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The human impact of health care analytics

Examples of OptumIQ™ in action

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- Health is a tricky thing. When you're in good health, it rarely crosses your mind. Like your vision. How often do you really think about it? It's a fundamental part of our lives, yet something that's easy to take for granted. But if your vision disappeared overnight, it would change your life dramatically. It's easy to not even think about until it's all you can think about.

- When I was seven, my dad gave me my first camera, and ever since that moment, all I wanted to do was take pictures. I've been a professional photographer for about 20 years and I just assumed that I would do it forever. About six months ago, I noticed a shadowy spot in my left eye. When it didn't get better after a few days, I went and saw my doctor and he ran some tests and we scheduled a follow-up visit. Then a few weeks later, the spot was bigger. It was getting harder to read fine print and to take pictures. My doctor called and said that I have an advanced form of age related dry macular degeneration. At this point, it was affecting about a third of my vision and I had to admit that I might have to give this up. More than a million Americans have what I have and there's no cure. There's no way to slow the progression by eating better or exercising. But I have hope. My doctor said that there are clinical trials all the time, experimental treatments that could possibly halt the progression. I know it's a long shot, but I'm not ready to give up.

- Although the person you just saw isn't a real patient, the scenario is real. She represents the one in 14 Americans over the age of 40 who have some form of age related macular degeneration. Unfortunately, patients with advanced forms of this disease often become legally blind. The good news, clinical trials are helping us advanced our understanding of new medicines and fueling medical breakthroughs. And when you're talking about potentially curing degenerative diseases, time is precious. The success of trials depends on many factors. Most importantly, finding the right patients. By one estimate, more than 58 study participants are needed globally to fill the current clinical trial demand. Historically the approach, to finding patients has been manual and time intensive which drives up costs and slows down research. But today, we're surrounded by vasts amount of data and analytical tools which are changing the clinical paradigm making it simpler to find the right patients for the right trial. Let's hear about the very real challenges researchers face.

- Apellis is a public biotech company that is active in the field of immunology. We have a couple of late stage clinical programs. The phase three programs are focused on ophthalmology the advanced stage of so called dry macular degeneration and then a rare disease called paroxysmal nocturnal hemoglobinuria. One of the main challenges that we have as a biotech company is we have this incredible commitments to getting new therapies to patients as quickly as possible. But we have to go, obviously, through all of the right steps in order to do that in a safe way and in a way where we actually establish efficacy for these patients. The goal is to get better therapies quicker to patients. During the clinical trial, when you have a product that works, it brings hope to patients and it is something that gives incredible satisfaction and it gives frustration that you cannot give it to the other patients that need that as well. As a physician, that is what I want. I mean, as quickly as possible, bring these therapies to patients. We came to Optum really with the objective of identifying patients in the wide world that normally we wouldn't have access to. Optum gave us a window into doing that.

- We developed the digital research network to help people like Dr. Francois and all of you on the front line of clinical research move our understanding of health forward faster. Our network is integrated research offering that speeds up the trial process. It all starts with data. We're using US data from over 200 million claims, over 100 million electronic health records and the 1.3 billion prescriptions that are processed annually. We then stream all relevant electronic patient data and use it for patient finding and clinical trial purposes. We're eliminating the slow, manual processes to speed up enrollment and remove the costly errors and unpredictable timing too common in research. And our digital research network can make a huge difference for patients. We're bringing cutting edge research to patients as an option of care. We can help identify trials for patients in their local communities with their own physician. And we're also conducting trials that are seamlessly integrating with their normal care delivery so as not to disrupt our patients' lives. And for the patient, easier participation in a trial makes it more likely they will be able to complete that trial. This goes at the very heart of our mission to transform the drug development process to one that's grounded in real world patient behavior and physician practice.

- The digital research network is just one example of how Optum is advancing our understanding of health. It's driving faster enrollment, generating about 30% in time and cost savings, improving the effectiveness of trials and giving patients real hope for the future.

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Connecting patients with clinical trials

7 min.

