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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“Do I need to cleanse my gut?” and other thoughts about bacteria

If you’ve seen commercials on TV or scanned the dairy aisle at your local grocery store, you may have noticed the recent trend encouraging people to try supplements, yogurts and other products intended to help people improve their health by cleansing their gastrointestinal (GI) tract. As a dietitian, I get many questions from my clients […]
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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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Do bundled payments encourage more procedures? New study offers answer

New research aims to determine whether a claim that bundled payments may actually increase costs rather than control them holds any weight. Becker’s Hospital Review and McKnight’s reported on the study from the Centers for Medicare and Medicaid Services and the Altarum Institute. At issue was whether bundled payments — also known as episode-based payments […]
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MACRA requires knowledge of qualities of “good” data

Medicare is allowing physicians and group practices to set their own course toward compliance with the Medicare Access and CHIP Reauthorization Act, or MACRA. But regardless of the path chosen, accurate measurement is key. That’s because the most basic level of participation requires physicians to submit data on one quality measure and one improvement activity […]
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