Advancing provider performance

Advancing Provider Performance with Analytics

Alex:

Good morning, I'm very excited to introduce our presenter today. We're going to kick this session off with Morgan Bradham, Vice President of Operations at Palmetto Primary Care Physicians. Morgan has been a partner with Optum for multiple years now, and she really knows the ins and outs of these use cases. So I'm super excited for all of you to hear her perspective success at PPCP. So thank you again for joining. And without further ado, I'll pass the mic over to Morgan.

Morgan Bradham:

Good afternoon. Thank you Alex. I appreciate the introduction. Like Alex said, my name's Morgan Bradham. I am the Vice President Operations at Palmetto Primary Care Physicians. I have been with the company for almost a decade now, and I started my career with the company in our quality department. And that is where I have lived until about May of last year, I moved into the Operations role. So I started out working on as a project manager on our PCMH contracts and moved into managing some of our transitional care management lines business, and then moved into overseeing our quality department and stayed in that role for quite some time. And I'm also still our ACO administrator.

Morgan Bradham:

So I'm going to start out just giving some background on the company so that you kind of get a feel for who we are and what we do.

Morgan Bradham:

Palmetto Primary Care Physicians, PPCP, as we're going to call it from here on out, we're the largest independent multispecialty physicians group in the state of South Carolina. We were ranked number one in quality for South Carolina based practices, based on the 2019 and 2020 CMS reporting for ACOs. We have about 200,000 patients through around 40 offices in eight counties. We have over 110 medical providers in eight specialties.

Morgan Bradham:

We also have several ancillary lines of business. We have our own centralized moderate complexity lab. We have a full service diagnostic and imaging center in north Charleston. We also have an urgent care center in north Charleston. We have four locations of physical therapy and our specialties include; neurology, endocrinology, gastroenterology, I mentioned PTV, we also have psych audiology and we do have a doctor that sees pediatrics.

Morgan Bradham:

So just a quick profile so just so you understand our setup, there are 22 physician partners that own the company. They actually came together about 25 years ago with the goal of getting away from hospital employment and kind of pooling resources so that they could get a discount on malpractice. And it has definitely snowballed from that mom and pop to what we are today.

Morgan Bradham:

But as I mentioned, there are 22 physician partners, now we're getting ready to add about four more. We have 16 employed physicians, 78 advanced practitioners, 30 primary care locations. Like I said, we're in eight counties and we have over 600 employees.

Morgan Bradham:

So just to give you all some background and history, and this is really more targeted towards the quality mindset of the company. And I've worked for a hospital system, but I will say these guys are the most innovative group I've worked with as far as quality and trying to find ways to do things differently and really getting into value-based medicine before that was even a requirement in South Carolina. And I don't know if you've been here or you may live here or you visited, but South Carolina, we are slow to adopt. So that's a feat for that to happen here.

Morgan Bradham:

But in 1997, we implemented medinformatics. We were one of the first groups in South Carolina with a fully integrated EHR system. In 2009, we were among the first in the nation and the first in the state of South Carolina to pilot PCMH. And we were in a pilot program with Blue Cross Blue Shield. 2016 was our first year participating as a Medicare shared savings program as an ACO. In 2017, we... The year of 2016, we realized we needed data. So we implemented OPA and we began our scorecard initiative. And I'll get into that a bit later.

Morgan Bradham:

2019 and 2020, we ranked number one, like I mentioned, in the quality scores. In 2019, we saved over 9 million. We were really building some momentum there and then COVID got us like it did everybody. So still saved over 2 million, despite the COVID impacts, which I thought was incredible. And our quality score's really didn't dip very much because our guys were able to pivot quickly with the emphasis we put on annual wellness visits. So we switched that over to telehealth pretty fast and rebounded.

Morgan Bradham:

Our mission, vision, and values. Our mission is to be your family's home for high quality cost effective healthcare. Our vision is to be the model for patient-driven healthcare and physician independent. And our values are centered on compassion, integrity, accountability, and excellence.

