Best practices to decrease growing emergency department costs

The costs of services provided by hospital emergency departments have become a source of major concern for payers. When a member receives care at an emergency department (ED), the facility and physicians separately submit evaluation and management (E/M) codes on the claim for services performed. E/M codes are based on services performed while caring for […]
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Not science fiction: AI is creating value in surprising places

You might think of artificial intelligence (AI) in health care as science fiction — something that’s a future possibility. But the truth is, the future is here now. AI is a collection of methods and technologies for performing tasks we often associate with the human mind, such as learning and reasoning. AI approaches already have […]
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Transforming payment accuracy with cloud technology and big-data culture

This is the second blog in our two-part series: “Payment Accuracy Gives CIOs an Opportunity to Self-Fund Transformation” An interview with Julie Durham, VP of Software Engineering and Payment Integrity, Optum Health plan CIOs balance efforts between “keeping the lights on” and evolving the digital ecosystem. Yet simple, early wins in payment accuracy can streamline […]
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Navigating your alternative payment model journey: implementing, scaling and evolving your program

David Mauzey, General Manager, Optum Payment Innovation, was a guest speaker at the Scottsdale Institute on September 26. He shared how bundled payments can help accomplish business strategies. Part II of this two-part blog concludes with suggested best practices to consider when implementing, maintaining, scaling and evolving your alternative payment model. Implementing your program Here […]
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Best practices for Medicaid risk adjustment accuracy

Applying risk adjustment best practices to the ever-changing landscape of managed Medicaid risk adjustment For those providing health care in managed Medicaid markets, there are many challenges such as: Risk adjustment models and timing vary from state to state. This makes it hard for managed care organizations (MCO) managing multiple plans to run a risk […]
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Considerations for centralizing payment accuracy

This is the first blog in our two-part series: “Payment Accuracy Gives CIOs an Opportunity to Self-Fund Transformation” An interview with Matt Choffin, VP of Commercial Payment Integrity, Optum Health plan CIOs balance efforts between “keeping the lights on” and evolving the digital ecosystem. Yet simple, early wins in payment accuracy can streamline operations and […]
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Navigating your advanced payment journey: Creating a focused strategy and rollout

Key influencers pointing toward evaluating your value-based contracts Regulators are demanding that providers implement advanced payment programs to drive better health care outcomes. Many employer groups with a high population of specific surgical procedures and chronic conditions want bundled payment programs. Many providers use home-grown tools that aren’t maximizing the potential of their current value-based […]
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Best practices for a healthy worksite: Promote a healthy holiday season

Happy Halloween! In celebration of this sugar-filled holiday, here are a few tips on how to promote healthy holiday behaviors at your worksite. Take these tips to heart. Thanksgiving is just around the corner. People often eat more than they intend to during the holidays. This may be due to the festive mood or pressure […]
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Expanded Optum Advisory Services receives accolades from Everest Group, Modern Healthcare and KLAS

In late 2017, the consulting division of the Advisory Board Company became part of Optum Advisory Services. Combining our capabilities has proven powerful. I credit our success to the talented people, powerful analytics and our sole focus on health care. Over the course of the last year, our combined organization has received recognition and honorable […]
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Risk Adjustment Spotlight: Evolving strategies to drive risk adjustment performance

If you think the risk adjustment chart review process is frustratingly fragmented, you are not alone. Integrating in-house efforts with outsourced point solutions are often not only frustrating; they are also costly in terms of time and money. Increasingly, health plans are turning to Software as a Service (SaaS) as a way create an more […]
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