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Clinical trials are helping us advance our understanding of new medicines and fueling medical breakthroughs. The success of those trials depends on many factors — most importantly, finding the right patients. By one estimate, over 58 million study participants are needed globally to fill the current clinical trial demand, and historically, 70% of trials do not hit enrollment targets.

Optum SVP and Chief of Clinical Development Dr. Kristen Buck explains how artificial intelligence is helping to close those gaps.

Learn more about the Optum® Digital Research Network

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- Synchronized care adopts a team led approach supported by data and technology to change the way we care for patients with multiple chronic conditions. Think about this, 91% of people who require complex and expensive specialty medication suffer from multiple chronic conditions. We also know they have an increased risk of mortality and hospitalizations and that they account for two thirds of all healthcare spending in the US, a significant contribution to the rising cost of care. Optum is bringing together the data, analytics, and expertise from across the healthcare system that can help people lead healthier lives and reduce the financial burden of chronic disease on our society. To hear a real life example of how we're synchronizing care to create this new normal let's hear from pharmacist, Michael Zeglinski.

- I want you to meet Jason. That's not his real name. We changed it for privacy. But his story is very real. Jason has two chronic conditions. Rheumatoid arthritis, which he manages with a specialty medication and heart disease. Recently Jason was discharged from the hospital where he had a serious heart procedure done called a coronary artery bypass graft. Also known as a CABG. People recovering at home from a CABG require very careful monitoring and may need additional care. A couple years ago, Jason's wife passed away. She used to handle all the medical stuff in their house. Like getting prescriptions filled and taking care of him when he was sick. Now, back at home he has to manage everything on his own. Less than 24 hours after Jason left the hospital an OptumRx specialty pharmacist received an automatic alert that he'd been discharged. These alerts trigger a synchronized care approach so that Jason's entire care team works together to help him manage his complex conditions. Traditional PBMs would not be aware of a patient discharge for weeks or even months without synchronized data. This is important because those first 24 hours are so critical. And with his medical history Jason is at risk of being readmitted. With Jason's approval, the specialty pharmacist looked over his medical, pharmacy and lab data. Which is another differentiation that helps members get the care they need. In this case, the specialty pharmacist saw that because of his procedure Jason was on several new prescriptions. And Jason's doctor had told him to stop taking his rheumatoid arthritis medication because it could suppress his immune system and lead to infection so soon after surgery. Now, fully prepared with the right data the specialty pharmacist called Jason for a formal medication review. Jason confirmed that he'd stopped taking the arthritis medication. But he was worried about managing the pain at home alone. The specialty pharmacist also learned about Jason's in-home situation. That he was managing his own care and feeling overwhelmed. The pharmacist laid out a plan. First, he'd call the physician and discuss alternate ways to manage Jason's arthritis pain. Then, he'd contact an Optum Health Nurse Advocate about in home care and health counseling. And he let Jason know that we are available 24/7 to answer questions or provide options. Whether that means lower cost drugs or tips for making sure he takes his medication as prescribed. But the story doesn't stop here. We provide members like Jason with digital tools and advice so they can easily take an active role in their own care. Members can manage their prescriptions including checking prices, staying adherent and placing refills all from a smartphone or tablet. We use every interaction whether virtual or in person as an opportunity to synchronize care for people like Jason. So they can better manage their complex conditions and live healthier lives.

- This is just one example of how synchronized care is helping patients like Jason. With 24/7 specialty pharmacy support monthly cost savings of up to $25 per patient and better overall medication adherence.

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Synchronizing care for polychronic patients

Duration: 5 min.

91% of people who require specialty medication suffer from multiple chronic conditions, and they account for 2/3 of all health care spending in the U.S. Using a team-led approach supported by data and technology, synchronized care can help these patients receive the care they need while simultaneously reducing costs and improving their experience.

Optum SVP Michael Zeglinski tells Jason's story and shows how a synchronized approach helps achieve these lofty goals.