Morgan Bradham:

Getting into our quality outcomes. Our MSSP 2021 highlights. This was released in 2021. This is 2020 data. I'm sure if you have any experience with an ACO or quality money in general, you know everything runs quite a bit behind. We have 18,000 thousand covered lives. Our quality score was 98.47. Our ACO total savings for Medicare was over 2.4 million in 2020. Readmission rate was about 14.92%. I think that sounds abysmal, but the national average was quite a bit higher. And then this is what we were most proud of. Our number of poorly controlled diabetic patients was one of the lowest in the nation. We had 9.2% of patients that were under or above that threshold. So that put us in the 90th percentile. The national average was about 14.7%. And I'll get into what we attribute some of that success to.

Morgan Bradham:

So our quality team structure and staffing. Like I said, our partners have always been pretty innovative and they made an investment pretty early on in a care coordination staff. Right now it includes two PharmDs. One of those supervises our medication prior authorization department, and that's staffed by 10 pharmacy technicians.

Morgan Bradham:

We have two social workers, one in each of the major markets. We have one full-time data analyst, Amanda Walworth, she's our OPA super-user. So she is the person to credit with running these reports and making my data dreams come true. And we have one full time dietician, two PRN, four registered nurses that are solely dedicated to transitional care management, backed by three support staff who do the admin work for them.

Morgan Bradham:

We have a quality trainer that goes out to site, and she uses the scorecards to guide her movement across the organization, and to focus when she is on a site on what they're actually doing that could be improved.

Morgan Bradham:

We also have a quality CMA. She handles reporting in clinical projects, such as our reflex A1C project, and we do use some Optum data for this. And I just wanted to mention this as well, because this has been a game changer for us. And as you guys know that with diabetes, that time from when the patient actually have diabetes from the time of diagnosis, sometimes that can be years, and our goal is to reduce that. So what we do is anytime a patient has a their blood drawn, obviously we have the glucose level. And if the glucose level is over a 100 and they have a risk factor as defined by the ADA, we add on an A1C. Or if it's over 126 fasting, we add A1C. And we result those in that way, we're catching diabetics that may have not even been diagnosed yet or may still be in that pre-diabetes range. So we can go ahead and do early intervention and get them into classes.

Morgan Bradham:

So we have a CMA who handles some of that. Right now one of our pharmacists is doing it. So we're in some staffing transitions, as I'm sure you can all imagine. And we also have a value-based contract administrator, and I'll go into that role a little bit later.

Morgan Bradham:

We have a support services manager. She supervises our transitional care staff, medical records, document management. She ensures accuracy in patient data and proper structured field documentation. We also have two registered nurses and two support staff that work after hours evening triage to reduce ER admits and provide 24/7 care for patients.

Morgan Bradham:

So I'm going to go into kind of the specifics and the approach that we take to data and how we use our Optum product to help us to achieve what we have this far. And I'll be talking about; one, provider scorecards, two, utilization management, three, provider education, and four, risk stratification.

Morgan Bradham:

So starting out with provider scorecards. As you can see here, this is OPA's Stars Measure Dashboard. That's what we use to produce provider scorecards. Current cadence is quarterly. We're moving them monthly this year. We also pull them on demand for providers if they want some more instant feedback.

Morgan Bradham:

So this is just showing like kind of the view from inside of Optum and what abilities we have to filter. We also are able to compare market to market. So we have filters built in there so we can show the Columbia market how they're performing, the Charleston market, et cetera. So that has proved to be really helpful.

Morgan Bradham:

Our measure highlight from 2019 to 2020, again, with the full year data we're looking at, I'm just focusing on calendar years, and since 2020 claims run outs, not quite done. Wanted to make sure we had complete data for you. But we moved from 76% compliance on colorectal cancer screening to 83% compliance, which put us in the 90th percentile, that was among other ACOs. So we were really excited about that.

