Category Archives: Health Plans

Spotlight on Caring: Crystal T.

Many Medicare Advantage members take several medications. Even though providers are careful to provide clear instructions, it can be confusing to take each one the right way at the right time. As a HouseCalls advanced practice clinician, Crystal takes time at each home visit to review a member’s medication to ensure the member is following […]
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How analytics can help create more competitive health care networks

Even before the COVID-19 pandemic, the health care market was shifting rapidly. Now health plans are in an even more complex and challenging space, and they must focus on modernizing their networks.  One of the key factors to that modernization is being able to dive deep into network analytics.  “Those who are in the position […]
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Timing is everything: CMS 2022 Advance Notice Part I and other guidance

The COVID-19 pandemic has had a significant impact on how Americans seek medical care. It has also impacted the delivery of care and operations of health care providers. During the ongoing pandemic, the Centers for Medicare & Medicaid Services (CMS) released several waivers and flexibilities. This is to support health care providers and health plans […]
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Health plans use analytics to elevate client reporting

Employers face constant pressure to strike a balance between building human capital and driving financial performance. This health care dilemma pulls organizations in two directions when it comes to reporting. They’re looking for ways to support employee health and wellness while remaining competitive in the market. Add to that the increasing challenges of an evolving […]
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Spotlight on Caring: Cassandara S.

HouseCalls advanced practice clinicians, like Cassandara in this example, are known for their astute assessment skills. Their systematic approach can uncover serious issues that members may have been ignoring or minimizing. As Cassandara demonstrated so well, it also takes thoughtful determination to identify how to best connect a member to the appropriate care team and […]
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AI-enabled risk adjustment: Move from volume to precision targeting of charts

Millions of Medicare Advantage medical charts are retrieved and reviewed manually each year to improve accuracy and completeness of member health status. Traditional retrospective risk adjustment processes lack the technology and tools to predict and prioritize charts likely to support unreported diagnosis codes. The result has been a less efficient process, which can disrupt providers […]
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Spotlight on caring: HouseCalls COVID-19 response

Across the health care system, COVID-19 has demanded fast, thoughtful transformation to deliver care. Recognizing that members still needed support even when in-person visits weren’t possible, Optum® HouseCalls created a highly flexible, responsive solution. Learn how Optum HouseCalls was able to use telehealth to continue “visiting” members and support other front-line teams. Continuing member care […]
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Innovations in payer tools help reduce incorrect claims

Innovation is abundant in health care today. From new technology to virtual visits to clinical trials, people across the medical spectrum are finding new and better ways to deliver care. The payer space is also seeing tremendous change. And innovations from Optum are helping drive more efficiencies and growth. “We’re taking a holistic approach to […]
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Spotlight on caring: Aline D.

The home environment often helps members open up in ways they may not in a clinician’s office. Perhaps that’s because the advanced practice clinician and the member don’t feel rushed. The advanced practice clinician has the time to encourage one-to-one conversations with members. They take the time to listen to a member’s health concerns and […]
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Spotlight on caring: Carrie B.

Whether members live alone or even when they have others in the home with them, they can ignore worsening health conditions. It takes an expert perspective — like that of a HouseCalls advanced practice clinician — to identify symptoms that have become normalized. In this case, HouseCalls advanced practice clinician Carrie’s thoughtful physical assessment helped […]
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