Learn more about OptumRx®
synchronization efforts

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- Healthcare delivery is always complex and managing multiple conditions can be even more challenging. Many of us can relate to the joy of welcoming a new baby into the family. Unfortunately, many have also experienced the struggles and the heartbreak that sometimes accompany the desire to have a baby. Chronic conditions such as high blood pressure, diabetes, and Crohn's disease can make that journey even more complicated and potentially dangerous for both mom and baby. To achieve the best outcome, you need the right team of healthcare experts in place. Clinicians with quick access to information aided by knowledgeable recommendations to help make the best decision for mom and baby. I'd like to share one couple's journey to parenthood led by a team of healthcare experts invested in making their dream a reality.

- It was one thing I knew for sure. Always wanted to be a mother. We had tried IVF five times. The last one we had, we were at an ultrasound and found out there was no heartbeat. And that nearly broke me. We both grieved for the family that we thought we were never ever going to have. We actually almost gave up. And we figured, "We're not done yet. "Let's try one more time." When we went in for the ultrasound, I was holding my breath. There were two embryos. Please be a heartbeat, please let there be a heartbeat. And then we heard the two heartbeats.

- Susan came to us over age 35. She also had pre-existing diabetes. Elevated sugar and poor sugar control kills unborn babies. A delay can literally be the difference between life and death. It was critical to get Optum on board.

- Our goal is to get the patient's blood sugars into range and the best way to do that is an insulin pump.

- [Susan] Once we talked to Optum, it really was the easiest way to proceed with everything.

- [Cathy] Once the information is populated into the patient's chart, it's easy to see where you need to make the adjustment.

- I can put in the order of Optum through my EMR and the next day I'm getting data back from Optum on blood sugar control. The log of the patient's sugars, graphs of where the sugars are at so that if I don't wanna look at numbers I can actually look at a picture. And then they let me know any medication alterations that have occurred.

- [Cathy] Optum IQ is how we put our data analytics and expertise to work. Our dashboard consolidates all the information in one place.

- [Susan] My doctor was getting reports from Optum. When I went for my checkups I would walk in and she'd say, "Things look great, keep going."

- Optum is the strategic partner that I need to provide patients the best possible care. The reason I went into medicine was to make people empowered to reach their dreams.

- [Susan] The day we delivered, when the doctors put them on my chest, it was the very best feeling in the world. We got the family we always dreamed of with the best team of people that I could've imagined.

- Isn't that an amazing story? I had the opportunity recently to sit down with Doctor Humphrey to gain more insight on Susan's journey. Welcome, Doctor Humphrey, it's so great to have a chance to sit down and talk with you. The video was just amazing.

- It is such a beautiful video and the outcome could not have been better thanks to Optum.

- Oh, that's great. And I noticed in the video that Susan was using the insulin pump. You talked about that. And I'm just curious what makes an insulin pump such a good situation for patients like Susan and why do you work with Optum to manage the pump?

- That's a great question. The insulin pump is sort of fascinating. It is a very technical device that works like the human pancreas that makes insulin. And insulin has to be released at a basal rate, or a baseline rate, and then it has to spike with specific things like meal times. And there can be multiple baseline rates throughout the day. And then depending on the meal time, the spikes are different. And so when you take the data from an individual, 'cause everyone's a little bit different, you can end up with very different responses to insulin and very different insulin needs. Thankfully, Optum is able to take all of the patient's data and figure out the right number of basal rates because they use more than one baseline rate throughout the day. So that very quickly, with Optum's help, I'm able to get patients' blood sugars under control. And that's critical for the health of the baby and results in great outcomes like Susan's.

- We heard you talk about the risk of uncontrolled blood sugar to the unborn baby but what about after the child's born? Is there a risk to a child who was in an environment with uncontrolled blood sugar after?

- It's amazing when you learn the science behind this but uncontrolled sugars actually convey to the baby and change the baby's programming. They cause the baby to need to spend potentially extra time in the hospital, maybe even in the Neonatal Intensive Care Unit, because of dangerously low blood sugars for the baby or problems like elevated bilirubin and jaundice that require treatment. They also change the programming of the baby's metabolic system to make that baby as a child more likely to be obese and as an adult more likely to be obese and diabetic.

- Doctor Humphrey, how does your partnership with Optum help you deliver better care to patients that have these high risk conditions like diabetes or high blood pressure?

