Category Archives: Health Plans

Best practices to decrease growing emergency department costs

The costs of services provided by hospital emergency departments have become a source of major concern for payers. When a member receives care at an emergency department (ED), the facility and physicians separately submit evaluation and management (E/M) codes on the claim for services performed. E/M codes are based on services performed while caring for […]
Read More »

Not science fiction: AI is creating value in surprising places

You might think of artificial intelligence (AI) in health care as science fiction — something that’s a future possibility. But the truth is, the future is here now. AI is a collection of methods and technologies for performing tasks we often associate with the human mind, such as learning and reasoning. AI approaches already have […]
Read More »

Transforming payment accuracy with cloud technology and big-data culture

This is the second blog in our two-part series: “Payment Accuracy Gives CIOs an Opportunity to Self-Fund Transformation” An interview with Julie Durham, VP of Software Engineering and Payment Integrity, Optum Health plan CIOs balance efforts between “keeping the lights on” and evolving the digital ecosystem. Yet simple, early wins in payment accuracy can streamline […]
Read More »

Best practices for Medicaid risk adjustment accuracy

Applying risk adjustment best practices to the ever-changing landscape of managed Medicaid risk adjustment For those providing health care in managed Medicaid markets, there are many challenges such as: Risk adjustment models and timing vary from state to state. This makes it hard for managed care organizations (MCO) managing multiple plans to run a risk […]
Read More »

Considerations for centralizing payment accuracy

This is the first blog in our two-part series: “Payment Accuracy Gives CIOs an Opportunity to Self-Fund Transformation” An interview with Matt Choffin, VP of Commercial Payment Integrity, Optum Health plan CIOs balance efforts between “keeping the lights on” and evolving the digital ecosystem. Yet simple, early wins in payment accuracy can streamline operations and […]
Read More »

Expanded Optum Advisory Services receives accolades from Everest Group, Modern Healthcare and KLAS

In late 2017, the consulting division of the Advisory Board Company became part of Optum Advisory Services. Combining our capabilities has proven powerful. I credit our success to the talented people, powerful analytics and our sole focus on health care. Over the course of the last year, our combined organization has received recognition and honorable […]
Read More »

Risk Adjustment Spotlight: Evolving strategies to drive risk adjustment performance

If you think the risk adjustment chart review process is frustratingly fragmented, you are not alone. Integrating in-house efforts with outsourced point solutions are often not only frustrating; they are also costly in terms of time and money. Increasingly, health plans are turning to Software as a Service (SaaS) as a way create an more […]
Read More »

Let’s get started: Guidance for building a blockchain alliance

This is the 3rd blog in our series “A Reality Check on Blockchain for Payers” An interview with Lorraine Frias, senior director of strategic initiatives, Optum Blockchain works when organizations come together to share and audit information and automate common processes. But how do payers work together without risking their competitive positions? Lorraine Frias is […]
Read More »

Stay ahead of HEDIS updates to maximize your quality improvement efforts

Insights from Quality Advisory Services within Optum Advisory Services Managing a Healthcare Effectiveness Data and Information Set (HEDIS®) program is not a one-time exercise. With yearly updates coming from the National Committee for Quality Assurance (NCQA), it requires your HEDIS management program to evolve and morph; you continue to use what works and refine and […]
Read More »

Let’s be practical: Consider “here and now” uses for blockchain

This is the 2nd blog in our series “A Reality Check on Blockchain for Payers” An interview with Lorraine Frias, senior director of strategic initiatives, Optum, and Mike Jacobs, senior distinguished engineer for product engineering and data solutions, Optum. The reality is health care is an industry plagued by data silos. Until blockchain, no technology […]
Read More »