Clinical Conference: A Discussion with Optum

This article is sponsored by Optum. This article is based on a Q&A discussion that took place during the Clinical Conference with Terry Wihlen, Vice President of Clinical Operations in Senior Community Care at Optum. The Q&A took place on May 5, 2022. The discussion has been edited for length and clarity.

Skilled Nursing News: Terry, why don’t you tell me a little bit about your role as well as some background on Optum.

Terry Wihlen: I’m a regional clinical vice president for Optum in our Home & Community business, where our clinical team provides care to our institutional special needs members that have the United health care nursing home plan, and also our institutional equivalent members living in assisted living areas.

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SNN: Can you tell us a little bit about Optum’s infection preventionist program and how it assisted skilled nursing facilities throughout the pandemic?

Something that I’m passionate about, and I loved all the passion that’s in this room here, every speaker is here because they care and they believe what we do for our elders because they need our assistance, and we’re dedicated to that. A little bit about Optum: we are one company under UnitedHealth Group that is the parent company with about 350,000 people that we have across the world.

UnitedHealth Group is built on two pillars. One pillar is UnitedHealthcare, and that’s everything that has to do with benefits. The other side is Optum, and it’s where I fall. In Optum, there are three large businesses; there’s our pharmacy, which is a PBM, there’s a data analytics component of it, and then there’s all the different clinical delivery organizations, and I’m part of one of the clinical delivery organizations that represents well here.

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What did we do with our infection preventive program? Like I said earlier, everyone is extremely passionate about what they do. At the time COVID hit, I was the leader of the Northeast Region in downstate, New York/New Jersey. It was extremely challenging, heartbreaking. We felt a little helpless at times because we’re not staff in the nursing home, but we want to be really good partners and assist our nursing home partners who were really struggling. One of the ideas that came out of COVID and the passion of our Advanced Practice Clinicians [APCs], our physician assistants and nurse practitioners was how we can help with COVID through the stages and in the future, and we decided to launch an infection prevention program within all of our markets.

The infection prevention program is through CDC. It’s about 23 courses that you take, and then you sit for a certification. We had about 40 APCs that went through with that. We built out our team with our medical directors, our senior clinical person at the time, and also the regional clinical VPs and clinicians to help our nursing home partners. How did we help? We provided training on infection prevention techniques, which includes cleaning, hand washing, PPE, cohorting. We served as a consultant to our business partners to help them build out their infection prevention plan that was being enacted in all the nursing homes.

Really, it came out of COVID, we’re still extremely passionate about it. We’re currently looking to modify how we’re doing and how we’re helping our nursing home partners deal with not only COVID but also any type of outbreak, scabies, other respiratory viruses, GI viruses, because it’s rooted in doing the right thing to help control spread of infection, and it’s not just COVID.

In what ways do you guys hope to continue this program and expand beyond COVID? Because, as you mentioned, there are other things that are going on in nursing homes that were problems before and will continue to be issues after?

We plan to make sure that each market has a couple infection prevented certified clinicians that are APCs or physician assistants to help our partners to be able to work through the needed requirements, to have a good program in place. The programs are really about not only the infection prevention but also antibiotic stewardship, which a lot of people have talked about here and how important that is to our nursing home, but mostly to our members that were prescribing the right medications, were being proactive to look for outbreaks and knowing how to respond.

How do you think skilled nursing providers should think about infection control differently than they did before the pandemic?

I think it needs to be on the forefront of everyone’s mind. We’ve learned that during COVID, whenever there’s an outbreak, expect 25%, 40% of your staff potentially to be out sick. Any type of training that you’re doing cannot just be a IP person in the nursing home, it needs to be the medical director, the DON, the administrator, your IP person who is in the nursing home to help train and talk about why we’re doing this so people feel your passion to be able to drive results when people aren’t there because of illness. We had some nursing homes in Downstate, New York, where there was no administrator, no DON, one RN for AD residents, and we just did self-care. How do we get to this point? It was a wildfire, but we’re hoping that with training and education we can help support nursing homes to be ready for the next wave, whether it’s COVID or something else.

You’re talking about getting multiple people trained in these types of practices and not only does that have to do with the people getting sick but also just staffing shortages. Could you elaborate a little bit on the importance of continuing that training throughout various positions in a nursing home so that there is someone available who can provide that assistance?

Sure. It’s everyone’s responsibility, not just the RNs in the home, the CNAs, the LPNs, it’s everyone’s responsibility to know what happens when you have an outbreak, and how everyone can pitch in to help cohorts, help move members, protect themselves, protect others. A lot of support is also needed in any type of outbreak, because you know you need to have someone to say you’re doing this right, here’s a different way you could do it. There has to be a large number of people who are comfortable with the process and the procedure to be able to have the maximum effect within the whole nursing home.

What are some of the successes that you have seen through this program? What are some of the things that make yourselves proud to be able to put this program together?

Urgency drove us to bring this forward. We had a lot of urgency, like everyone else did for vaccinations. Our vaccination rates were higher than the national average because I feel that our clinicians were asking the whys. Why are people saying no to the vaccination, but not only doing that for our members but also for the nursing home staff. It was a time when everyone didn’t really understand, should I take this vaccination now it’s mandated? Do I leave my job if I don’t take it? We would meet with staff and nursing homes to talk from an outside perspective, the risks of vaccinations, why you should do it. That was very helpful for some of our homes.

What are some of the ways you think that skilled nursing clinical leaders can keep infection prevention at the forefront, given the increased regulatory scrutiny?

I think a couple of people touched on that earlier. Just a couple of statistics from CDC, one to 3 million infections in nursing homes per year, 150,000 for hospitalizations, 380,000 deaths when it comes to serious infections. CDC states that if you put a good program in place and follow the different procedures to implement it, make sure everyone is aware of it, you can have a significant reduction. 70% decrease of healthcare associated infections when you have a really good program in place. There is a lot of energy right now from CDC, from CMS to really drive the quality of care.

It does align with some of their initiatives, especially with reducing avoidable hospitalizations. If you think you have a really good infection control plan in place, good antibiotic stewardship, you should be able to easily detect a change of condition. Talk to the family, talk to the resident about their advanced care plan and ongoing education regarding disease trajectory for that member and how infections do play some role in that.

I think that as a leader we have to be passionate about this. We have to continue to push our staff to learn more about it, to understand it, to ask questions, to be part of the solution within the nursing homes, and as Optum as a guest in our nursing homes, we’d love to share what we can do to help support the mission of the home.

Could you just tell our audience a little bit more about what this program looks like? If somebody from Optum is working with a facility, what exactly should they expect?

If an infection preventionist is working with a facility, they can help develop their policies and procedures with the facility, and consult on what the best practices are. They could help define what a good antibiotic stewardship council looks like within the nursing home. Help to get the different types of data that’s available on resistance within the community.

Help with educating staff again and again about PPE and how to properly put it on and take it off. There is so much right now. There’s so many different people coming in and out of nursing homes, agency staffing that we need to be super vigilant on how we train and educate anyone who steps through that door, because if that one person breaks down, the system breaks down and we’ve seen that over and over again.


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