Optum

Optum operates the nation’s leading Centers of Excellence (COE) transplant network which is developed and maintained using a process of qualifying, contracting and case management consulting unique to the industry.

Transplant programs offered

There are two programs available: the Transplant Resource Services (TRS) with an enhanced Ventricular Assist Device (VAD) program, and the Managed Transplant Program (MTP).

  • Transplant Resource Services – a transplant network comprised of high-quality, clinically superior COE’s. Once a COE program is qualified clinically, Optum leverages its unparalleled purchasing power to drive deep contractual savings. Clients save an average of 53% percent per transplant episode, in addition to the cost avoidance achieved through the statistically superior clinical outcomes realized through COE network programs.
    • The Ventricular Assist Device program delivers a greater value for organizations by offering superior clinical quality, broad national access, deep contractual discounts, and by controlling cost variation. Optum’s VAD program identifies and qualifies the top VAD centers in the nation and provides access to quality providers for VAD implantation and post-surgical maintenance.  The VAD COE network is proven critical to superior clinical outcomes. VAD procedures performed at non-COE facilities are nearly twice as likely to result in discharge mortality than VAD procedures performed at a VAD COE.
  • Managed Transplant Program carves out the clinical and financial aspects of transplant cases.  The program provides first-dollar coverage for virtually all transplant types, with an unlimited lifetime benefit. Optum takes all of the risk for transplants, for a simple standard monthly premium. Optum pays claims that result from transplant cases. Individuals in need of a transplant services have access to expertise through the Optum Centers of Excellence transplant network. At the same time, a transplant nurse case manager will help guide patients through every aspect of the transplant process.

 

Case Study

Optum’s client was an East Coast independent health plan with 230,000 members. This client experienced year-over-year medical trend increases. Optum analyzed the client’s cost trends and delivered a solution tailored to their population specific needs using Optum cancer, transplant, chronic-kidney-disease and case-management services.

The Client Needed:

  • Lower health-care costs with long-term savings goals
  • Reduced utilization
  • Reduced unit costs

Optum Delivered:

  • $7.0 million in medical expense savings
  • A 44 percent year-over-year decrease in
  • end-stage renal disease hospital admissions
  • A 2.5 percent decrease in hospital admissions
  • A 7.3 percent decrease in hospital LOS for cancer
  • $3.1 million in transplant medical-cost savings from guidance to high-quality, cost-efficient providers

Call Re-Solutions today to learn more about Optum’s transplant programs.