate (HCA). Shadina supports more than 50 provider practices in the In-Office Assessment Program and is responsible for working directly with care delivery organizations to help them achieve complete and accurate risk adjustment.

Since becoming an HCA in 2020, Shadina has realized the importance of maintaining a strong relationship with her providers in order to be successful. By working together, they can find new ways to provide exceptional patient care and improve outcomes.

Shadina is one of more than 1,000 Optum Health Care Advocates across the U.S. who deliver wraparound services for providers that are customized to the level and type of support each practice requires. HCAs work directly with care providers to help identify patients in need of preventive measures or complex condition management.

This includes identifying the best method to share gaps in care information, bidirectional EMR access, training and education, and preparing health assessments.

In this short blog, Shadina shares her perspective on the essential building blocks for increasing provider engagement in prospective risk adjustment programs. These include regular touch points, mutual trust and a customized approach.

Shadina knows that each practice is unique, so to better understand their needs she stays in close contact with them through in-person meetings, video conferences, phone calls and emails. By understanding the practice’s strategy, objectives, needs and challenges, she can manage the relationship with more insight and tact to create a positive relationship.

Shadina considers these meetings the cornerstone of her relationship. She works with the staff to discuss performance based on various risk adjustment metrics, with a focus on specific patients and their risk assessments. Patients overdue for a risk assessment are prioritized for outreach, with the goal of improving patient experience and outcomes.

For example, Shadina works with a small family medical center in Pennsylvania that submits around 180 patient health assessments annually. The initial meetings between Shadina and the practice were productive, but Shadina could sense some hesitancy to fully commit to the program.

However, a few months into the program, everything fell into place for the practice manager when Shadina showed her the practice’s performance on a particular metric. Shadina explained what the practice needed to do to improve, and they made plans to work toward a new goal.

This practice is becoming more engaged as they see the potential for success. Physician leaders at the practice recognize the value of regular touch points with Shadina and have started attending the monthly meetings. As Shadina continues to make inroads through communication, she steadily builds trust with practice staff.

Shadina understands that providers’ trust of risk adjustment vendors may not always be high. Common concerns are that they might be overly aggressive or demanding. When she starts collaborating with a new practice, it's typical for them to initially feel hesitant. They often wonder about the time and effort the program requires, the additional workload it might bring and whether it will truly benefit their high-risk patients.

Trust is pivotal for building relationships, and it needs to be earned over time. For example, in 2020 Shadina started working with a new practice enrolled in the In-Office Assessment Program. The practice serves approximately 1,500 patients, yet it only has 2 staff members tasked with handling risk assessments.

This led to lower return rates and a significant administrative overload for the staff. Shadina knew that implementing an auto-pull system would save the practice considerable time, but it required buy-in from the IT team.

Over the next 4 years, Shadina worked diligently with the practice to help them develop workflows that would decrease administrative burden and improve program performance. Her support and dedication created a strong foundation of trust, and in 2024 the practice presented her auto-pull concept to IT, who agreed to the build.

When a practice shifts its focus to risk adjustment, the sheer volume of data, technology and program intricacies can be daunting for the staff. But with collaborative problem-solving between the HCA and practice team, the program can start to build momentum.

Shadina frequently discusses workflow enhancement with her providers, a dialogue that often sparks process improvement initiatives. A prime example of this is a recent project completed at Excel Medical Center in Philadelphia.

Excel Medical Center enrolled in the In-Office Assessment Program in 2020. Shadina worked closely with the clinical and administrative staff at Excel to assess the practice’s needs, resources and goals. In 2022, Optum integrated with Excel’s EHR to create a more streamlined workflow for Excel and provide access to patient insights and alerts from Optum data and analytics.

Shadina meets monthly with Excel’s director of operations and population health specialist to review utilization lists, address issues related to assessment submissions, refine the digital integration process and optimize workflows. Together, they devised new processes and workflows to improve Excel’s digital capabilities.

For providers on the journey to value-based care, there isn’t a “one-size-fits-all” approach. Some are further along, having embraced greater risks, while others are just beginning their journey. Along the way, practices may encounter various challenges. The role of an HCA is to engage with providers at their current stage and offer support throughout their progression.

By supporting providers with insights to deliver comprehensive care, we can advance whole-person health. This helps build a value-based system of care focused on better outcomes at lower costs, where patient, provider and payer incentives are aligned.

Optum Health Care Advocates can bridge the capability gaps essential for the success of value-based care, simultaneously saving time and minimizing hassles for providers. Shadina John is a perfect example of how HCAs asking, “What can I do to support my providers today?” allows practitioners to focus more on what matters most — patient care and positive outcomes.