Category Archives: Health Plans

Transforming payment accuracy with cloud technology and big-data culture

This is the second blog in our two-part series: “Payment Accuracy Gives CIOs an Opportunity to Self-Fund Transformation” An interview with Julie Durham, VP of Software Engineering and Payment Integrity, Optum Health plan CIOs balance efforts between “keeping the lights on” and evolving the digital ecosystem. Yet simple, early wins in payment accuracy can streamline […]
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Best practices for Medicaid risk adjustment accuracy

Applying risk adjustment best practices to the ever-changing landscape of managed Medicaid risk adjustment For those providing health care in managed Medicaid markets, there are many challenges such as: Risk adjustment models and timing vary from state to state. This makes it hard for managed care organizations (MCO) managing multiple plans to run a risk […]
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Considerations for centralizing payment accuracy

This is the first blog in our two-part series: “Payment Accuracy Gives CIOs an Opportunity to Self-Fund Transformation” An interview with Matt Choffin, VP of Commercial Payment Integrity, Optum Health plan CIOs balance efforts between “keeping the lights on” and evolving the digital ecosystem. Yet simple, early wins in payment accuracy can streamline operations and […]
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Expanded Optum Advisory Services receives accolades from Everest Group, Modern Healthcare and KLAS

In late 2017, the consulting division of the Advisory Board Company became part of Optum Advisory Services. Combining our capabilities has proven powerful. I credit our success to the talented people, powerful analytics and our sole focus on health care. Over the course of the last year, our combined organization has received recognition and honorable […]
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Risk Adjustment Spotlight: Evolving strategies to drive risk adjustment performance

If you think the risk adjustment chart review process is frustratingly fragmented, you are not alone. Integrating in-house efforts with outsourced point solutions are often not only frustrating; they are also costly in terms of time and money. Increasingly, health plans are turning to Software as a Service (SaaS) as a way create an more […]
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Let’s get started: Guidance for building a blockchain alliance

This is the 3rd blog in our series “A Reality Check on Blockchain for Payers” An interview with Lorraine Frias, senior director of strategic initiatives, Optum Blockchain works when organizations come together to share and audit information and automate common processes. But how do payers work together without risking their competitive positions? Lorraine Frias is […]
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Stay ahead of HEDIS updates to maximize your quality improvement efforts

Insights from Quality Advisory Services within Optum Advisory Services Managing a Healthcare Effectiveness Data and Information Set (HEDIS®) program is not a one-time exercise. With yearly updates coming from the National Committee for Quality Assurance (NCQA), it requires your HEDIS management program to evolve and morph; you continue to use what works and refine and […]
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Let’s be practical: Consider “here and now” uses for blockchain

This is the 2nd blog in our series “A Reality Check on Blockchain for Payers” An interview with Lorraine Frias, senior director of strategic initiatives, Optum, and Mike Jacobs, senior distinguished engineer for product engineering and data solutions, Optum. The reality is health care is an industry plagued by data silos. Until blockchain, no technology […]
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AI helps health care professionals focus on the work that matters

Artificial intelligence (AI) in health care can have a high return on investment — not by taking the place of humans, but by enabling them to work at their highest level of certification. It can allow doctors to focus on patients, auditors to focus on assessing finances, and medical coders to focus on accurately reflecting […]
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Let’s cut through the noise: Understand near-term and long-range uses for blockchain

This is the 1st blog in our series “A Reality Check on Blockchain for Payers” An interview with Lorraine Frias, senior director of strategic initiatives, Optum, and Mike Jacobs, senior distinguished engineer for product engineering and data solutions, Optum. As blockchain rapidly grows up, many speculate it will solve a lot of the data problems in […]
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