Health Plans

Pressing challenges, unprecedented opportunities

A new health care marketplace is taking shape – one that presents greater quality, cost and compliance pressures. Health reform and shifting demographics have created unique opportunities for health plans to grow their business by entering new markets, offering new products, and becoming increasingly focused on consumers. 


Resource Center 

Proactive approach to payment integrity is a strategic investment
Increased cost pressures and rapid market changes necessitate proactive payment integrity.
Testing will allow plans to see where there is work to be done — while there is still time to do that work.
Health plans need a process that breaks testing into meaningful components and helps them achieve a successful transition to ICD-10.
Newly covered members in 2014 represent uncharted territory--and opportunity
Payers must position their organizations to adapt swiftly to opportunities and recover quickly from missteps as tens of millions of newly covered members enter the insurance marketplace.
The High Potential of Medication Adherence
Higher levels of medication adherence can lead to lower health care costs and improved outcomes.
Plans must provide population health incentives to promote provider risk sharing
The delivery of health care has changed dramatically and has a direct impact on health plans’ growth strategies, care management, and cost and quality initiatives. Among these initiatives is risk sharing, which calls for all stakeholders to take on more risk in order to improve health outcomes.
OptumTM Consumer Acquisition Platform
A Next-Generation Approach to Acquire, Retain and Engage Members.
EFT/ERA systems are good for health care, good for payers’ bottom lines and good for their relationships with network providers.
Complete EFT/ERA systems can significantly reduce administrative costs by creating savings in paper and printng, postage, manual labor, banking fees, fees for voided or returned checks and call center volume.

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