Making connections across the health system
enables us to tackle its biggest challenges
The challenges facing health care today — lack of access, high costs and a frustrating consumer experience — cannot be solved by any single part of the health system. It requires a collaborative effort fueled by connecting disparate systems, data sets and people.
Connecting data illuminates trends and predicts health care issues for individuals and populations. Enabling collaboration among health plans, providers, employers, government and life sciences makes care more comprehensive. It also makes wellness easier and more achievable for patients and stakeholders alike.
Together, we are reshaping the health system — converging information, networks and people — to provide critical health insights that deliver the best care for everyone.
“In 2020, the urgency to create a more connected, streamlined and equitable health system has become more apparent than ever, and our work to support the people and communities we are privileged to serve continues to intensify.”
President and Chief Operating Officer, Optum
It starts by uncovering and predicting opportunities
with data, analytics and technology
Synthesizing disparate pieces of health data can reveal a new perspective. Whether offering proactive preventive solutions; tailoring care that minimizes the risks of complex conditions; coordinating care among providers, agencies and people; or revealing gaps in determinants of health — data drives our ability to see and predict opportunities to improve health outcomes. New technologies and models foster connections between data sources, care teams, organizations and partners. These connections propel health care forward to create a stronger system with patients at the center.
Creating richer patient data sets to accelerate oncology research
Oncology researchers face many challenges, such as getting data specific to the population of interest. Connecting oncology data with data extracted from records on care given by other specialties gives a more complete picture of patient care and outcomes. With this richer data set, researchers can design better clinical trials and commercial teams can accelerate the development of treatments to benefit more people.
Helping clinicians intervene to realize the best patient outcomes
Data and analytics fuel an approach that suggests proactive interventions for people with comorbid medical and behavioral conditions. Medical-Behavioral Integration combines data from many sources to identify the people most likely to benefit from comprehensive care management. This helps clinicians know when and how to intervene for the best outcomes and most effective use of resources.
Tools and insights help build a connected system that fosters consumer-centric care
When employers and health plans collaborate to improve consumer engagement, they strengthen communication and improve population health. By bringing together physical and virtual platforms, we create a more connected experience focused on consumers’ needs. This comprehensive health care system empowers consumers throughout their care journey.
Managing multiple parts of the system addresses complex conditions
Care management, utilization management, network/Centers of Excellence management and focused claims reviews add up to superior care experience and lower total cost of care.OR
As incidence and costs of cancer, heart disease, kidney disease and musculoskeletal conditions rise dramatically, health plans and employers are looking for comprehensive benefit management plans. These plans have four critical capabilities that engage people across the health care ecosystem. They improve outcomes while reducing costs for complex conditions.
Coordinating communication and data lets care teams treat the whole person
Managing the care of someone who requires one or more specialty medications is a complex undertaking. It requires real-time communication and sharing of data across an entire health care team. Leveraging coordinated care leads to a smarter, faster and more complete health journey.
Synchronized care describes our approach to connecting the data and expertise of pharmacy care with other medical services. This approach helps us to deliver improved, coordinated care for the people we serve. Coordinated care is vital for people who require complex specialty medications, since they often have multiple medical conditions and take multiple medications. For example, meet Jason, a specialty pharmacy patient whose recent medical journey encompassed 6 unique synchronized care opportunities. Jason is living with two very complex medical conditions: Rheumatoid Arthritis (RA), which he manages with a specialty medication, and severe coronary heart disease, which requires additional medications as well as a recent surgical procedure. Patients like Jason are constantly tracked through our synchronized medical and pharmacy data. So when Jason is released from the hospital, an automatic discharge notification alerts Brendan, an OptumRx Specialty Pharmacist. This is in contrast to conventional PBMs; they rely on just pharmacy claims data, delaying notifications by weeks or months. Within 24 hours of discharge, Brendan and Jason discuss and document Jason's treatment history and any prescriptions he got in the hospital.
Documenting medication records is a key pillar of quality care and helps reduce the chances of problems later on. With Synchronized Care, Jason's information is automatically shared with both pharmacy and medical teams so they have complete visibility into his situation. Acting on this information, Brendan was able to provide Jason with advice on managing RA symptoms while OptumHealth nurses coordinated in-home care to support his recovery. As a heart patient, having a heart rate/blood pressure monitor for home use is essential for Jason. Brendan discovered he didn't have one and flagged the issue for the OptumHealth nurses. They confirmed that Jason's benefit plan would cover a monitor and one was delivered. This corrected a potential gap in his medical care. Synchronized care extends far beyond just pharmacy, during follow-up calls, Jason revealed he had a poor diet and was flagged for referral into a wellness program. Because all of Jason's case history is contained within one seamless network, health care professionals across Optum were able to easily identify his needs and quickly offer holistic support. Finally, when Jason's RA symptoms became disruptive Brendan could quickly brief the rheumatologist on Jason's medication history, so the doctor could make an informed decision about resuming his medication. Jason's story is not only real; it's a real success. His RA symptoms are well controlled. His cardiac follow up has been trending in the right direction, and he is very happy with his diet changes and is feeling better. Jason's experience is just one example of how Synchronization allows health care professionals from across OptumRx and OptumHealth to work seamlessly together to deliver high-quality health outcomes for patients, and help our clients reduce their overall health care costs.
Learn more at Optum.com/OptumRx
Improving the payment experience pays off for consumers and providers
We don’t often think of billing systems and processes as part of care delivery, but their importance can’t be overlooked. In fact, 65% of consumers would consider switching providers for a better payment experience. Coordinating complex decisions, actions and interactions leads not only to happier consumers but also to less bad debt exposure, fewer denials and lower collection costs.
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