Morgan Bradham:

But I feel like using this scorecarding mechanism for providers and we publish it to them via email. What we're moving to this year is publishing it with their financials that they get every month for their sites, so that it's in that finance folder, and they can see everybody in their site. We also provide just a ranking of their overall, what we call their composite score. And I'll show you that on the next page.

Morgan Bradham:

So this is what we actually supply to the doctors is their measures. And then we also add AWV measure and we take basically their compliance, the percent compliance. And as you can see, all of these numbers are from 1-100 other than the diabetes, which is inverse. So we just flop that number. So if this one's 2.74, we would take, excuse my math, if wrong here, but 97.26. And that would be his score. We would average that, and that's how we compare the providers across the board. And we do bonuses in quartile. So top quartile gets X bonus and second quartile, third quartile and the bottom quartile.

Morgan Bradham:

So that has worked very well for us. The providers really like the emphasis on the quality measures and helps us keep our focus on the right things. Also, makes a good case for AWVs as well because not only are they getting that done and getting that risk stratification, but it also helps us with just making sure that we are seeing that patient every year, we're addressing all those preventative screenings that are ACO measures, and also just overall contributes to a lower total medical costs because we're preventing the bad things from happening when we can.

Morgan Bradham:

So utilization management. This is another report that we use in OPA. The name of this report is the Provider Performance Comparison Overview. And so what we do here is we pull this report, it gives you the doctor's name, and then we add in their practice or system, and then the specialty to whatever the provider belongs to, so then we make it easy to compare, like apples to apples.

Morgan Bradham:

So for example, when we pull this report, I have this one filtered just as fine. And so we have one, when it pulls up ortho, we put in hip, knee, they do shoulder, if they do hand, if they do foot and ankle, so that we aren't comparing a spine surgeon to a foot and ankle surgeon, because obviously those costs are going to be different.

Morgan Bradham:

So as you can see above... And I just love this report, because it's such good information for the providers. If you're in an ACO or even if you're not really in a shared savings like an ACO type arrangement, this is good information to have, because overall we're in the business of taking care of patients and that includes our wallet too. We want to make sure that our seniors aren't spending more money and really any of our patients, especially those Medicare patients that are on several medications that could be expensive. We don't want them unnecessarily spending for procedures and whatnot. So this is just good information to have.

Morgan Bradham:

But as you can see above, we identify that as far as like the spine surgeries go, one group is less than half per episode. So if you're looking across this, that's the number of patients that were in that group or for that time period, the number of episodes is how many different cases or diagnoses that they were treating. So as far as with the episodes, they could have been treating multiple diagnoses for a patient, so one patient may have to. So that's why that one's a little bit higher.

Morgan Bradham:

And then the amount normalized episode per case, that's kind of like the risk score, the complexity level. So you can kind of compare that as well. The amount normalized is how much was actually paid to that NPI with our Medicare dollars. And then the peer amount normalized is how much the average peer would've spent. So then it breaks it out per episode. So per diagnosis, that's how much we were spending. So this spine, back and neck surgeon on line one was per episode about $23,000. The spine surgeon on line two was spending about 10. So that's a significant savings for a patient.

Morgan Bradham:

And that may not be the dollar amount it breaks down to, but this is just a good baseline. And then the amount normalized index, so that's going to give you kind of the ratio. So really you're kind of looking for that to be less than one. Over one would indicate they're a little more expensive. Also, the thing that I like to look at as well is the encounters per episode. So if you're looking at the very last column where it says quality index, if you count two over encounters per episode, that's about how many visits or encounters that it took to resolve that condition. So as you can see, it's taking about 10 more visits for that person to resolve the condition, and the top person that we sent the most referrals to.

Morgan Bradham:

So what this did, is it gave us a really good conversation to have with our current referral partner and say, "Hey, this is what the data is telling us. What light can you shed onto this? Are we not doing them in surgery centers? Or did you have reasons that the patients needed to have them in the hospital? Talk me through this." It gave us some good conversation to have with current referral partners.

