Platinum Designation for Facility-Based Programs
It's critically important that you inform Optum at the time of member discharge or step-down to a lower level of care. Failure to do so will result in delays of reimbursement, and very possibly denial of submitted claims. Reporting member discharge is consistent for all levels of care, including acute inpatient, residential and partial hospitalization. Even if the member was admitted via our streamlined pre-certification process and concurrent reviews are temporarily suspended for your facility, you must always be sure to report every discharge or step-down level of care. Additionally, facilities may be contacted by Optum for intervention or review on an as needed basis, for admissions demonstrating significant complexity and/or recent chronicity.
Data on all Platinum programs is completed on a 12-month look-back cycle each spring. When the data run is completed, we will notify facilities of the status of their Platinumqualifying programs, including whether the Platinum recognition is retained, modified or rescinded for one or more of the facility's qualifying programs..
Platinum Designation for Facility-based Programs
Platinum is a facility measurement and recognition designation that acknowledges and rewards facilities for delivering both effective and efficient clinical care for all levels of facility-based care.
With its quadruple aim, Platinum allows for more specific comparisons of facility-based behavioral health programs. We will identify Platinum programs within the four condition categories: General Mental Health, SUD Alcohol, SUD Other, and Eating Disorders. And in addition, we monitor performance separately in three levels of care: Inpatient, Residential, and Partial Hospitalization.
programs will be
designated as Platinum
|Facility program admissions
will be evaluated in condition
|Facility program performance
will be evaluated separately
by level of care
Platinum Designation will:
- Deliver clinically relevant and actionable metrics
- Distinguish between specfic dianostic categories, levels of care and lines of business
- Facilitate determinations that are accurate with "apples-to-apples" performance assessments
The purpose of Platinum Designation is to recognize and reward facilities accurately for delivering effective and efficient care
Platinum endeavors to evaluate facilities based upon trends in health care, as well as the feedback we garner from our network providers and facilities. Listening to what you have to say presents Optum with a fantastic opportunity to incorporate your thoughts and innovations into an evaluation program that is better for you, our members and the behavioral health community at large. Using unbiased data that is quantified and compared to both regional and similar program benchmarks, Platinum Designations excel at Identifying variations in practice patterns, which drive increased costs and poor clinical outcomes.
Platinum status has its benefits
- Streamlining the traditional Clinical Review process resulting in fewer phone calls
- Identifying, recognizing and rewarding facility-based programs that provide effective and efficient care for our members
- Develop and promote transparency of effectiveness and efficiency metrics
- Monitor success metrics for continuous program improvement
For a more in-depth explanation of the Platinum Designation, please explore the links below. And be sure to visit this page frequently for updates and information about our Achievements in Clinical Excellence program.
- Platinum Designation Facility Flyer
- Platinum Designation Facility Presentation
- Platinum Facility FAQs
For questions or more information about Platinum or your current facilityranking, please contact us at firstname.lastname@example.org.
|Platinum Team Members|
|Alecia Lamb MHA, MS, MA, LPC, LCPC
|Patsy Reed, MA, LPCC, LADC
Behavioral Clinical Program Manager
Central and Northeast Regions
|Trisha Stewart BSN, RN
Behavioral Clinical Program Manager
Southeast and West Regions