- Optum has been my partner in taking care of patients and really provides me with three essential components. The first is a highly trained professional group of medical providers that're able to interact with a patient, help with blood sugar control, monitor blood pressures, and even help with other programs like the Preterm Delivery program or the Nausea Vomiting in Pregnancy program. The second thing that I get from Optum is that I get great documentation. So I have sent to me from Optum, detailed reports of interactions with patients, blood sugar values, blood pressure values, that're very easy for me to integrate into our electronic medical record system. And the third thing that I get from Optum is wonderful communication. I have an example of a story about that communication. I had a patient with dangerously high blood pressure that developed after hours. And the Optum nurse was the person to identify these critical range blood pressures which could cause a stroke for the mother or actually serious pregnancy complications. And this nurse reached directly out to me. It was a very expedited contact that allowed us to route the patient for the best care, which was delivery. And to have a partner like that in caring for patients and getting the right things done, it's invaluable.

- That is so great to hear. What a wonderful story. And we're so happy we could be a part of that outcome for your patients. So thank you again for your partnership and I'm glad we're together on this journey.

- It is my honor to be here sharing these stories because I want as many doctors and as many systems as possible to know about what they can get for their patients and the great care and great outcomes that they can see with the help of Optum.

- Thank you, that's great. Susan's story is an example of how strategic partnerships can make a real difference in people's lives. The results speak for themselves. With patients receiving around-the-clock support, we've seen 19% fewer NICU admissions and 93% insulin compliance.

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Delivering insights to support prenatal care

Duration: 9 min.

Many of us can relate to the joy of welcoming a new baby into the family. Unfortunately, many have also experienced the struggles and heartbreak that can accompany the desire to have a baby. Chronic conditions like high blood pressure or diabetes can make that journey even more complicated.

Hear about one couple's journey to parenthood and how it was impacted by health care experts empowered by critical data-backed insights.

Learn more about Optum® Women's
Health Services

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- Healthcare delivery is always complex and managing multiple conditions can be even more challenging. Many of us can relate to the joy of welcoming a new baby into the family. Unfortunately, many have also experienced the struggles and the heartbreak that sometimes accompany the desire to have a baby. Chronic conditions such as high blood pressure, diabetes, and Crohn's disease can make that journey even more complicated and potentially dangerous for both mom and baby. To achieve the best outcome, you need the right team of healthcare experts in place. Clinicians with quick access to information aided by knowledgeable recommendations to help make the best decision for mom and baby. I'd like to share one couple's journey to parenthood led by a team of healthcare experts invested in making their dream a reality.

- It was one thing I knew for sure. Always wanted to be a mother. We had tried IVF five times. The last one we had, we were at an ultrasound and found out there was no heartbeat. And that nearly broke me. We both grieved for the family that we thought we were never ever going to have. We actually almost gave up. And we figured, "We're not done yet. "Let's try one more time." When we went in for the ultrasound, I was holding my breath. There were two embryos. Please be a heartbeat, please let there be a heartbeat. And then we heard the two heartbeats.

- Susan came to us over age 35. She also had pre-existing diabetes. Elevated sugar and poor sugar control kills unborn babies. A delay can literally be the difference between life and death. It was critical to get Optum on board.

- Our goal is to get the patient's blood sugars into range and the best way to do that is an insulin pump.

- [Susan] Once we talked to Optum, it really was the easiest way to proceed with everything.

- [Cathy] Once the information is populated into the patient's chart, it's easy to see where you need to make the adjustment.

- I can put in the order of Optum through my EMR and the next day I'm getting data back from Optum on blood sugar control. The log of the patient's sugars, graphs of where the sugars are at so that if I don't wanna look at numbers I can actually look at a picture. And then they let me know any medication alterations that have occurred.

- [Cathy] Optum IQ is how we put our data analytics and expertise to work. Our dashboard consolidates all the information in one place.

- [Susan] My doctor was getting reports from Optum. When I went for my checkups I would walk in and she'd say, "Things look great, keep going."