Morgan Bradham:

And then the one in green was one we did and worked with as often. And that was in place that we felt like we could maybe start utilizing more. And then again, like we already kind of knew just from patient anecdotal that we were seeing pretty high costs come out of the lower two. So that was one that we didn't send as much referral to. And they also aren't reporting quality because they're not participating in the same contract. So that could also be an indication of the care that our patients are receiving.

Morgan Bradham:

This would lead me into our provider training and I'll tie this back to kind of how we've worked with the utilization reports with our provider training. But in 2017, we implemented mandatory quarterly provider trainings. This helped us to grow our shared savings dollars, increased quality scores year-over-year. This has probably been the single most successful or impactful thing that we've done. And without that Optum data that we've been able to provide, we wouldn't be able to target the trainings as well as we do. And I think that's what makes a huge difference for us.

Morgan Bradham:

We offer those virtual and in-person. They're held outside of clinic hours to minimize distractions. I can't tell you how much of a difference that made as well to going to a... We do like a six to eight o'clock in the evening, a one to three o'clock for those that do a half day clinic on Fridays. We do a 6:30 to 8:30 in the morning, but not doing things and expecting them to a lunch and learn or anything like. That just doesn't work for us. It may for other organizations, but I encourage you if your organization is trying to do something like that, and you're not really seeing the results, if you're not doing it outside of clinic hours, I think that's a great first step.

Morgan Bradham:

So we're seeing suboptimal performance, like I mentioned on any of our scorecard measures, that's how we focus our opportunities. And then it gives them the chance to interact with experts. So that's specialty providers, pharmacists, dieticians, social workers. So they're hearing about new medications from the pharmacist and they're not hearing about it from a drug rep. They're hearing about what is the cost benefit analysis on this? Who is the perfect patient for this medication? What are some things that you should try before putting a patient on these medications? So it really just gives us a chance to intervene and it saves our ACO and quality contracts money, but it also saves our patients a lot of money, too.

Morgan Bradham:

Peer interactions, providers sharing best practices. It's really comical to give them their scorecards at provider trainings because they're trading them like baseball cards. But it also just gives good information about, "Hey, you have a 90 something percent in breast cancer screening. What are you doing or what are you saying to your patients? Or you all do some kind of phone calls, or?" Just giving strategies that will help everybody improve.

Morgan Bradham:

So this is kind of an example agenda of what we do at our provider trainings. So our quality team, like I said, we use Optum identify our data trends like in the uptake of utilization, it leads to unnecessary imaging and testing. So we noticed that providers from our data were using Cologuard test inappropriately. So that was leading to unnecessary imaging and subsequent colonoscopies increasing total medical costs. Because if they're having the Cologuard and they were already ineligible for Cologuard, that's almost $700 for that test hitting our contracts. The patient is then having to pay a diagnostic rate for a colonoscopy.

Morgan Bradham:

And we just noticed it was sometimes just lack of education on the providers part. So we had the GI come in and review that. We also realized, before that, when we were reviewing some of this, it's also some patient misconception. They, from the television commercial at the dancing Cologuard box, their perception was, "If it's positive, I have cancer. Where we all know that Cologuard has a blood component, so it could be something else that's maybe more benign. And it certainly isn't a cancer senate. So we had patients requesting pet scans and things like that.

Morgan Bradham:

So kind of seeing that trend and that uptake helped us to do some intervention there. But we had our own GI address the group. He provided education about colorectal cancer screening and other GI topics; talked about H. pylori, hepatitis A&C. We also have our pharmacists take a big role in this. One of our pharmacists spoke about statin intolerance, exclusion coding to pull those patients out of the measure who don't belong. We talked about weight loss drugs. We've talked about tube feeding referrals. We went through a controlled substance policy reminders, COVID vaccines, PA updates, medication delegation for advanced practitioners. So having them for that time is so important so that we're able to say these things and we have their attention.

