Category Archives: Health Plans

Spotlight on Caring: Jessica D.

Members don’t always report (or even fully recognize) their health issues. As some conditions worsen, members may compensate with lifestyle changes such as resting more. That issue is compounded in rural areas where members have to travel far for care. These members may ignore worsening symptoms or delay preventive exams until a heath issue becomes […]
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Spotlight on Caring: Karen M.

HouseCalls advanced practice clinician Karen knows that some members are hesitant to engage in a home visit. People may have misconceptions about the purpose for coming into their home. However, HouseCalls APCs place an initial phone call to members before visits to answer any questions and explain the value of the visits. In this specific […]
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Spotlight on Caring: Carina G.

Spotlight on Caring: Carina G. Disease management is an important aspect of the Optum HouseCalls visit. HouseCalls advanced practice clinicians are trained to provide timely coaching, empowering members to take meaningful action that achieves lasting results. Here’s what this focused support meant to one member in particular as she worked with HouseCalls advanced practice clinician […]
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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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