- Optum is the strategic partner that I need to provide patients the best possible care. The reason I went into medicine was to make people empowered to reach their dreams.

- [Susan] The day we delivered, when the doctors put them on my chest, it was the very best feeling in the world. We got the family we always dreamed of with the best team of people that I could've imagined.

- Isn't that an amazing story? I had the opportunity recently to sit down with Doctor Humphrey to gain more insight on Susan's journey. Welcome, Doctor Humphrey, it's so great to have a chance to sit down and talk with you. The video was just amazing.

- It is such a beautiful video and the outcome could not have been better thanks to Optum.

- Oh, that's great. And I noticed in the video that Susan was using the insulin pump. You talked about that. And I'm just curious what makes an insulin pump such a good situation for patients like Susan and why do you work with Optum to manage the pump?

- That's a great question. The insulin pump is sort of fascinating. It is a very technical device that works like the human pancreas that makes insulin. And insulin has to be released at a basal rate, or a baseline rate, and then it has to spike with specific things like meal times. And there can be multiple baseline rates throughout the day. And then depending on the meal time, the spikes are different. And so when you take the data from an individual, 'cause everyone's a little bit different, you can end up with very different responses to insulin and very different insulin needs. Thankfully, Optum is able to take all of the patient's data and figure out the right number of basal rates because they use more than one baseline rate throughout the day. So that very quickly, with Optum's help, I'm able to get patients' blood sugars under control. And that's critical for the health of the baby and results in great outcomes like Susan's.

- We heard you talk about the risk of uncontrolled blood sugar to the unborn baby but what about after the child's born? Is there a risk to a child who was in an environment with uncontrolled blood sugar after?

- It's amazing when you learn the science behind this but uncontrolled sugars actually convey to the baby and change the baby's programming. They cause the baby to need to spend potentially extra time in the hospital, maybe even in the Neonatal Intensive Care Unit, because of dangerously low blood sugars for the baby or problems like elevated bilirubin and jaundice that require treatment. They also change the programming of the baby's metabolic system to make that baby as a child more likely to be obese and as an adult more likely to be obese and diabetic.

- Doctor Humphrey, how does your partnership with Optum help you deliver better care to patients that have these high risk conditions like diabetes or high blood pressure?

- Optum has been my partner in taking care of patients and really provides me with three essential components. The first is a highly trained professional group of medical providers that're able to interact with a patient, help with blood sugar control, monitor blood pressures, and even help with other programs like the Preterm Delivery program or the Nausea Vomiting in Pregnancy program. The second thing that I get from Optum is that I get great documentation. So I have sent to me from Optum, detailed reports of interactions with patients, blood sugar values, blood pressure values, that're very easy for me to integrate into our electronic medical record system. And the third thing that I get from Optum is wonderful communication. I have an example of a story about that communication. I had a patient with dangerously high blood pressure that developed after hours. And the Optum nurse was the person to identify these critical range blood pressures which could cause a stroke for the mother or actually serious pregnancy complications. And this nurse reached directly out to me. It was a very expedited contact that allowed us to route the patient for the best care, which was delivery. And to have a partner like that in caring for patients and getting the right things done, it's invaluable.

- That is so great to hear. What a wonderful story. And we're so happy we could be a part of that outcome for your patients. So thank you again for your partnership and I'm glad we're together on this journey.

- It is my honor to be here sharing these stories because I want as many doctors and as many systems as possible to know about what they can get for their patients and the great care and great outcomes that they can see with the help of Optum.

- Thank you, that's great. Susan's story is an example of how strategic partnerships can make a real difference in people's lives. The results speak for themselves. With patients receiving around-the-clock support, we've seen 19% fewer NICU admissions and 93% insulin compliance.

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Simplifying the Health Care Experience

Duration: 8 min.

What if eating at a restaurant, buying a car or staying at a hotel worked like health care? When you compare the consumer experience in health care to those common everyday scenarios, it becomes obvious how broken our system is.

Optum360 VP Laura Anderson explains how technology can lead the way to a more seamless, intuitive and lower-cost future.

Learn more about Optum360® efforts to improve the patient financial experience

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