Morgan Bradham:

And them tying back to our discussion about the utilization management. When we were looking at that report that I mentioned earlier, we identified that our highest ortho spend was in spine surgery. So we brought in the lowest cost, highest quality spine surgeon as we looked at from the Optum data. He presented in conjunction with our PT, our physical therapist. This multidisciplinary team approach ensured a better referral, increased patient satisfaction, it lowered our medical spend, decreased overall medical costs. He basically came in and spoke about what imaging does a patient need to have before they come to us. What are the things that like... We really at Palmetto Primary Care want all of our clinicians to practice at the top of their license. So we don't want necessary referrals going out the door.

Morgan Bradham:

He also drew a line to our physical therapist and just helped providers understand, like if you're seeing X symptoms, send a physical therapy, if you're seeing Y symptoms, back to referral or to orthopedics. So it really helps to us to send people to our PT and to help that service line be profitable. But at the same time, it brings down the total medical cost because we're able to... PT is a cheaper alternative than surgery. And almost any case I can think of, much less invasive. So we want to encourage that when we can. And hearing that from an orthopedist, instead of me, the MBA who works in operations, its always important for a clinician to speak peer-to-peer.

Morgan Bradham:

So these specialist guest appearances that we do in the quality training arena are so important. As you can tell on this one, we talked about osteoporosis drugs and update to the algorithm, urine drug screens, advanced care planning, and annual wellness visits, our treadmill stress test, nuclear cardiac stress test. So this has been super helpful, but just wanted to tie that back to how we use that Optum data mentioned to bring in this orthopedist. So that was a great move on our part because we did see decreased medical costs going forward from that,

Morgan Bradham:

And then moving into risk stratification. As I mentioned before, we have a value-based contract administrator in quality. This is a fairly new position. And what she does is help us drive an increase in RAF scores. We added that basically because during COVID, we were shifting the way we did things. And not only adding this did our benchmark increase for MSSP which obviously increases the budget of what you have to spend for your patients, but it also, we increased our incentive money on our Medicare Advantage plans as well.

Morgan Bradham:

So as you can see in 2019, we'd only brought in about $88,000 from our UHC Medicare population from... And this is just from, if you're familiar with MCAIP it's M-C-A-I-P, it's acronym, it's like risk adjustment incentive money. I'm not sure if it's available in all markets, but I know it's available in a lot in the south. But working with Optum, the Optum path forms, that provider assessment form. So Carla, our value-based contract administrator works with those forms and she increased those from 88,000 to 419,000 in 2020. And what we've been paid out so far in 2021 is about $173,000. And we've got still some more coming. So good news there.

Morgan Bradham:

And we also use the suspect condition report in OPA for the MSSP and then we use the payer reports for what I mentioned in this chart here on the right side. But I think that concludes my presentation. I'm happy to answer questions and I appreciate your time.

Alex:

Thank you, Morgan. That was amazing. I was just sort of reeling at all the sort of return on investment numbers there. So thank you for sharing those. We did have one question about the HEDIS quality measures and I can lean in here if you need help or if there's any difference in the answer. How much of a lag do we have in reporting period for your HEDIS quality measures?

Morgan Bradham:

I think it's six weeks for like what we have for our Medicare ACO, because that's the only claims data that we have in Optum. But I believe it's right at maybe four to six weeks. But you or Danielle may know better than I do about that.

Alex:

Okay, cool. Yeah, that 90-day claims run out. But just a quick note for OPA end users, there is an option in these reports to kind of toggle the lag period on and off. So if you are receiving any information for claims that are adjudicated within that six-week time period, they can flow into a report based on your desire for that data.

Alex:

Perfect. Let me see, I'm getting over to my chat here. The other question we had was around the suspect condition reports. Can you give us a little context about how you're using those relative to that HCC coding work?

