Author Archives: Optum

How Medicare plans can improve their Star ratings

By: Wes Morris, Associate Director, Optum Clinical and Quality Solutions The Five-Star Quality Rating System is an important part of the Centers for Medicare and Medicaid Services’ (CMS) goal to improve the quality of care and general health status for beneficiaries. For Medicare plans, the consequences of falling short of an overall 4-star rating can […]
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5 Leading Indicators Your Nurse Scheduling System Needs a Check Up

Hospitals operate 365 days a year, 24/7 with no down time, so efficiently managing and scheduling staff is important. With this in mind, it is no wonder that about 31 percent of total hospital spend on Workforce Management (WFM) software in the U.S. is spent on nurse scheduling and staffing, according to a 2016 WFM […]
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Ask the expert: Essentials to managing prospective payment systems

By: Heather Johnson, Manager, Process Management Payment Integrity, Optum This is the 3rd blog in a 3-part series “Optimizing Payment Integrity software to avoid payment pitfalls” Prospective payment methodologies carry opportunity and risk for payers and providers alike. It takes resources and expertise to ensure the accuracy of provider reimbursements — particularly in the face of constant […]
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The Rise in Global Obesity: Why this Matters to Employers

Earlier in the summer, the New England Journal of Medicine published a study that showed that more than 10 percent of the world’s population is now obese. For better or worse, it’s common to hear about the prevalence of obesity in the United States.  It is better because there are numerous public health campaigns and […]
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Ask the expert: Save with a five-phase approach to application manager services

By: John Hoffman, Director, Application Managed Services Operations — Payment Integrity Software — Payment Integrity, OptumIT This is the 2nd blog in a 3-part series “Optimizing Payment Integrity software to avoid payment pitfalls” There is an art and science to effective claims adjudication. The science lies in more edits, which can drive 1–2% in cost avoidance. But […]
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Key takeaways from Optum Forum 2017

Optum Forum 2017 was filled with collaboration, great discussions and networking for more than 1,500 health care stakeholders. We gained new insights into how health care policy is changing, the challenges ahead of all of us and what we can look forward to with new technologies. Throughout the week, more than 200 breakout sessions brought […]
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The human and financial toll of chronic illness

By Dr. Aaron Cohen $1.3 trillion every year. That’s the impact of seven chronic conditions on the U.S. economy, according to a 2014 Milken study.1 Maybe it’s not surprising, given the human toll: nearly half of Americans suffer from at least one chronic disease. One in four lives with multiple chronic conditions. 2 According to […]
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Ask the expert: Maximizing payment integrity success through software

By: John Hoffman, Director, Application Managed Services Operations — Payment Integrity Software — Payment Integrity, OptumIT This is the 1st blog in a 3-part series “Optimizing Payment Integrity software to avoid payment pitfalls” In the dynamic health insurance industry, the claims operations organization within a payer is committed to paying a provider’s claims as quickly and accurately […]
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Improve specialty adherence through video chat, mobile apps and videos

A person with a chronic condition goes to his doctor, who prescribes medication to treat that condition. Simple enough, right? Yet 20–30 percent of the time, a person doesn’t fill their prescription. And about 50 percent of medications for chronic disease are not taken as prescribed. 1 Many don’t realize the consequences of non-adherence. When […]
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Ask the expert: Key steps to evolve to a pre-payment strategy

By: Erin Schmuker, Vice President, Product Solutions – Payment Integrity, Optum This is the final blog of our 2 part series “Maximizing post-payment recovery, preparing for pre-payment success“ Your transition to pre-payment success can be a natural extension of your post-payment efforts to create a comprehensive payment integrity strategy. How? The first step is to look […]
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