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 steo-down level of care.
The future of providing excellent health care has arrived and it's called ACE - Re-introducing Achievements in Clinical Excellence.
ACE is a facility measurement and recognition program that acknowledges and rewards facilities for delivering both effective and efficient clinical care for all levels of facilitiy care.
ACE is the next evolution of a great idea
ACE is the next measurement program iteration that progresses several steps forward from the measurement program known as Facility Quality Measure, or FQM. Where FQM was strictly a data gathering device, ACE parses important clinical data and proactively measures effectiveness and efficiency improvement, as well as providing a pathway to achieving clinical success.
FQM was initiated in 2006* to increase transparency of facility-based effectiveness and efficiency metrics for consumers, payers and facilities. FQM evaluated facilities on one efficiency metric and multiple effectiveness measures. The result of those measures was public acknowledgement of high-performing facilities on the liveandworkwell.com website and other provider search directories available to members. in 2018 FQM evolved into the first version of Achievements in Clinical Excellence, or ACE. Ove rthe ensuring years, Optum gathered provider feedback and continually made modest improvements to the program based on provider feedback.
Today ACE 2.0 incorporates significant enhancements
ACE 2.0 now publicly recognizes the top 15% of all PHP, Residential as well as acute inpatient network facilities who have met and/or exceeded our benchmark criteria for delivering both effective and efficient care to Members. These top-performing faciltlies are recongized publicly via the Platinum ribbon symbol within our online provider directories, like liveandworkwell.com (unless public recognition of providers is prohibited by state law, statue or regulation).
ACE 2.0 allows Optum to better understand how every facility can become a more effective and efficient provider, which in turn is insight we can share to help guide and encourage facilities to achieve the highest level health care delivery.
*Methodology enhanced in 2008 and Public Sector data added in 2010
ACE Platinum status has its benefits
- Streamlining the traditional Clinical Review process resulting in fewer phone calls
- Identifying, recognizing and rewarding facilities that provide effective and efficient care for our consumers
- Develop and promote transparency of effectiveness and efficiency metrics
- Monitor success metrics for continuous program improvement
For a more in-depth explanation of the ACE Facility program, please explore the links below. And be sure to visit this page frequently for updates and information about ACE.
- ACE Facility Flyer
- ACE Facility Program Description
- ACE Facility Presentation
- ACE Facility FAQs
- Example Facility Scorecard
For questions or more information about ACE or your current ACE ranking, please contact us at firstname.lastname@example.org.