Morgan Bradham:

Yes. What Carla does is she will review the reports that give the list of conditions like either from the payer or from Optum, whichever, and then she reviews the conditions that it says it is suspect obviously. And she goes in the patient's chart, looks to see if it's been... Because with claim flags, sometimes they've been addressed in the period of time from when the report was published until now, or the time she's looking at it. But she'll go in check and see if it has been addressed. If it hasn't been addressed, then she will look back through previous notes and see if she can find evidence that the patient does have the condition.

Morgan Bradham:

She also looks through our patient documents at our outside reports from other specialists and she identifies all the conditions that were suspect that are a true gap. And she also has the ones that maybe she can't find evidence of. And then she puts that in a section in our chart, easy clinical work. She puts that in, basically it's called the point me a reason, but it flows down into the chief complaint. So she puts it in the chief complaint. So when the provider pulls it up, they work from the chief complaint screen and just remove that information before they lock the note and then they address those, put them on the problem list, move them into assessment, they bill out on the next claim.

Alex:

Awesome. Yes, Michelle, very helpful. I agree.

Alex:

Any other questions that you can put into the Q&A portion of your screen or into the chat widget as well? Let's see here. I think we do have one more. Hold on. Let me get to it. We had a question around using Epic. Morgan, do you all use Epic?

Morgan Bradham:

We do not. We use the eClinicalWorks.

Alex:

Okay. All right. Sounds good. So Linda, we will follow up with you and kind of give you a little bit of context there. Just writing down your name. And if you want to send me your email address via chat or Q&A, happy to field that question with our team of value advisors. And Nick asked about any new OPA reporting projects. So do you have plans for new and exciting projects?

Morgan Bradham:

I believe our pharmacists are working on something with the team right now. I have been in provider scorecard land for the past a little bit because we just did our ACO bonus distribution for 2020. And so we are kind of working through those scorecard meetings with providers. So I have my head buried with that, but I know our pharmacists are working on a newer project with that, I believe, it may have something to do with maybe the statin intolerance, statin adherence. And then I think we are getting ready to kick back off our CKD project and working on AFib since we've hired some more staff. And our pharmacists are freed up a little from some of their COVID duties.

Morgan Bradham:

So we're looking forward to getting that CKD report back up and running. We were using that to... They were checking... The pharmacists were going back through and checking lab levels for GFRs and then going in to see if they could make that connection of what stage CKD they had and send that over to providers, so that gets coded on a claim, because that is a huge riff for RAF scores. So it makes a big impact there. So we're looking forward to getting that back online here in the first quarter.

Alex:

Perfect. Maybe we'll have another webinar on that in just a couple of months.

Morgan Bradham:

Of course. Yeah. I have to say, we've got really good over here, so I'm sure they were cooking up some other ideas that I'm not even aware of.

Alex:

Awesome. Very, very cool. All right. We have a question around where we are getting our data. So do you gather information from patients only or do you collect data from observations or other categories of patients?

Morgan Bradham:

I'm not sure I followed the question, but I mean our data sources are mainly just our EMR data and the claims data for Medicare. But we use our EMR data for all of our other general reports. I'm sorry. I don't know if that answers the question.

Alex:

Yeah. Linda feel free to send a follow up question in there. Let's see. We have another question around the quality index scores in provider reporting. Do you utilize the quality index scores?

Morgan Bradham:

Are you talking about the quality index scores that are on... Let's see, I'm backing up. The quality index form, the utilization management?

Alex:

Yes.

Morgan Bradham:

I'm assuming that's what they're referring to, but yes we do look at that. This is actually a screenshot I took straight off of my board presentation from the doctors. As you can see there, I highlighted that the other group did have a higher quality index score. So that's why we did go back to that group and have a conversation about, "Hey, are these patients, did they need to have the surgery done in the hospital? Why was that chosen over as surgery center and what case?" So just I'm making sure we were driving those costs down, but we absolutely take into consideration of quality score.

