Achievements in Clinical Excellence (ACE) - Clinicians
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specific information:
- ACE is a quality-driven, data-rich measurement program that recognizes excellent performance
- What does the ACE program hope to achieve?
- ACE broadens the scope of clinical outcomes data by
- What are the perks of the ACE program?
- The importance of Platinum recognition
- Where can I view my scores?
- How effectiveness and efficiency metrics are compiled
- Note on specific state exclusions
- Additional Information, FAQs, Forms
ACE is a quality-driven, data-rich measurement program that recognizes excellent performance
ACE is a quality-focused measurement program that recognizes excellent service from our network clinicians and creates more transparency for care advocates and Members. Using nationally-based, regionally-adjusted metrics, Optum will identify clinicians and groups who deliver both outstanding care for Members by consistently meeting ACE metrics. The results of this data-driven system will allow us to recognize and reward those providers who meet or exceed ACE benchmarks.
What does the ACE program hope to achieve?
Optum seeks to recognize and reward clinicians who consistently meet ACE metrics and provide outstanding care for Members. Our motive is to create an environment of better transparency and choice for Members, and a more loyal patient population for our network providers. It is our strong belief that Member outcomes are the most important indicator of quality health care service.
ACE broadens the scope of clinical outcomes data by
- Utilizing metrics based on effectiveness and efficiency data submitted via ALERT Wellness Assessments
- Presenting clinicians with feedback using nationally-recognized, evidenced-based measures
- Allowing for comparisons of practitioners by region and area of clinical specialty
- Rewarding clinicians with significant perks and better visibility on liveandworkwell.com
What are the perks of the ACE program?
Network clinicians and groups who achieve Platinum status will be rewarded in a number of ways. To begin with, Platinum clinicians and groups will be eligible for a twelve-month fee increase. In addition, Platinum clinicians and groups will also be able to take advantage of FREE, Optum-sponsored CEUs through Relias Learning.
It’s important for individual clinicians and groups to continue submitting ALERT Wellness Assessments, even if the practice resides in a state excluded from the ACE program (please see below). Data will continue to be evaluated and clinicians and groups in the excluded states may still qualify for ACE perks.
The importance of Platinum status
While every clinician listed on the liveandworkwell.com website has met rigorous credentialing standards required by Optum, the ACE program relies on metrics compiled from data submitted through ALERT Wellness Assessments for effectiveness and from claims for efficiency. These scores are then used to identify network clinicians and groups who have achieved Platinum. When a clinician or group demonstrates consistency in meeting ACE metrics, they are recognized as a Platinum provider and are identified with a Platinum ribbon within their listing on the liveandworkwell.com website and other provider search directories available to Members and care advocates.
Platinum recognition on liveandworkwell.com is important because it helps makes the provider more visible to both members and care advocates searching for services on the liveandworkwell.com website.
The Platinum ribbon designation is intended only as a guide when choosing a clinician or clinician group and should not be the sole factor in a Member’s selection of a treatment professional. For more on Optum’s clinician evaluation program, click here.
Due to state regulatory requirements, outpatient providers in the following six states are excluded from being publicly recognized for their Platinum achievement: California, Colorado, Maryland, Missouri, New York and Texas.
If your practice resides in one of the excluded states, it’s very important that you continue submitting ALERT Wellness Assessments. Even though your practice may reside in one of the excluded states, your data will still be evaluated and may still qualify you or your group for performance-based contracting increases. And once we receive national recognition and NCQA accreditation for our ACE metrics, we will have your data on hand in order to appropriately identify you within the ACE program.
Practitioners will be able to view their scores by logging into Provider Express with their Optum ID, clicking on the Provider Reports tab, and then clicking on "Achievements in Clinical Excellence" on the dashboard. Scores will be made available for viewing on or about November 1 annually. Clinicians will then have a 60-day period to review their data prior to any public recognition. Questions regarding ACE scores may be made by submitting an ACE Review Request Form. To ensure a timely review, it is important that you submit a review request within 30 days of being notified of your score.
How effectiveness and efficiency metrics are compiled
The foundation of ACE is driven by input from our National Advisory Council and network clinicians regarding performance measurement, and is guided by current clinical outcomes research.
Effectiveness
The effectiveness measure is compiled from the clinician Severity Adjusted Effect Size (SAES) metric from submitted ALERT Wellness Assessments.
Severity Adjusted Effect Size (SAES) is a standardized measure of change commonly used in the social sciences to describe the effectiveness of treatments. SAES was chosen to measure clinical outcomes for the ACE program because it meets the requirements for:
- Transparency
- Incorporates input from external statisticians and subject matter experts
- Integrates benchmarks
Additionally, SAES takes the concept of effect size one step further by incorporating statistical adjustments to account for Member characteristics (e.g., clinical severity). In the same way that SAES can be used to measure the effectiveness of a single treatment episode for one clinician, it can also be used to derive a measure of effectiveness for group practices.
