Often we hear specific feedback from our valued members about our clinicians. These notes of gratitude underscore the impact that each Optum HouseCalls employee has in achieving our mission to help members live healthier lives and make the system work better for them. One important way our clinicians do that every day is by recognizing […]
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As a clinician myself, I have seen the power of the in-home assessment to help members live healthier lives—a key aspect of our mission. The work our Optum HouseCalls clinicians do often results in members reaching out to tell us how a visit made all the difference in their lives. In this example, proactive care […]
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Health plans are seeing exponential growth in both the use and medical cost expense of specialty medications. In the past decade, the Food and Drug Administration (FDA) has approved more than 250 specialty medications. By 2020, specialty medications are estimated to cost $400 billion. Forty percent of that cost is expected to be paid under […]
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Collaboration around the business of health care is critical In a recent marketplace survey by NEJM Catalyst on the transition from fee-for-service to value-based care, we gained interesting insight into the state of value in health care. These included snapshots of revenue distribution, models in use, barriers, important measures and more. All are important points […]
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The years ahead will see greater challenges in cardiovascular disease (CVD) care. To prepare for what’s coming, providers and payers will benefit from working together to optimize quality of care and patient outcomes and lower the total cost of patient care. The relentless rise of cardiovascular disease CVD is the costliest chronic disease in the […]
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Has it been four months already? That’s when the first performance period began for CMS’ latest bundled payment model, BPCI Advanced. Now participants are less than a month away from the March 1st deadline. By March 1st, they can drop participation in any (or all) of the 32 clinical episodes without penalty or financial risk. […]
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Health plans are focusing on ambulatory surgery centers (ASCs) as a source of cost savings. The same procedure performed in an ASC may be less than it is in other outpatient ambulatory settings. Acute care facility inpatient admissions will gradually decrease as most health plans are moving services to the outpatient service facilities such as […]
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Medical bills: trying to understand them may be nearly as painful as the injury or illness that generated them. This is an exaggeration, of course. But for many consumers, those bills can represent big problems, such as how to pay for their health care, how to plan for future care and how to achieve financial […]
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The artificial intelligence (AI) journey from theory to mainstream has evolved in waves. While health care may see AI as an abstract concept, I believe that technology capabilities have already entered their second wave of evolution. The roots of artificial intelligence (AI) technologies go back to 1950, when Alan Turing suggested that machines could be […]
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Speaking from experience With limited resources during the short HEDIS season, health plans must make quick decisions to prioritize the number of medical records to retrieve, abstract and over read to meet their goals. One year when I was at a health plan, we were at the end of the HEDIS season. We were two […]
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