Category Archives: Health Plans

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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Anticipating MACRA and Medicare Advantage impacts

MACRA continues to evolve and while its impacts may have been somewhat softened over the last several months, MACRA’s intent is still to have an impact on care costs and quality over short and long term. While many providers are concerned and strategizing about the financial and administrative implications of MACRA, payers should also consider […]
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The Power of Three: A New Model for Quality and Risk Adjustment Provider Engagement

Experienced quality and risk adjustment experts help improve member outcomes By Sam Diederich, Vice President of Strategy and Business Integration, Optum When payers manage quality and risk adjustment for government-sponsored membership, it creates a significant burden for care providers. Consider the situation from the provider’s point of view. Each payer sends data and asks for information […]
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Artificial intelligence unlocks buried data

Did you know that more than half of the information contained in electronic medical records is unusable to health care organizations? Mark Morsch, Optum360 Vice President of Technology, says studies show 60 to 80 percent of EMR content is unstructured. That means some data that could potentially be used to create a more complete picture […]
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Learn to speak the same health care language

Take a trip around the world and you’ll hear a lot of different languages, including some you probably won’t understand without a translator. Data is the language of today’s health care system. But a patient’s journey through that system collects data from a variety of sources in many different formats. It’s hard for anyone to […]
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Learn why to participate in the next-gen CMS BPCI Program

The Centers for Medicare and Medicaid Services (CMS) delivered the next generation of the Bundle Payment for Care Improvement (BPCI) program on January 9, 2018. CMS refined the original program definitions focusing on volume episodes and expanded the eligibility to include physician group practices including surgical centers. Medicare data for applicants over the past four […]
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The cure for analysis paralysis

A whole week devoted to health IT and how it’s transforming the world? Now that’s what I’m talking about! Las Vegas is home to this year’s HIMSS conference. (Shout out to our crew in Booth 6425 — stop by for a coffee if you’re in town! Our folks would love to talk shop with you.) […]
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