Efficiency
The efficiency metric is the difference between the predicted Average Number of Visits (ANOV) and the expected ANOV. This difference is what we refer to as the residual Average Number of Visits per treatment episode. Below summarizes how Optum calculates the residual Average Number of Visits.
- Predicted Average Number of Visits
Calculation of the predicted Average Number of Visits (ANOV) accounts for multiple treatment episodes for each clinician and patient case mix. The ANOV represents the average number of visits per episode that is “predicted” based on the clinician’s performance with his/her observed case mix. The model adjusts for case-mix variables that include member demographics, severity and acuity, and other treatment characteristics. - Expected Average Number of Visits
The expected ANOV represents the average number of visits “expected” for an average clinician with a similar member case mix. The model adjusts for case-mix variables that include member demographics, severity and acuity, and other treatment characteristics. - Residual Average Number of Visits
The residual ANOV represents the difference between the predicted ANOV and the expected ANOV for a clinician. A negative residual means that the predicted ANOV was LOWER than the expected ANOV given the clinician’s case mix. A positive residual means that the predicted ANOV was HIGHER than the expected ANOV given the clinician’s case mix. The residual for an individual clinician or group is then benchmarked against regional criteria and used to determine if the provider meets the regional benchmark for rANOV.
A "treatment episode" is comprised of consecutive outpatient visits and/or medication services incurred by a patient with a clinician or group over a 12-month period. An episode begins with the first date of service (“index” date) incurred after a minimum of 120* days in which the Member was not treated by the clinician. An episode ends 12 months after the start date unless there is a gap in treatment of 120 days or more. If a gap in treatment of 120 days or more occurs within the 12-month period, the episode ends at the last date of service before the gap.
*The 120-day gap in treatment that indicates the beginning or end of a treatment episode applies to Psychologists (LP, PhD) and Master's-Level Clinicians (e.g., MFT, LCSW). The gap expands to 180 days for Psychiatrists (MD) and Nurse Practitioners (e.g., NP, MHNP), who may see patients less frequently for medication management.
IMPORTANT NOTICE IF YOUR PRACTICE IS IN ONE OF THE EXCLUDED STATES
Optum is pursuing national recognition and NCQA accreditation for our metrics, which will pave the way for inclusion of your state in the ACE program. Until then, however, it is still very important that you continue submitting ALERT Wellness Assessments. Your data will continue to be evaluated and you may still be eligible to receive pay-for-value performance rewards and FREE CEUs.
Additional Information, FAQs, Forms
If you have additional questions or would like more information, please email: ace@optum.com
If you’re not already registered with Provider Express, sign up today and discover its many benefits.
ACE is a quality-driven, data-rich measurement program that recognizes excellent performance
ACE is a quality-focused measurement program that recognizes excellent service from our network clinicians and creates more transparency for care advocates and our members. Using nationally-based, regionally-adjusted metrics, Optum will identify clinicians and groups who deliver both effective and efficient care for Optum members. The results of this data-driven system will allow us to annually tier clinicians, and recognize and reward those providers who meet or exceed ACE benchmarks.
What does the ACE program hope to achieve?
Optum seeks to recognize and reward clinicians who consistently demonstrate effective and efficient clinical care. Our motive is to create an environment of better transparency and choice for Optum members and a more loyal patient population for our network providers. It is Optum’s strong belief that patient outcomes are the most important indicator of quality health care service.
ACE broadens the scope of clinical outcomes data by
- Utilizing metrics based on effectiveness and efficiency data submitted via ALERT Wellness Assessments
- Presenting clinicians with feedback using nationally-recognized, evidenced-based measures
- Allowing for comparisons of practitioners by region and area of clinical specialty
- Rewarding clinicians with significant perks and better visibility on liveandworkwell.com
What are the perks of the ACE program?
While every clinician listed on the liveandworkwell.com website has met rigorous credentialing standards required by Optum, the ACE program relies on metrics compiled from data submitted through ALERT Wellness Assessments for effectiveness and from claims for efficiency. These scores are then used to tier network clinicians and groups. When a clinician or group meets both the effectiveness and efficiency metrics, they will be recognized as a Platinum provider and a Platinum ribbon within their listing on the liveandworkwell.com website. Providers meeting the effectiveness metric will receive a Gold ribbon within their listing on liveandworkwell.com.
Status recognition on liveandworkwell.com is important because it helps make the provider more visible to both members and care advocates searching for providers on the liveandworkwell.com website.
The ribbon designation is intended only as a guide when choosing a clinician or clinician group and should not be the sole factor in a member’s selection of a treatment professional. For more information on the ACE Clinician evaluation program click here.
