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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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Increasing affordability 

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Reducing the total cost of care is a challenging but 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

Improving genetic test reimbursement

It’s an exciting time for genomics. But to control costs, plans must get a handle on the clinical side of this market.

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Article

Specialty drugs and prior authorizations

A prior authorization process may not be enough for health plans to ensure that specialty drug utilization meets their policy criteria.

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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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Webinar

How advanced data science can predict disease

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

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Webinar on demand

The rising costs of cancer care

Understand the trends and how to respond.

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Article

Navigating forward: Holistic risk

Learn how CEOs can protect their organizations from growing uncertainty.

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Article

To be early is to be early

Find out what three things to do now for MY2021 and beyond.

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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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Article

The customer experience trap

Why is consumer loyalty decreasing when innovation in customer experience has become an even bigger focus?

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Article

The path to 4+ Star performance

Read how adopting our three-point strategy can impact 2023 Stars performance.

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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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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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White paper

Identify and address low-value care​

Learn how Symmetry® EBM Connect® enables health plans to better understand the appropriateness of care.

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e-book

Transforming the six zones of consumer experience

Discover innovations to drive engagement, loyalty and growth.

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White paper

Social determinants of health

Discover a nonclinical approach to health and well-being.

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Webinar

Improving care management and population health

Find out how Optum® RxComplex technology identifies members who may need an increased level of support and guides members into appropriate care management programs.​

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