Category Archives: Health Plans

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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Leveraging market landscape data for 2021 bid preparation

The Medicare Advantage (MA) bid process is a function of the overall product strategy that a health plan organization wants to put in place over a multi-year time frame in the marketplace. When preparing bids, several entities of each health plan in an organization are needed such as: executive, finance, marketing, sales and operations. During […]
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2020 MA plans: More benefits at little or no cost to members

In 2019, more than 20 million members enrolled in Medicare Advantage (MA) plans. That number is expected to grow to more than 30 million members before 2030.1 For the 2020 plan year, the Optum Advisory Services actuarial practice is highlighting 2020 premium and supplemental benefit changes. We believe that MA growth can help private health […]
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Spotlight on Caring: Ed V.

HouseCalls enables its advanced practice clinicians to be as flexible as possible to adjust to each member’s needs. Just as importantly, our clinicians are trained to be persistent in reaching out to primary care providers, when warranted, to make sure that members get timely help. This flexibility and persistence can make all the difference as […]
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Spotlight on caring: Marcia K.

The home visit is a vital way to connect with members in a way that enables them to more fully communicate their concerns and needs. But first you have to earn their trust — from the call to set up the visit, to the invitation to sit on their couch. Each HouseCalls advanced practice clinician […]
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Social determinants of health data challenges and their impact on risk and quality

The impact of social determinants of health (SDOH) on patient care is becoming more and more critical. Over the past few years, the Centers for Medicare & Medicaid (CMS) has focused on addressing SDOH for all members. This shift may affect risk and quality success and requires an evolution in coding capabilities within existing documentation […]
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