Providers residing in the following six states will not be publicly recognized in Optum’s clinician evaluation program: California, Colorado, Maryland, Missouri, New York and Texas.
If your practice resides in one of the excluded states, it’s very important that you continue submitting ALERT Wellness Assessments. Even though your practice may reside in one of the excluded states, your data will still be evaluated and may still qualify you or your group for performance-based contracting increases. And once we receive national recognition and NCQA accreditation for our ACE metrics, we will have your data on hand in order to accurately rank you within the ACE program.
Practitioners will be able to view their scores by logging into Provider Express with their Optum ID, clicking on the Provider Reports tab, and clicking on "Achievements in Clinical Excellence" on the dashboard. Scores will be made available for viewing on or about November 1 annually. Providers will then have a 60-day period to review their data prior to it being made public by submitting an ACE Review Request Form. To ensure a timely review, it is important that you submit a review request within 30 days of being notified of your score.
How effectiveness and efficiency metrics are compiled
The foundation of ACE is driven by input from our National Advisory Council and network clinicians regarding performance measurement, and is guided by current clinical outcomes research.
Effectiveness
The effectiveness measure is compiled from the clinician Severity Adjusted Effect Size (SAES) metric from submitted ALERT Wellness Assessments.
Severity Adjusted Effect Size (SAES) is a standardized measure of change commonly used in the social sciences to describe the effectiveness of treatments. SAES was chosen to measure clinical outcomes for the ACE program because it meets the requirements for:
- transparency
- incorporates input from external statisticians and subject matter experts
- integrates benchmarks
Additionally, SAES takes the concept of effect size one step further by incorporating statistical adjustments to account for member characteristics (e.g., clinical severity). In the same way that SAES can be used to measure the effectiveness of a single treatment episode for one clinician, it can also be used to derive a measure of effectiveness for group practices.
Efficiency
The efficiency metric is the difference between the predicted Average Number of Visits (ANOV) and the expected ANOV. This difference is what we refer to as the residual Average Number of Visits per treatment episode. Below summarizes how Optum calculates the residual Average Number of Visits.
- Predicted Average Number of Visits
Calculation of the predicted Average Number of Visits (ANOV) accounts for multiple treatment episodes for each clinician and patient case mix. The ANOV represents the average number of visits per episode that is “predicted” based on the clinician’s performance with his/her observed case mix. The model adjusts for case-mix variables that include member demographics, severity and acuity, and other treatment characteristics. - Expected Average Number of Visits
The expected ANOV represents the average number of visits “expected” for an average clinician with a similar member case mix. The model adjusts for case-mix variables that include member demographics, severity and acuity, and other treatment characteristics. - Residual Average Number of Visits
The residual ANOV represents the difference between the predicted ANOV and the expected ANOV for a clinician. A negative residual means that the predicted ANOV was LOWER than the expected ANOV given the clinician’s case mix. A positive residual means that the predicted ANOV was HIGHER than the expected ANOV given the clinician’s case mix. The residual for an individual clinician or group is then compared to other clinicians or groups within the region to determine level of performance.
A "treatment episode" is comprised of consecutive outpatient visits and/or medication services incurred by a patient with a clinician or group over a 12-month period. An episode begins with the first date of service (“index” date) incurred after a minimum of 120* days in which the member was not treated by the clinician. An episode ends 12 months after the start date unless there is a gap in treatment of 120 days or more. If a gap in treatment of 120 days or more occurs within the 12-month period, the episode ends at the last date of service before the gap.
*The 120-day gap in treatment that indicates the beginning or end of a treatment episode applies to Psychologists (LP, PhD) and Master's-Level Clinicians (e.g., MFT, LCSW). The gap expands to 180 days for Psychiatrists (MD) and Nurse Practitioners (e.g., NP, MHNP), who may see patients less frequently for medication management.
Note on specific state exclusions
Due to state regulatory requirements the following six states are excluded from participation in the Optum’s clinician evaluation program: California, Colorado, Maryland, Missouri, New York and Texas. Regrettably, this means clinicians and groups in these six states are ineligible to receive stars on the liveandworkwell.com website even though they qualified for a star ranking based on CFE. Additionally, CFE scorecards will no longer be updated after October 31, 2014.
IMPORTANT NOTICE IF YOUR PRACTICE IS IN ONE OF THE EXCLUDED STATES
Optum is pursuing national recognition and NCQA accreditation for our metrics, which will pave the way for inclusion of your state in the ACE program. Until then, however, it is still very important that you continue submitting ALERT Wellness Assessments. Your data will continue to be evaluated and you may still be eligible to receive pay-for-value performance rewards and FREE CEUs.
Additional Information, FAQs, Forms
If you have additional questions or would like more information, please email: ace@optum.com
If you’re not already registered with Provider Express and have an Optum ID, sign up today and discover the many benefits Provider Express offers.