Optum

Optum’s Disease Management programs empower individuals — in collaboration with physicians and other health care providers — to effectively manage their conditions, associated risk factors and co-morbidities.

Disease Management programs offered

Optum helps people engage the right health care provider, take the right medications, receive the right evidence-based care and make the right lifestyle choices. Our model is like no other in the industry because our programs are:

  • Integrated: We keep common longitudinal records for each individual across our full continuum of wellness, health care decision support, case management, complex medical conditions, and behavioral health products and services. This ensures the coordination of clinical resources and the sharing of critical clinical information whenever and wherever it is needed.
  • Coordinated: People, working with dedicated Disease Management nurses, focus on their personal physicians’ treatment plans so they may address areas of opportunity to impact care, medications and lifestyle. Coordinated communications, engagement activities and incentive plans drive meaningful improvement in health.
  • Comprehensive: A whole-person approach to addresses immediate needs and underlying issues. A dedicated Disease Management nurse with condition-specific expertise screens for co-morbidities, risk factors and medication compliance. In addition, every interaction is an opportunity to teach people about their conditions and their implications, and how to avoid triggers and reduce or eliminate risk factors. This ultimately empowers individuals to become active participants in the management of their own health.

Optum has programs that address the following conditions: Asthma, Bariatric Surgery, Cancer, Chronic Kidney Disease, Chronic Obstructive Pulmonary Disease, Congenital Heart Disease, Coronary Artery Disease, Diabetes, Heart Failure and offers a Specialized Physician Review Service.

Case Study

Optum’s client was composed of various provider medical groups responsible for the management and coordination of outpatient medical services for chiropractic services. The client’s network was previously managed by a West Coast network management company.

In taking over management, Optum further reduced the client’s medical spend by 38 percent in directing patients to quality free-standing clinics to lower costs.

The client needed to:

  • Transfer risk liability
  • Utilize management capabilities
  • Reduce medical expense

Optum:

  • Assumed full financial risk, resulting in per-member-per-month (PMPM) cost savings of $2.40 and reductions in medical spend of 38 percent and in missing utilization and overall costs.
  • Delivered detailed utilization reporting at the health plan medical group level that identified underperforming providers.
  • Reduced providers’ billed charges by 58 percent using Optum networks.

Call Re-Solutions today to learn how to put Optum’s Disease Management programs to work for your business.