Category Archives: Health Plans

An expert viewpoint: Calendar for HEDIS success

Blog #2 in a 2-Part Series In part 1 of this blog series, I made the case for taking a year-round approach to improve HEDIS season efficiency. Here, I offer the framework for a tool to jumpstart your success. Maintain momentum quarter after quarter with a HEDIS calendar Create your calendar by documenting events and […]
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An expert viewpoint: Why HEDIS is a marathon, not a sprint

Blog #1 in a 2-Part Series You may think of HEDIS season as a point-in-time push where you focus significant resources on getting the documentation you need to show that members received their necessary treatments, screenings and more. Likely that effort consumes your priorities, starting with the January prep through the June submissions. But your […]
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Cloud enables storage and powerful analytics across the enterprise and populations

This is the 4th blog in our series “From data diffusion to insights with enterprise-wide data strategy” An interview with Francois Charette, Senior Vice President of Product Engineering, Optum Health plan organizations have a short window of opportunity to become true orchestrators of care by capitalizing on the data locked in their systems. Francois Charette is […]
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An expert viewpoint: Discover HEDIS improvements beyond standard workstreams

There are excellent strategies to improve your HEDIS performance by reflecting on the past year and making course corrections. But there are even more transformational considerations that can yield exponentially higher benefits.  Ask yourself and your team: How siloed is the HEDIS effort within your organization? If the focus starts and stops with the Quality […]
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Business use cases for the enterprise data platform and big-data analytics

This is the 3rd blog in our series “From data diffusion to insights with enterprise-wide data strategy” An interview with Sameer Siraj, Strategic Product Management, Health Care Technology as a Service, Optum In the third of our four-part series, Sameer Siraj describes how an enterprise data platform combined with machine learning and analytics supports contextualization. Contextualization […]
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Who has a stake in the payer journey from data islands to big data?

This is the 2nd blog in our series “From data diffusion to insights with enterprise-wide data strategy” An interview with Zahoor Elahi, Senior Vice President of Strategic Product Management, Optum Health plans and health systems are ripe for disruption. Big-tech continues to significantly invest in health, wellness and life sciences. They are using technologies such as […]
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Enterprise data strategy in the quantum age

This is the 1st blog in our series “From data diffusion to insights with enterprise-wide data strategy” An interview with Sameer Siraj, Vice President, Strategic Product Management, Health Care Technology as a Service, Optum Across all industry sectors, U.S. health care payers are the least advanced in digital business strategies. Many health plans continue to rely […]
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4 questions to ask when evaluating Natural Language Processing (NLP) for risk adjustment

Natural language processing (NLP) has proven to be a highly effective way to hone in on specific, relevant clinical information to fuel effective risk adjustment. But there are a range of NLP strategies and options. Which best serves your needs? Here are four questions to guide your evaluation. 1. Is NLP integrated into the risk […]
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Outcomes management helps ensure optimal care to members

To improve member outcomes and enhance the quality of care, provider groups and practices need useful feedback. A flexible model backed by real-time and actionable reporting provides such feedback. Understanding the program objectives and managing to specific outcomes is vital to improving quality and risk adjustment performance. Payers set outcomes goals, and an outcomes manager […]
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How technology enables the data sharing essential to high-performing health plans

This is the 2nd blog of a 3-part series “The Power of Three, a New Model for Quality and Risk Adjustment Provider Engagement” In today’s health care environment, members are demanding better outcomes at a lower cost. It’s that simple. But it hasn’t been so simple for health plans to achieve. Taking preventative action hinges […]
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