Q: What is the purpose of ACE?
A: ACE is a facility measurement program that rewards those facilities who deliver both effective and efficient clinical care.
Q: What has changed with the ACE redesign?
A: This is the next iteration of the ACE program. Previously only qualified acute inpatient facilities were evaluated, and they were tiered Platinum (for meeting both effectiveness and efficiency metrics) through Criteria Not Met (for qualified facilities that met neither the effectiveness nor efficiency metrics).
ACE now specifically positions facilities based on four condition categories, and only those facilities that rank within the top 15% of that specific condition category will be designated Platinum. ACE 2.0 eliminates all lower tiers, such as Gold, Silver, etc.
Q: Why are you changing the ACE program now?
A: We’ve listened to what providers have had to say about ACE and responded with a newly refined program that addresses feedback we’ve received.
Q: What sort of feedback have you addressed with the redesigned ACE program?
A: ACE 2.0 now takes a finer approach to measuring facilities, categorizing them by condition category so that evaluations are a truer “apples to apples” comparison. In addition to Acute Inpatient, ACE 2.0 now evaluates data from PHP and Residential levels of care. This was a change made to align with the feedback we’ve received from providers regarding ACE as well as closely examining overall facility performance from past years.
ACE 2.0 has now instituted a clear and unambiguous system so that, for example, we are able to pinpoint and identify the top performing mental health facilities or top performing substance use facilities in the network. Each facility, within a condition category, will have a specific ranking which means a facility will be #1, #2, #3 and so on of all facilities evaluated in a particular condition category.
Q: What are the condition categories being evaluated in ACE?
- Mental health
- ETOH Substance use
- Opioid and other Substance use
- Eating disorder
Q: Can one facility be considered ACE Platinum in one category and not another?
A: Yes. For example, a facility that offers mental health services and alcohol detox may be considered ACE Platinum for its work with alcohol detox, but not ranked within the top 15% for its mental health performance. By the same token, a facility can be designated Platinum in more than one category.
Q: Why are you now including other levels of care?
A: Partial Hospitalization (PHP) and Residential levels of care, as well as Acute Inpatient, are also now being evaluated. This change is in line with feedback we’ve received from providers regarding ACE.
Q: What are the qualifications or criteria for being evaluated in ACE 2.0?
A: ACE now breaks out facility evaluations into four condition-specific categories, with additional condition-specific categories possibly added in the future. This will allow for a truer “apples-to-apples” comparison of performance. To qualify for evaluation, a facility must be in-network and have a minimum number of qualified admissions to the facility's IP, PHP or Residential Levels of Care (LOC) for the condition category being evaluated.
In order to qualify under a specific condition category, the facility must meet the following minimum admissions:
- 25 admissions for Mental Health (excluding eating disorder and autism admissions)
- 25 admissions for ETOH substance use
- 25 admissions for opioid and other substance use
- 10 admissions for eating disorder
Q What are the metrics, how are they different from the previous iteration of ACE?
A: Once again, provider feedback was taken into serious consideration when the ACE metrics were refined. To begin with, the redesigned ACE program has eliminated the Peer Review metric from the effectiveness portion of the evaluation and replaced it with the Step-up Rate. Additionally, ACE has now eliminated the 90-day readmission rate along with the 30-day follow-up rate. The efficiency metrics remain unchanged.
- 30-day readmissions rate
- 7-day follow-up rate
- Step-up rate from lower levels of care
- Residual Lenth of Stay
- Behavioral Health Spend per Episode and includes cost for all levels
Administrative (These do not count toward final ACE score)
- Portal usage
- Compliance with precertification
- Peer review rate
Q How does the ACE ranking methodology work?
A: Eliminates tiers and pass/fail ‒‒ final rankings among network facilities are now derived from scores in each of the program categories. A facility’s overall performance is measured by standardizing each metric against a regional mean and regional standard deviation, and the result is then weighted in order to provide a more accurate portrait of a facility’s performance across a continuum of care. The facilities that rank in the top 15% of each category (General Mental Health, Substance Abuse – Alcohol, Substance Abuse – Other, and Eating Disorder) will be recognized as Platinum. There will be no other tiers in the redesigned ACE program.
Q: Can you explain your data standardization?
A: ACE converts data from percentages, cost and utilization into a common scale or standardized data set. Data standardization is achieved by subtracting the individual metric score from the mean of the region and then dividing by that metric’s regional standard deviation. A score of 0 indicates the facility is performing at the mean in that region. A score of +1 indicates the facility is performing better than the average facility in its region by exactly 1 standard deviation. A score of -1 means the facility is performing 1 standard deviation below the average facility in its region.
Q: What do I as the provider get out of ACE?
A: ACE recognizes great effort, but more importantly, allows Optum to reward outstanding performance. Some of the perks of being recognized as an ACE Platinum provider include:
- Streamline clinical review
- Ease of claims access\
- Improved access
- Help in promoting your Platinum achievement
Q: Is there additional training for using ReviewOnline?
A: If your facility has not been trained or requires training in the use of our secured ReviewOnline web tool, Optum will schedule an onsite training session at your facility’s convenience.
Q: What if my facility doesn’t want to use ReviewOnline?
A: As a Platinum status provider, utilizing our secured online platform, ReviewOnline, is the only way to take advantage of the time-saving streamlined clinical review process. Facilities that have not yet been trained to use ReviewOnline should schedule training at their earliest convenience.
Q: Can you prove the validity of your program?
A: ACE 2.0 is a measurement program. As such, its validity is based on the accuracy of the data collected and the regional benchmarks established. The benchmarks established for ACE 2.0 have been developed based on the widely accepted practices and methodology of CMS, as well as NCQA’s HEDIS.
Q: Who is Optum; are you the same as UBH?
A: Yes. Optum specializes in health management solutions that address the physical, mental and financial needs of individuals and organizations. The name “Optum” is our new overall branding umbrella that will allow us as a corporate entity to separate out and further continue to offer distinguished behavioral health services. For tax and billing purposes, our legal, and therefore contracting, entities remain United Behavioral Health and U.S. Behavioral Health Plan of California. Aligned under one brand name, each Optum business (OPTUMHealth, OPTUMInsight & OPTUMRx) provides different but equally important services in the continuum of behavioral health care.