Author Archives: Optum

Spotlight on caring: Marcia K.

The home visit is a vital way to connect with members in a way that enables them to more fully communicate their concerns and needs. But first you have to earn their trust — from the call to set up the visit, to the invitation to sit on their couch. Each HouseCalls advanced practice clinician […]
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Graph technology: Powering a new age of consumer choice in health care

Learning from other industries, health care is catching on to how consumers shop, compare options and make selections that best match their needs. At home, you watch a movie. Then the system compares you with other people who watched the same movie and recommends other films based on similar connections. Or you go online and […]
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Social determinants of health data challenges and their impact on risk and quality

The impact of social determinants of health (SDOH) on patient care is becoming more and more critical. Over the past few years, the Centers for Medicare & Medicaid (CMS) has focused on addressing SDOH for all members. This shift may affect risk and quality success and requires an evolution in coding capabilities within existing documentation […]
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What’s ahead for tobacco cessation programs?

As 2019 draws to a close, tobacco use is still a problem in your workplace. This year the Center for Disease Control and Prevention (CDC) Office on Smoking and Health declared 2019 its Year of Cessation, but our work is not done. We recently learned from our webinar that 60% of attendees, most of whom […]
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The way from here: The collaborative future of MMIS procurement

As states move forward with plans to overhaul aging Medicaid Enterprise Systems (MES), collaboration is only going to increase in importance. That’s why organizations like the National Association of State Procurement Officers (NASPO) are working to streamline Medicaid Management Information System (MMIS) procurement. In NASPO’s case, they’re harnessing resources from multiple states to create cooperative […]
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How to make a health care startup entanglement extravaganza

Just 90 seconds to pitch their idea. That’s all most of the startup companies had. A dozen lucky companies were selected to present a six-minute pitch. And many others were invited to sit down in private one-to-one sessions. Who was listening? Investors and executives from some of the top names in health care, including Optum, […]
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HEDIS measures, ECDS and telehealth: Are health plans ready?

According to the National Committee for Quality Assurance (NCQA), the Electronic Clinical Data Systems (ECDS) reporting standard represents a step forward in adapting the Healthcare Effectiveness Data and Information Set (HEDIS®) to accommodate the expansive information available in electronic clinical data sets for quality improvement.* In addition, the growing use of telehealth reflects overall health […]
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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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