Title
Authorize the Interim Chief Executive Officer for NMC or his designee to execute an amendment No. 4 to the agreement (A-14280) with Optuminsight, Inc. for perioperative and case advisor consulting services to analyze and advise regarding the quantity and quality of certain patient procedures, adding $234,000 for a revised total agreement amount not to exceed $2,454,000, with no change to the agreement term March 26, 2019 through March 31, 2025.
Report
RECOMMENDATION:
It is recommended the Board of Supervisors:
Authorize the Interim Chief Executive Officer for NMC or his designee to execute an amendment No. 4 to the agreement (A-14280) with Optuminsight, Inc. for perioperative and case advisor consulting services to analyze and advise regarding the quantity and quality of certain patient procedures, adding $234,000 for a revised total agreement amount not to exceed $2,454,000, with no change to the agreement term March 26, 2019 through March 31, 2025.
SUMMARY/DISCUSSION:
Optuminsight Advisory Services specializes in helping hospitals and healthcare systems address efficiency challenges pertaining to surgical and other related procedures with expert guidance, insights, strategies, and implementation support to improve processes and capture additional volume. Optum’s team continues to provide leadership in the following areas: improve volume growth by effectively organizing the scheduling process, improve customer service for both patients and physicians by improving access, adjust surgical suite numbers to optimize labor and productivity of staff, improve pre-procedure preparations to prevent delays and cancellations, improve surgery efficiency - length of procedures, and improve surgeons and specialists engagement in governing room capacity management.
This amendment No. 4 adds physician advisory services including case reviews and appeals assistance to support utilization review recommendations such as level of care, admission status, and clinical appeal management. Utilization review is essential to billing compliance and is required by CMS and Medi-Cal. Medi-Cal require that each hospital day is adjudicated through the utilization review process. Any hospital day(s) with questionable level of care or admit status need to be reviewed by a California licensed physician who is not involved in the care of the patient; no Medi-Cal claims can be submitted until this process is completed.
OTHER AGENCY INVOLVEMENT:
The Office of County Counsel reviewed and approved this amendment no. 4 as to legal form, and the Auditor-Controller reviewed and approved as to payment provisions. The amendment no. 4 was reviewed and approved by NMC’s Finance Committee and by its Board of Trustees on November 12, 2021.
FINANCING:
The cost for this amendment is $234,000 of which has been included in the Fiscal Year 2021-22 Adopted Budget and remaining balances will be included in corresponding years.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
This amendment is for executive level consulting services, the outcome of which will contribute to a more efficient use of resources within the organization. Services also include analysis and recommendation regarding patient procedures with regards to improvements in efficiency.
__ Economic Development
X Administration
X Health and Human Services
__ Infrastructure
__ Public Safety
Prepared by: Daniel Leon CFO, 783-2561
Approved by: Charles R. Harris, Interim Chief Executive Officer, 783-2504
Attachments:
Optuminsight Amendment No. 4
Optuminsight Amendment No. 3
Optuminsight Amendment No. 2
Optuminsight Amendment No. 1
Optuminsight, Agreement