Category Archives: Health Plans

Shifting Star cut points and how health plans can avoid surprises

Are you confident of what  your plan’s rating will be when the Star Ratings are released this year? For the 2018 Star Ratings, 76 contracts missed a 4-star rating due to the shift in cut points. Some plans might have been prepared for the potential of coming up short. But for many plans, this was […]
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Pacing and prioritizing health plan renovation

This is the final blog in our three-part series, “The CIOs Role in Digital Transformation”  An interview with David Chennisi, Senior Vice President of Optum Advisory Services As health care shifts from volume to value, CIOs are challenged to harmonize stakeholder needs, advance infrastructure to “free the data,” and build better digital experiences throughout the health […]
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Aligning the C-suite by defining the use case

This is the 2nd blog of a 3-part series “The CIO’s Role in Digital Transformation” An interview with David Chennisi, Senior Vice President of Optum Advisory Services In the second of a three-part series, “The CIO’s role in digital transformation,” Optum Advisory Services Senior Vice President David Chennisi draws on 30 years’ experience in health IT […]
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Building health plans for the new consumer

This is the 1st blog of a 3-part series “The CIO’s Role in Digital Transformation” An interview with John Santelli, Chief Information Officer, UnitedHealth Group and Executive Vice President, Optum Technology As costs shift to consumers, the demand for retail-like convenience, price transparency and digital tools grows. Today’s health care CIOs have a powerful opportunity […]
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Viewpoint: Part 1 of the 2019 CMS Advance Notice

By: Rich Gamret, FSA, MAAA, Director, Actuarial Consulting, Optum CMS recently released Part 1 of the 2019 Advance Notice of Methodological changes for Medicare Advantage. This was a first for the industry — this information has historically been released in February. As required by the 21st Century Cures Act, CMS is focused on improving the […]
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HEDIS® season preparation: Map your glide path to success

With HEDIS Medical Record Review (MRR) season right around the corner, there are still things you can do to help create a successful season. In this post, we’ll focus on a few key activities that can be done in January to assist the upcoming HEDIS MRR season. A best practice to support a sucessful HEDIS […]
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Optum wins “Triple Crown”: Recognized “Leader” in three Everest Group PEAK Matrix™ Reports

By John Reynolds, Senior VP, Optum In what we’re calling “The Triple Crown,” Optum has been named Leader in three categories measured by Everest Group’s 2017 PEAK Matrix™ reports: Healthcare Provider Information Technology Services Healthcare Payer Information Technology Services Healthcare Consulting Services Everest Group’s PEAK Matrix assesses service providers’ capabilities and categorizes them as Leaders, […]
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HEDIS season preparation: Are you confident in your HEDIS retrieval chase logic?

HEDIS Medical Record Review season is right around the corner. Once a production chase file is dropped, it can be difficult to make changes. Every active field day matters, so in this post we’ll discuss maximizing your time in the field via proactively addressing your chase file. Here are some steps to consider taking. Execute […]
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A whole-person view reveals individual needs

For many people, the health care system is disjointed and confusing. It’s easy to get overwhelmed and frustrated, which leads to disengagement. This is literally bad for one’s health. To make matters even worse for consumers, they are assuming more of the financial risk than ever before to manage their health. This comes also at […]
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How Medicare plans can improve their Star ratings

By: Wes Morris, Associate Director, Optum Clinical and Quality Solutions The Five-Star Quality Rating System is an important part of the Centers for Medicare and Medicaid Services’ (CMS) goal to improve the quality of care and general health status for beneficiaries. For Medicare plans, the consequences of falling short of an overall 4-star rating can […]
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