Tag Archives: Optum

Three steps: Get ready for risk-based, fee-for-value health care

Ready or not, here it comes — risk-based, fee-for-value health care is here or coming to a market near you! Health care providers are no longer asking whether they should get ready. They are asking: How fast should we make the transition? They know it may not be pretty. “Organizations need to set a goal […]
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Becky’s Story: A Total Game Changer

Clinical research studies are vital in the health care industry to find out what is working and what isn’t. In some instances, they also create the potential to save a life. That was the case for a woman named Becky Fowler. She signed up for a research study on cholesterol with PMG Research and Wilmington […]
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Redefine acute care to combine fee-for-service (FFS) with care management.

Badly broken bones, appendicitis, hemorrhages and head injuries mean there will be a need for acute care hospitals no matter how the healthcare industry changes. But we need to change how we think about acute care in relation to the rest of healthcare. A traditional definition says acute care is the opposite of chronic or long-term care. […]
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Analytics are becoming a habit of highly effective ACOs

Even the most practiced at population health management may struggle with one factor deemed by many to be crucial for success as an accountable care organization or ACO. The challenge? Implementing a health IT infrastructure and data analytics strategy. Health IT Analytics lists analytics as a defining capability of successful ACOs. It reports that a robust […]
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Use data to prepare for payer/provider risk contract negotiations

In my experience negotiating risk contracts with providers on behalf of payers, I saw some significant differences in the way provider organizations approached these negotiations. Some providers came to the negotiating table with data, analytics and a clear strategy to support their position. Others would accept proposed terms without fully evaluating and analyzing the cost […]
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Weintraub believes data usage needs next wave of evolution

When you take a look at all the data systems that the health care industry as a whole has in place, Michael Weintraub, President and CEO, Optum Analytics, said in an interview conducted at the Forbes HealthCare Summit, the challenge is that there are hundreds if not thousands of disparate enterprise software systems that need […]
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Weintraub foresees future data usage exploding

The amount and depth of health care information on individual patients and entire populations is huge and growing larger by the day, Michael Weintraub, President and CEO, Optum Analytics, said in an interview conducted at the Forbes HealthCare Summit, and this data represents a tremendous opportunity to influence the decision making process. “The capabilities are […]
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Trusting predictive analytics

Most likely, the last time you purchased something online you were offered “recommendations” or saw what “others also liked.” The technology behind these common prompts uses predictive analytics. Your online merchant is leveraging data about your shopping and online searching behavior to predict their desired outcome — that you might buy something else! As we […]
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Making the most of health care claims data in value-based care

In my last blog post, I wrote about the need for using clinical data to create a comprehensive data set for analytics. The other side of that equation, however, is using claims data effectively. Providers already can more easily leverage claims data than clinical because of stronger reporting tools and standards, but there are some […]
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10 tips for working with MCOs to advance Medicaid program integrity

Have you turned to managed care organizations (MCOs) to reduce Medicaid costs and improve patient care? If so, you probably know how difficult it is to know for sure whether your MCOs are doing all they can to reduce fraud, waste and abuse. In May 2015, CMS proposed a new rule that MCOs strengthen their […]
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