Morgan Bradham:

And then with the group that had the slightly lower quality score, it was helpful because we blind this data and show it to the other groups. We obviously don't don't tell them who it belongs to, but we do blind it, and we were able to show them. And they were like, "Oh gosh, they have a much higher quality score than us." We kind of do the bare minimum on MIPS because we didn't know that this was being reported in this manner."

Morgan Bradham:

So again, I think it's kind of a test to south Carolina's lack of sophistication at some points in some of the quality contracting, especially surrounding those that aren't our primary care. But we certainly look at that, and that's a conversation we have. So that group is actually, really they started sharing their quality assurance projects with us monthly. So really appreciate the transparency that, that inspired in them once we started working in that capacity.

Alex:

Awesome. Also, let's see here. When we have this many questions coming across, it's really exciting, but I end up having to toggle and scroll. So bear with me for just a minute. We have a question around incentive payments. So do your providers get a return on their time investment. Is there incentive money that's being tracked by provider and passed along to them? Or how does that work?

Morgan Bradham:

The providers don't track the incentive money. We kind of provide that reporting to them, but we do share the incentive money with them. So our advanced practitioners get the opportunity to have a quarterly bonus. Our employed physicians participate in what we call profit sharing quarterly. Our partners, they own the company, so they obviously get a return in that capacity. And then at the end of the year, our ACO money is distributed. So that's like, we got a little over a million in 2020, was our payment, because obviously if you share a little over two, if your share rates around 50%, that's where you end up.

Morgan Bradham:

And then the year before that we were right around 5 million. So we do, do a bonus for providers and a very sizable bonus. So they get that based on their quality scores. So that's where I mentioned here with the provider score cards, under percent compliant, we flip that diabetes number and then average it, rank them into quartiles and we do bonuses based on their patient panel and based on their quality score. But the quality score's weighted about three times more than the patient panel.

Alex:

Awesome.

Morgan Bradham:

And we also use the quality money to offset what we kind of charge as like back office support for providers. And they like that as well because that money helps to pay for the pharmacist, the dieticians, the social workers. So really helps them to do what they do best in the office and see the patient and be able to pass the patient to the pharmacist, to have a discussion about a new statin insulin. Or having a pharmacist follow them for titrating insulin. Or even our social workers, making a warm handoff to a therapist that is their gender preference, location preference, specializes in what they're looking for. Or a celiac patient, they don't have to spend 30 minutes in the office going over diet. They have a dietician to do that.

Morgan Bradham:

So they appreciate the support on that side as well for what we allocate for salary back to those folks, because it does give them the opportunity to, one, make more money on a fee-for-service end. Two, they keep providing better care to their patients. And three, they are increasing their quality bonus because we're increasing outcomes.

Alex:

Very helpful. Melissa, please let me know if you have any follows to that or if that answers the question.

Alex:

All right. We haven't had any questions come in for a couple of minutes while you were answering that, but do want to give folks some time.

Morgan Bradham:

Okay.

Alex:

All right. So just a reminder and I'll kind of use this as a little bit of a buffer before we end the call. You will receive a popup window in your browser for the survey after this call. Like I mentioned, it's a really great way to kind of let us know how this content resonates with you or if there's any additional content that you would like to see us work on.

Alex:

Oh, we do have another question coming in. Oh, that's that's a similar question. Okay. So we will follow up Linda on that question around the data points and the data that's coming in around inpatient and observation patients.

Alex:

All right. So thank you everyone again for your time. We will end the session for today, but I will be sending out an email with a link to the slides as well as the recording on the client learning community. So if you think of anything after the call today, please feel free to email me as a reply or to our oa_training@optum.com, email address. Always happy to hear from you and to help connect you to the right stakeholders at the organization.

Alex:

Have a wonderful rest of your day. And Morgan, thank you so much for a wonderful presentation.

Morgan Bradham:

You're welcome.

Alex:

As always, it was riveting to hear from you. Thank you.

Morgan Bradham:

All right. Thank you so much.

Alex:

All right, bye now.

Morgan Bradham:

Bye-bye.