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       July 2020

The Monthly Exchange is designed specifically for and about the Optum Workers’ Comp and Auto No-fault division. It includes division accomplishments, health and wellness, and other company news.

SPOTLIGHT

OWCA strengthens position in the auto no-fault industry 

OWCA is expanding our SRPS in-network conversion (Network Enforcement) to include auto no-fault prescription (script) claims. Historically, SRPS been a third-party biller specific to workers’ compensation. SRPS buys workers’ comp script claims from pharmacies at point-of-sale and collects payment from payers. When scripts are found to be for Optum clients, we convert them in-network, adjudicate using client-specific edits and bill the client at their contract rate, just like an in-network transaction. 

How clients benefit

Our pharmacy care management clients benefit through increased network penetration, reduction in higher-cost third-party bills and associated collection calls, application of client-specific edits to ensure the medication is appropriate for the claim, cost-savings and improved data capture for clinical oversight.

Expanding to auto no-fault

We are now building functionality to allow SRPS to also buy auto scripts at point-of-sale so that auto clients can realize the same kinds of savings that workers’ comp clients already achieve. This auto expansion incorporates auto-specific regulations, as well as policy-limits that vary state-by-state.  Over the coming months, SRPS is expanding existing contracts with major pharmacy chains and independent pharmacies to include auto no-fault claims. This initiative will help to improve SRPS' position in the auto market and benefit our auto clients.

Rollout plans

We will roll out the program in New York, New Jersey, Pennsylvania, Michigan and Florida by August 1, 2020. Client participation in the Optum Network Enforcement program with SRPS requires a signed PBM contract, as well as electronic eligibility from the client. Existing auto clients who meet these requirements will have the SRPS expansion turned on automatically. Additional existing and new auto clients can be onboarded once they meet the contract and eligibility requirements.

The last few Monthly Exchange newsletters have featured, how our employees are “Living Our Values.” We’re showcasing a different core value each month and highlighting individuals who have received Bravo recognition for living a value.

This month, we are celebrating INNOVATION.

We believe:

Our fundamental role is to Make Health Care Work for Everyone. The health care environment must be engaged in constant change, yet embody a positive dynamic – it must change progressively. In turn, we must be thoughtful advocates of such change. We must value and be proficient at adapting to change as we pursue a course of continuous, positive and practical innovation as a core competency within our enterprise. 

We value Innovation:

We will learn from experiences of the past and use those insights to invent a better future to make the health care environment work and serve everyone more fairly, productively and consistently. 

We behave:

We will continue to respectfully challenge the status quo. We will encourage and invest in new ideas. We will be curious and not afraid to fail in honest efforts to focus on practical and purposeful innovation that builds value and benefits the entire health care system – so it truly works for everyone.

Jason Barker said of Darick Jarvis

“Thank you for all that you did to help us with the P2P database move to Elk River. You came up with some key innovative solutions that helped us get around some major obstacles we faced along the way.”

Andria Glasstetter said of Joanne Alvarez

“Thank you so much for your innovative thinking in asking if we could install the Input Mapper on both RD’s – it works!  You rock!”

Justina Cohalla Neatherly said of Christian Kelley

“During migrations you noticed a pattern with some delays in orders, you suggested we proactively research the doctor’s file for the remaining migration waves – this was a great idea! We were able to identify issues before they BECAME an issue, prevent future delays and save time for the team.”
 

Jahan Henriquez said of Christine Demartinis

“Thank you for the time you put into the new Clinical Care Management Project. Implementing a new system in that time period took a lot of hard work and I look forward to working with you and our team on the launch!”

Lane Criddle said of John Osborn

“I just used your Data Transfer Screen program for the first time – it’s got to be the coolest testing tool I’ve seen. It will for sure help the QA group for years to come!”

Robyn Dahlquist said of Krystal Holt

“Thank you for creating that spreadsheet that can be used by all the other team members.  We appreciate you sharing your knowledge on how to do things more efficiently.”

JULY NEWS

Putting transparency around the transparent pricing myth in pharmacy benefit management

As we compete for clients in the marketplace, we are often questioned about our thoughts on and approach to what is called “transparent” pricing. Some PBM companies currently pitch a “transparent” pricing model that is enticing to prospective clients. But, we don’t think these models are really transparent and can be deceiving to their buyers. The sparkle of a lower-cost transparent pricing model is often quickly dulled by the addition of administration fees and click fees to cover the workers’ compensation cost of services.

