Category Archives: Health Plans

A case for thinking big: Driving breakthrough cost savings

By: John Reynolds, Senior Vice President, Optum This is the 1st blog of our eight part series “Bending the Cost Curve with Comprehensive Sourcing.” As a payer seeking sustainable growth, you need to lower your total costs to fund your future. But here’s a simple, if uncomfortable truth: You likely need to think bigger, broader […]
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Real-time scheduling brings transparency to nurse staffing

Have you ever played Jenga®? It’s the game where wood blocks are stacked to build a tower and players take turns pulling one block out of the structure at a time. Pull the wrong block and CRASH! — it all comes tumbling down. Building a great Jenga tower takes time, patience and a lot of […]
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How can health plans manage unpredictable transplant costs?

While overall health care costs have been rising in the last decade, transplant costs have surged, becoming an unpredictable and volatile expense for payers. Financial projections are often hard to make in transplant episodes, which occur unexpectedly with costs varying widely based on organ type, clinical complexity, transplant facility and geography. Transplant providers themselves vary […]
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Health plans: Best practices for increasing agility in an ever-changing market

Amid the national health care debate, many health plans are focused on anticipating changes in regulations, membership populations and consumer needs. Nevertheless, leading health plans are also focused on enhancing operational excellence to enable their organization to quickly manage and distribute products that align with the ever-changing needs of their market and members. Many health […]
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Kidney Resource Services: Earnestine’s story

Chronic kidney disease (CKD) is a complex and costly condition. One in seven adults has CKD. Earnestine was one of them. Fortunately, through Optum® Kidney Resource Services, she was able to work with Carolyn, a nurse case manager, to help her follow the strict diet recommended by her doctor, take her medications and understand her […]
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2018 Bid submission: Best practices for aligning bid strategy and operational execution

The Centers for Medicare & Medicaid Services (CMS) released its 2018 Advance Notice and Draft Call Letter in February, proposing numerous changes for Medicare Advantage (MA) and Part D plan sponsors. The combination of benchmark, risk adjustment, quality Star rating, cost sharing and benefit design requirements, coupled with uncertainty of several 2018 payment variables and […]
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Consumer-centric wellness solutions for health plans

When individuals are able to proactively manage their health and wellness — whether they have multiple chronic conditions or are relatively healthy — they’re able to live their best lives. And as health risks are reduced, so are costs. Optum offers NCQA-accredited wellness solutions tailored to the needs of each population’s needs. These services are […]
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Health plans: Consider new metrics for assessing organ transplant programs

Organ transplants save lives, and the number of transplants is rising. That’s why it’s important for health plans to reassess the metrics they use to measure the value of organ transplant programs. Our white paper,“Reassessing how payers determine the value of organ transplant programs,” explores the Transplant Value Initiative. This Optum initiative looks at how […]
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Payers, avoid value leakage. Opt for the right comprehensive sourcing model

Part 2 of a 2-part series Payers leave a lot of value on the table when they manage IT, process, and medical costs separately. Our research shows that payers can achieve breakthrough cost savings improvements if they manage medical and operational costs together. This blog series offers a plan that enables payers to convert their […]
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Better outcomes and reduced costs for our frailest populations

Patients living in skilled nursing facilities (SNFs) are a small subset of Medicare beneficiaries. But these clinically complex individuals generate nearly two times the average medical expense for all Medicare members, according to The Henry J. Kaiser Family Foundation. By promoting more intense attention to this institutional population, health plans can drive better care and […]
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