Better care at a lower total cost is in sight
The annual cost of health care in the United States is $3.6 trillion — and growing. The country will face dire consequences if we don’t reverse the trend to lower the total cost of care. We must solve this problem — and we are.
Drug prices get a lot of attention, but they are only one piece of the puzzle. We need to look at lowering costs by segment as well as holistically.
This demands an increased focus on patient experience as well as quality of care. And it requires collaborating to implement quality-driven incentives and business practices that integrate data and analytics into everyday practice.
From operations to delivery, we’re defining a new era of health care on a societal scale.
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Triple Aim
Better patient experiences and outcomes at lower costs
Proactive approaches to chronic disease can lower total cost of care
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A dedicated investment in prevention holds great promise to lower the costs of chronic diseases, which account for nearly 75% of U.S. health care spending.
Proactive steps like annual screenings, early interventions and lifestyle changes can significantly curb the risk, or delay the effects, of chronic disease on our society.
Americans currently use preventive services at only about half the recommended rate. Increasing the use of 20 proven clinical preventive services to 90% would result in an annual savings of $3.7 billion, according to a study published in Health Affairs.
How do we accomplish that increase? Education, encouragement and empowerment are key. Identifying at-risk individuals and providing them with the right resources at the right time helps people improve their own health.
These strategies are being employed across Optum through efforts like:
- Integrated wellness coaching that reshapes healthy lifestyle habits
- Care reminders that prompt people to take action
- Employee well-being programs that provide help in detecting disease
Value-driven care ensures a smooth experience and efficient use of resources
Transforming traditional care models through intelligent uses of data and technology empowers clinicians to deliver superior quality care and ensures a smarter, more intuitive experience for patients at a lower cost overall.
Key to this approach is an uncompromising focus on optimizing quality of care and eliminating waste and inefficiency.
The Optum Optimal Care lifecycle uses advanced technology to deliver evidence-based health care recommendations at the point of care to help clinicians avoid unneeded treatments.
For example, initial results show the program driving significant reductions in unnecessary knee arthroscopies with patients who followed an evidence-based course of treatment of weight loss, the use of anti-inflammatories and physical therapy.
Aligning Operations
Collaboration aligns operations with care priorities
Driving value is more than just changing payment models
Value-based care is centered on providing the highest quality care to patients, but it also requires the management of costs for long-term sustainability for health care organizations. Moving to value-based care may seem straight-forward, but it is actually easier said than done. How can organizations make value-based care work for patients and for them?
It starts with collaboration. Providers need to know other providers so they can choose judiciously when referring patients and making decisions. But collaboration needs to go beyond clinical partnerships. Studies show that payers and providers must share data to succeed in value-based care endeavors, which means changing the way both operate.
The next key is getting the right data, and the platforms to analyze it, into providers’ hands. As providers enter into value-based care arrangements, they need actionable information to support decision-making that helps them provide quality care and manage their costs.
Simplifying the payment continuum — together
When providers and payers work more seamlessly to leverage data and analytics across systems, operational efficiencies and cost savings can be directed toward better patient care.
In its collaboration with John Muir Health, Optum360® streamlined the system’s revenue cycle, freeing up its clinicians to focus on care delivery. By reducing administrative complexity and friction between provider and payers, John Muir is delivering a better, more transparent patient experience, where costs are known up front and scheduling an appointment is easy.
Reducing administrative costs begins with payments
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Data and Analytics
Better care decisions start with data and analytics
Using health care intelligence identifies the best behavioral health interventions
Research has shown that integrating behavioral and medical health care improves outcomes and patient experience. But despite a decade of development, medical-behavioral integration models struggle to deliver on their promise and value and to optimize total cost of care.
Data and analytics can create a more sophisticated clinical approach that aligns interventions for people with comorbid medical and behavioral conditions and addresses the complexity of their care.
Algorithms identify individuals who are most likely to benefit from holistic care management. They are then matched, with greater precision, to appropriate care services, such as an integrated clinical care team, single medical-behavioral treatment care plan and coordination with medical and behavioral providers.
A portfolio of lighter-touch methods can be used to address those with moderate to low medical-behavioral integration needs.
This approach makes the most effective use of clinical resources.
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