Evaluation and Contracting
How do we evaluate excellence? Optum's Clinical Sciences Institute, a group of more than 100 practicing clinical experts, helps develop our evaluation criteria. Only those programs deemed to be clinically superior through our evaluation process are considered for a Centers of Excellence network.
Each medical center is evaluated annually. Our criteria includes:
- Procedure success and survival rates
- Quality of medical professionals
- Number of patients treated with a specific condition
- Quality of patient/family-oriented services
- Involvement in clinical research
- Patient satisfaction survey results
- Program depth and breadth
- Treatment planning and coordination
Different Criteria for Different Conditions
Because each condition has different measures of success, each Centers of Excellence Network has different evaluation criteria. For example, we evaluate pregnancy success rates and instances of multiple births for our infertility network. In our congenital heart disease network, medical centers are evaluated based, in part, on the number of cardiovascular transplant surgeons and pediatric cardiologists they have on staff.
Participating Centers of Excellence programs must be willing to meet Optum's contracting terms. Rates need to provide economic value to Optum's clients and be competitive with other network medical centers.
NCQA has reviewed and certified Optum's Credentialing and Utilization Management functions only. Date granted: 7/1/2014. Expiration date: 7/1/2016. For complete details on the scope of this review, visit www.ncqa.org.