Read more to learn what’s not so transparent about transparent pricing

OWCA Town Hall recording available 

View Now

A recording of the June 24 Town Hall is now available on OWCA’s Hub Connect page.

Please share any feedback via email using this address: OWCAcommunications@optum.com.

When emailing, remember to include “Town Hall Question/Comment” in the subject line.

Return to Office: The Podcast Series

All of the uncertainties around COVID-19 and the frequently changing safety rules and precautionary measures can cause anxiety. To help calm the uneasiness as it applies to returning to the office, Optum has created ― Return to Office: The Podcast Series. Episodes range from a little over three minutes to about seven minutes and cover a variety of topics including:

  • Working in Ambiguity and Uncertainty
  • The Mental Prep You Need
  • Calm and Refocus a Distressed Staff
  • Lead Effectively During Uncertainty
  • Be at Your Best
  • Be a CEO: Chief Empathy Officer

Check out the podcasts, here.

Return to office etiquette

  • Use the ProtectWell™ symptom screening app before leaving your home
  • Wear face masks when entering the building and when you’re away from your desk
  • Maintain physical distancing from others
  • Observe posted rules about appropriate social distancing and limited occupancy throughout the buildings including elevators and restrooms
  • Use wipes and/or sanitizer stations around the building
  • Additional guidelines, here.

DAY IN THE LIFE

Lorenzo Garza
Manager
Settlement Solutions

Department size: 101

Department head: Jeannine Foster

Customer served: Internal/external, client/claimant

Years with Optum: 3

Rapid Fire Questions

What are you most proud of?

My family, my education and my service to country (U.S. Naval Submarine Force).

What was the best concert you
ever attended?

It’s a three way split, The Eagles, Jackson Brown, and the Rolling Stones.

What’s the craziest thing you’ve
ever done?

Free form ascent (no oxygen equipment) from 50 feet underwater during a simulated submarine emergency escape.

To learn more about what the Settlement Solutions group does, check out this
three-part series on Hub Connect:

Part one   |   Part two   |   Part three 

A day in the life with LORENZO GARZA
MANAGER, SETTLEMENT SOLUTIONS

What’s a typical day involve for you?

Each morning begins with a detailed/statistical review of the previous day’s performance. Settlement Solutions is made up of six principal services:

  • Medicare Connect – Mandatory Insurance Reporting 
  • MSA Development – Medicare Set-Asides (future medical expenses)
  • Centers for Medicare & Medicaid Services (CMS) submissioncases that are approaching settlement
  • Conditional Payment – responding to the Federal Government’s demand for payment and mitigating erroneous charges
  • Clinical mitigating overexposure to pharmaceutical and medical expenses
  • Compliance helping establish policy, procedure and responding to market demand for expert opinion and consulting.

Every day, the Settlement team must receive and process cases within our regulatory and contractual performance requirements while also engaging with our principal customers, including adjusters, insurance carriers and third-party administrators (TPAs). 

What’s the biggest challenge in your role?

Balancing time and priorities within our environment of regulatory and contractual compliance while also supporting quality and high-end customer engagement.

What’s the most satisfying part of your role?

Working with my team. Settlement Solutions is a complex service encompassing federal compliance, medical and legal process requirements. At any point in our working day, we are collaborating with or responding directly to attorneys, physicians, nurses, pharmacists, or government representatives, while maintaining a high level of engagement with our clients. The front line staff and management work hard to ensure they are technically sound and aware of changes to our regulatory environment.

What has been your favorite project?

Our system platform upgrade. We had a condensed timeline, heavy business and technical requirements, many twists and turns and plenty of opportunities to go wrong. Thanks to a skilled project team, which included members from IT, business and compliance, we were able to successfully complete the project “just in time.

What would you like others to know about your role that isn’t obvious?

Settlement Solutions is a claims production environment. However, front-line consulting is key. This can come in the form of directly contesting a service or charge to an accepted injury, helping our clients resolve reporting errors, or preparing for future medical costs and settlement. As a small department, our monthly phone volume average is 1,800 service calls (inbound/outbound) and 28,000 service emails, which is the principal way we engage with our clients.

What is your favorite part about working here?

