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Perspectives on health plan trends

Together, we are driving toward the same things for our health care system — better quality, lower cost, and higher consumer and provider satisfaction.

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- [Craig] Hi, I'm Craig Savage, Senior Vice President and Global Leader of Optum Payer Consulting, and I wanted to share with you some information that can help us work together to continue to move the needle in the right direction around four key pillars of need in the marketplace. First, improving member outcomes, experience and engagement. Second, driving provider enablement and improving the overall relationship with our providers. Third, enhancing member growth and geographic expansion. And finally, improving affordability and reducing the total cost of care. Our health plan partners agree that there has been a seismic shift in healthcare that has changed our system forever. Areas like constant regulatory changes, membership growth in MA and Medicaid, constant evolving digital technologies, health equity, and many more important factors are requiring plans to think differently about how they currently operate, as well as how they achieve future goals. It's time to think differently and move beyond point solutions to a holistic health system approach. As you work on delivering your most strategic priorities, Optum can help to augment, accelerate, and align with you to help make the health system work better for everyone. The three key areas where we focus to help drive change include providing governance and oversight to collaborate and drive opportunity identification, outcome delivery, and change management. Second, gaining organizational alignment on your most strategic priorities. And finally, creating value via multi-payer platforms, solutions, and insights to automate key business processes and improve data sharing, while driving greater value for our members and engagement. Considered together, our three areas of focus fundamentally accelerate time to value and results for our clients. Our payer thought leadership page is designed to give you information to put into action around the four key pillars that are top of mind for health care leaders, and the digital technologies that power successful outcomes in each of these areas. If you are interested in a specific topic, please don't hesitate to contact us and we would be happy to drill into your specific area of need. Thank you.

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Advancing member health and experience  

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To drive systemic change, SDOH initiatives have taken on greater importance. Increased financial pressure, food insecurity and housing challenges have been worsened by COVID-19. Virtual care strategies focus on meeting members where they are.

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Webinar

Women's Health: Maternity Wellness for Your Client Base

Learn how Optum aligns with partners across the nation to improve outcomes and equity for maternal health patients.

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Webinar

The COVID-19 Effect: Early Observations of 2020

Optum analytics experts examine the impacts on 2020 data due to COVID-19 and offer recommendations for the future.

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Toolkit

Redesigning the future of telehealth: The essential toolkit

A look at the state of telehealth today and insights for it to remain an affordable option post COVID-19.

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White paper

Four myths: Carving out specialty pharmacy

Plan sponsors are considering carving out specialty pharmacy. We address four myths and the member impact.

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Driving growth at scale  

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Payers are focused on growth and entry into new lines of business including Medicare Advantage, ACA and Medicaid. They’re also looking at developing new plan and network designs. Successful growth requires effective risk management and strong performance on quality outcomes.

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White paper

Accelerating growth in the health economy

Explore how leaders can react to new variables with speed and precision and prepare for growth.

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White paper

Health plan pitfalls

Based on in-depth interviews with plan leaders, we identified major themes as gaps that payers may overlook.

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White paper

Mastering growth with government contracts

Optum Advisory Services provides a look into how government program expansion is creating opportunities.

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Thought leadership

Advisory Board best practices for health plans

Discover insights, actionable strategies and tools to support sustainable growth and practical innovation.

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Increasing affordability  

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Reducing the total cost of care is a challenging key affordability lever. Health plans are investing in analytics to better understand cost drivers in complex care, care gaps, medical cost management, specialty Rx, digital technology and SDOH.

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Toolkit

Achieve success in claims editing

Explore best practices around delivery models, content and rule definition to manage claim edits with optimal outcomes.

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Article

HEDIS 2020 reflection and 2021 goals

Review the HEDIS 2020 measurement year to uncover success and analyze three key tips to advance in 2021 and beyond.

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Case study

Close claims payment gaps

See how a California health plan used Claims Edit System Second Pass to improve financial performance.

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Podcast

Until It's Fixed

Listen to this can’t-miss podcast for professionals across health care.

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Cultivating provider relations  

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Improving provider/payer communication by removing points of friction in clinical and administration processes is a key driver of success in the health system. Strategies to reduce provider burden while increasing transparency enable more time to focus on patients.

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Article

How artificial intelligence improves risk adjustment

Examine how AI is improving health care by providing tools and interpreting data through actionable insights.

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Webinar

How Advanced Data Science Can Predict Disease

See how combining advanced data science with risk adjustment is leading earlier disease detection and prediction.

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Article

Will telehealth have lasting impact?

Providers should consider telehealth tactics to lay a solid foundation for optimizing reimbursement.

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Embracing data sharing and collaboration

Harvard Business Review Analytic Services and Optum bring in industry research through the lens of COVID-19 crisis.

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