Category Archives: Health Plans

How the right HSA provider can support your employees’ health and security

Medical bills: trying to understand them may be nearly as painful as the injury or illness that generated them. This is an exaggeration, of course. But for many consumers, those bills can represent big problems, such as how to pay for their health care, how to plan for future care and how to achieve financial […]
Read More »

Next AI ‘wave’ will be a sea change for health care

The artificial intelligence (AI) journey from theory to mainstream has evolved in waves. While health care may see AI as an abstract concept, I believe that technology capabilities have already entered their second wave of evolution. The roots of artificial intelligence (AI) technologies go back to 1950, when Alan Turing suggested that machines could be […]
Read More »

What will you do differently this HEDIS® season?

Speaking from experience With limited resources during the short HEDIS season, health plans must make quick decisions to prioritize the number of medical records to retrieve, abstract and over read to meet their goals. One year when I was at a health plan, we were at the end of the HEDIS season. We were two […]
Read More »

Best practices to decrease growing emergency department costs

The costs of services provided by hospital emergency departments have become a source of major concern for payers. When a member receives care at an emergency department (ED), the facility and physicians separately submit evaluation and management (E/M) codes on the claim for services performed. E/M codes are based on services performed while caring for […]
Read More »

Not science fiction: AI is creating value in surprising places

You might think of artificial intelligence (AI) in health care as science fiction — something that’s a future possibility. But the truth is, the future is here now. AI is a collection of methods and technologies for performing tasks we often associate with the human mind, such as learning and reasoning. AI approaches already have […]
Read More »

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 […]
Read More »

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 […]
Read More »

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 […]
Read More »

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 […]
Read More »

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 […]
Read More »