Category Archives: Health Plans

HEDIS® season preparation: Map your glide path to success

With HEDIS Medical Record Review (MRR) season right around the corner, there are still things you can do to help create a successful season. In this post, we’ll focus on a few key activities that can be done in January to assist the upcoming HEDIS MRR season. A best practice to support a sucessful HEDIS […]
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Optum wins “Triple Crown”: Recognized “Leader” in three Everest Group PEAK Matrix™ Reports

By John Reynolds, Senior VP, Optum In what we’re calling “The Triple Crown,” Optum has been named Leader in three categories measured by Everest Group’s 2017 PEAK Matrix™ reports: Healthcare Provider Information Technology Services Healthcare Payer Information Technology Services Healthcare Consulting Services Everest Group’s PEAK Matrix assesses service providers’ capabilities and categorizes them as Leaders, […]
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A whole-person view reveals individual needs

For many people, the health care system is disjointed and confusing. It’s easy to get overwhelmed and frustrated, which leads to disengagement. This is literally bad for one’s health. To make matters even worse for consumers, they are assuming more of the financial risk than ever before to manage their health. This comes also at […]
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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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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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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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Ask the expert: Key steps to optimize an existing post-payment strategy

By: Erin Schmuker, Vice President, Product Solutions – Payment Integrity, Optum This is the 1st blog of our 2 part series “Maximizing post-payment recovery, preparing for pre-payment success” There is an increasing focus on pre-payment. However, your organization may not be able to fully commit to a comprehensive payment integrity approach. Even the most robust […]
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