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Our deep expertise, advanced analytics and innovative technology help our customers drive sustainable health economics and more personalized care.

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We create innovative, data-driven solutions that span the health ecosystem to make a difference today — and help reimagine health care for tomorrow.

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Until It's Fixed podcast series

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Driving sustainable, consumer-focused care

Find resources to navigate forward and create a more consumer-focused, economically sustainable health ecosystem that drives better outcomes.

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Healthcare has been in an era of transformation for some time. But the disruptions of COVID-19 have accelerated change into previously unseen speeds. At Optum, we have the ability to observe the foundational changes being made across the national healthcare landscape. And we see several macro forces emerging.

With disruptions of COVID-19, I think, there are several changes that are here to stay. First is the focus on an advancement of digital health. Second is continued market pressures from new market entrants and non-traditional providers. Third, traditional providers see their sort of one size fits all model, really changing as a result of these external entrants, and need to continue to monitor external threats, and reevaluate their value propositions.

Healthcare leaders can take advantage of this disruption in several ways. First, focus on the people. Understand what your consumers, or patients, or members need, want and expect, and tailor your approach and your business towards that. Second, embrace digital health. And third, and perhaps most importantly, become more agile, motivating support leadership teams to make informed decisions in more rapid cycles.

There are several pieces of evidence of radical change in the healthcare value chain. First is the disruption in our supply chains and dropping consumer engagement. Also, cash shortages across the board will have implications for some time to come. A CEO can better understand the value chain shifts in their market by looking at specific shifts in consumer behavior to see if they are substituting services outside their ecosystem, and what types of services those are. And, at the same time, monitor consumer and technology companies for what offerings they are introducing into the market.

CEOs can look within their own organizations for opportunities to adjust in a few ways. First, CEO's can see if COVID has revealed any gaps in service that are associated with their business proposition, or mission. If they have assets that are underperforming, or unrelated to the core business proposition that reveals where to consider divestiture.

CEOs can ensure that their organizations are truly aligned with consumer preferences by taking several steps. It starts with segmentation. Organizations need to understand who they are serving in a nuanced way, appreciating their customers' attitudes and behaviors towards health and wellness in order to create more tailored offerings that are not one size fits all. Then, overcoming access and engagement barriers. Addressing issues related to costs, site, and modality of service, convenience, language, social determinants of health, and the like. And then, of course, measuring and monitoring. For metrics leaders can still look at things like utilization and retention by segment, however, by including NPS and consumer effort scores leaders can gather current sentiment on loyalty and learn how hard consumers have to work to engage services.

There are really two kinds of intelligence that a CEO should prioritize when assessing holistic risk. The first is broader market analysis. The other is potential operational impacts. There are several innovative ways to address this risk. On the business risk side, the main one is considering new strategic partnerships. On the financial risk side, several options. One is moving reimbursement models towards risk arrangements, or value-based care. Another is investing in new ways to close care delivery gaps and address care needs. And finally, but potentially most important, consider ways in which CEOs can impact other related issues such as social determinants. And here, it's about considering how CEOs can partner with local community organizations to connect with patients and members, and ensure better access to care and services that they may need.

There are several areas where regulatory or compliance activity that's related to COVID-19 will have impact. Certainly, Medicare and duals were hard hit by COVID 19. Unemployment now, or is soon to swell the Medicaid ranks, while many unqualified individuals are falling through the cracks. The CARES Act is limiting states' ability to reduce coverage and states will need to cut somewhere to balance budgets. There are questions, now, about what federal and state governments can even afford in the near future. CMS has extended telehealth coverage beyond the pandemic, but they may not convert CARES Act loans to grants, or reduce interest rates as providers hope. And the federal government has consistently shown a commitment to data: data security, interoperability standards, data sharing to support coordinated care and mandated consumer access are issues health organizations will need to be ready to contend with.

These forces will continue to put significant pressure on the healthcare industry. As a result, it is incumbent upon us, as leaders, to remain agile and nimble, to use new sources of data, to connect with our customers and consumers, and to create value for our healthcare purchasers. We have an opportunity, now more than ever, to truly transform our industry to help people live healthier lives, and to make the health system work better for everyone.

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