When managing ED use and spend, it isn’t always practical to deploy point solutions that focus exclusively on retrospective intervention. Optum® Emergency Department Spend Management is a comprehensive program designed to enable health plans to proactively manage the rising costs of ED use and spend.
Optum deploys an industry-leading predictive model that monitors data from a wide variety of sources. The model looks for trends and patterns of ED use and spend to proactively identify opportunities to intervene.
Prevention to accurately predict at-risk members and redirect care paths to enable engagement and intervention that may avert future misuse and reuse of the ED.
Post-encounter to identify inflated evaluation and management (E/M) codes and provide E/M recommendations for payment to ensure accurate reimbursement upon submission.
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Future frequent user ED spend flagged by predictive model.*