Connecting the dots. Our service naturally progresses from Medicare Connect (Mandatory Insurance Reporting), MSA development and Conditional Payment to final Settlement/CMS submission. Leveraging the totality of our department skills, helping our clients mitigate regulatory and financial risk, end-to-end, is a very unique position in the market.

MAKING A DIFFERENCE

Employees across our division continuously engage in onsite events
and social responsibility efforts within their communities.
The following is a highlight of our most recent employee engagement activities. 

IT TEAM CREATES POSITIVITY PARADE

In an effort to spread positivity in light of all that’s going on in the world right now, in June, the IT team created a positivity parade. Teams or individuals made positivity pictures/videos/presentations to be shared with the entire IT team in a virtual positivity parade during the IT monthly town hall. And some team members donated money to sponsor the visual “floats” for the positivity parade. $1,325 will be donated to charity. Participants could create any type of visual that sparks joy for them. A couple of entries are displayed below.

Thank you to the IT team for your creative Giving Back initiatives!

June TAKE-a-Step challenge

Congratulations to OWCA associates who participated in the Take-A-Step Challenge from June 1-14. This challenge was different from past events, steps were tracked through the Rally app rather than self-reported. Tracking through the Rally app allowed participants to earn Rally coins while taking steps to better health.

1,554.8 miles were walked by all OWCA participants, combined.

Kudos to the top five finishers:

  1. Refija Dizdarevic – SLC – 174.5 mi
  2. Tron Emptage – WSV – 171.4 mi
  3. Elizabeth Galbreath – WSV – 138.4
  4. Omar Pearson –  Lawrenceville, GA – 111.5 mi
  5. Ken Biddulph – WSV – 87.2 mi

HEALTH AND WELLNESS

5 places that you may be forgetting to put sunscreen

The summer heat is on and that means sunscreen is a must! The sun’s ultraviolet rays are the major cause of skin cancer. To protect yourself from sunburn and skin cancer, apply sunscreen liberally, and discover the five places that you may be forgetting about in this article from UHG’s wellness partner – Rally for Health.

8 stress relief tools for tough times

Between COVID-19 challenges and enduring the summer heat, stress is increasing for many. Stress is a normal response to difficult times, but is harmful to our bodies. Refer to this article from Rally for Health to learn eight stress-relief tools.

Is it an allergy or COVID-19?

The high humidity that comes with summer in some parts of the country can worsen allergy symptoms, which can make a person suffering with symptoms wonder whether they might have COVID-19. How do you determine if your symptoms are COVID-19 or allergies? 

PET OF THE MONTH


Meet Jax

Hi! My name is Jax, and my mom is Lisa Vanvaerenbergh. She works in marketing in the Tampa office and manages OWCA’s participation in industry events, as well as other marketing responsibilities.

I am a handsome, easy-going, happy-go-lucky Golden Retriever who loves to travel and go on adventures with the family. They even bought a camper so they could take me with them instead of leaving me behind in a kennel.  I am always smiling because I have an awesome life with plenty of ice cream and golf cart rides, and when I feel especially energetic, there is always a squirrel that needs chasing.  

If you would like to submit a story for Pet of the Month, please send it to MonthlyExchange@optum.com.

ANNIVERSARIES

Congratulations to ​employees celebrating milestone anniversaries in​ July!

Jodi Caswell (01)
Leslie Horton (01)
Patricia Paolini (01)
Sita Donthukurthi (01)
Swati Suryawanshi (01)
Alyssa Gamba (05)
Cora Gillinta (05)
James Branam (05)
Jennifer Herline (05)
Letta Smith (05)
Mckayla Ball (05)
Shannon Preston (05)
Theresa Garcia (05)
Zachary Casserly (05)
Adriane Livers (10)
Bonnie Williams (10)
Brenda Tanner (10)
Craig Roubinek (10)
Danette Seese (10)
Mary Roy (10)
Patsy Warren (10)
Srinivas Kalla (10)
Lamar Bryant (15)
Scott Woodhouse (15)
Janice Gilliard (20)
Karlene Sharp (22)
Michael Pope (22)
Ramona Webb (22)
Heather Edwards (25)
Zandra Wicks Duckett (26)

Please note, milestone anniversaries include 1, 5, 10, 15, 20 and each year thereafter. 

​NOTE FROM THE EDITOR

We hope you enjoyed this month’s issue. If you have ideas for a story or other comments, please share your feedback by emailing MonthlyExchange@optum.com.