Health plan drivers of innovative risk and quality provider reimbursement programs

Over the course of the past few decades, provider reimbursement has taken on different forms with varying degrees of acceptance and success. Many have had their share of challenges and opportunities, but for the most part, all were intended to create an environment that modified behavior, created visibility and perhaps motivated providers to achieve a […]
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Health plans recognize need to improve encounter data quality

Health care organizations are under increasing pressure to reduce costs. An important consideration is whether revenue for risk adjusted populations, including Medicare Advantage plans, is based on complete and accurate reporting of the health of your membership. Most health plans immediately look to their risk adjustment programs, such as in-office and in-home assessments, to ensure […]
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What if we could forecast the flu like we forecast the weather?

The local weather forecast helps us plan and prepare for severe storms. What if we could forecast disease outbreaks in the same way? That would allow government officials, health care providers, business leaders and concerned patients to make life-saving decisions. How to predict flu outbreaks The Optum flu forecast is a data-driven early-warning system for […]
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What do self-driving cars have to do with health care?

By Dan McCreary, Distinguished Engineer, Optum Our CIO recently told me he wants everyone in our division to know at least the basics of AI. And he means everyone, at all job levels, no matter what role they’re in. So I shared with him an idea I’d been toying with: the AI Racing League. Some […]
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Next-level cloud tech: 7 ways BPaaS can transform HHS

It’s the same challenging story: State and local health and human services (HHS) are under constant pressure to cut costs, become more efficient and improve outcomes for those they serve. But Medicaid and other HHS organizations also have a history of using complex, monolithic systems that take a long time to build and are difficult […]
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Spotlight on caring: Christy T.

The connection between our HouseCalls advanced practice clinicians and a member’s care team cannot be overemphasized. As our clinician Christy so aptly demonstrated in this example, we are an extension of that care team to identify and alert members as well as their care providers to clinical issues. In this member’s case, there was no […]
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Fingerstick vs. venipuncture: The cost-saving power of biometric screenings

Lowering health care costs remains a top priority for most employers today, and it’s not uncommon to find incentive programs encouraging employees to maintain health and lower risk factors. While gym memberships and smartwatch discounts are great techniques to engage employees in their health, as I recently discussed in our webinar, Biometrics Value Story: Attitude, Preferences, […]
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What chief marketing officers should be thinking about for 2020

As part of our series with marketing expert Jason Brown, CEO of BPD Advertising, a partner organization of the Optum Consumer Acquisition Services solution, we sat down to discuss how consumerism is changing marketing practices and what health system chief marketing officers (CMOs) should be thinking about as they prepare their 2020 marketing plans. What […]
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Managing complex, costly conditions with Centers of Excellence

Today, four condition categories — cancer, musculoskeletal, cardiology and kidney — drive a quarter of all health care spending, accounting for $455 billion annually.1 A large majority of employers (87%) are concerned with costs related to these conditions.2 Likewise, these conditions are overwhelming for individuals and their families. They don’t understand what their insurance covers […]
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Spotlight on Caring: David R.

In addition to rigorous training to prepare our HouseCalls advanced practice clinicians, we also equip them with powerful screening tools. These tools, like the QuantaFlo™ system noted in this example, amplify each clinician’s ability to assess a member’s well-being from the comfort and ease of their home.   When the member reported having leg pain, our […]
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