Helping providers deliver informed care through patient assessments

That support proved critical this year when Dr. Victor Seikaly, a physician with Sharp Community Medical Group in California, welcomed nearly 200 new patients after another physician retired. Kalinowski stepped in to help his practice through the transition while maintaining a focus on value-based care.

“I reviewed each patient’s diagnoses, labs and medications to identify documented evidence of chronic, ongoing conditions,” she said. “Then I mapped those findings to the appropriate codes and created patient profiles for Dr. Seikaly to reference before and during each patient’s first visit with him.”

Among the new patients was a senior with dementia. Research shows that up to 85% of people with dementia miss out on essential post-diagnosis care, which meant this first visit carried real weight.

"We had one shot to get this right,” Kalinowski said. “We have no way of knowing if they’ll come in for a second or third appointment. But we did know they wouldn’t be able to tell their full health story, so I made sure I got everything documented." 

The profile gave Dr. Seikaly a more complete view of the patient's conditions, including dementia and heart failure, before the appointment. With that information, he was able to conduct a thorough annual assessment and develop a coordinated care plan tailored to the patient's needs. Documented precisely, it also opened the door to additional support from the patient's health plan.

“Optum's support has been valuable to my practice,” Dr. Seikaly said. “Michelle was instrumental in helping us get up to speed quickly so my team and I could focus on patient care rather than administrative work. I recall one elderly patient in particular. The information provided in advance allowed us to conduct a thorough assessment in a single visit, which would have been difficult otherwise.”

“He’s the doctor providing the care, and that’s the most important job there is,” Kalinowski added. “I put the pieces together, so he had the information he needed to make informed care decisions.”

Kalinowski’s work is one piece of a larger effort. Across the program, about 300 field professionals work with more than 40 health plans and 29,000 provider groups, helping complete nearly 6 million assessments a year. That kind of collaboration between health plans, providers and coding experts helps ensure assessments translate into better-informed care, especially when patients are unable to advocate for themselves.