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The power of connections has an exponential impact on quality, experiences and costs

No group can solve health care’s biggest challenges alone.

Local care, condition management or frequent care interaction points are key areas where disparate parts of the system can coalesce and enhance the patient experience.

Providers, health plans and pharmacy services share knowledge, resources and insights to build a seamless ecosystem. This leads to more holistic, efficient, innovative care that improves outcomes and experiences while reducing costs — and that’s good for everyone.

 

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Local and Digital

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Coordinating care with local and digital connections

Patient-centric local care is the foundation of a connected system

People want their health care to be local. They want to know their provider. They want care experiences that foster a human connection and take all aspects of their health into consideration.

Starting with the provider as the core anchor point, we are creating a patient-centric, physician-led, value-oriented health delivery system that delivers better quality, experiences and affordability.

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Using data intelligently connects the business and care sides of health care

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Speaker: Health care is beyond appointments, beyond X-rays, doctors, and hospitals. Health care is about building a system people can rely on, at times, when they're most vulnerable.

Behind the scenes is a world of data and systems. Inside and know-how, seamlessly connecting the delivery of health care to the business of health care.

Optimizing performance by enhancing systems and improving data accuracy.

Controlling costs by reducing billing, coding, and payments errors, without compromising quality of care.

Eliminating friction between clinicians and insurance offices.

Accelerating access to life-saving services.

Extracting usable data using artificial intelligence.

Building for tomorrow and committing to a better experience for everyone.

So when the unexpected happens, your health care system is ready to respond.

Leading the way to better health care operations is Optum, innovating to enable a new level of success.

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Our data and technology ecosystem powers a connected local care network. Integrating data, analytics and clinical information makes the health system smarter, more efficient and better connected.

Seamlessly connecting the delivery of health care to the business of health care helps create a system everyone can rely on. This means optimizing performance, enhancing data accuracy, eliminating friction between payers and providers and accelerating patient access to life-saving services.

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Condition management

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Coordinating care by managing chronic conditions 

Progressive oncology care model improves quality, lowers costs

Meeting patients not just where they are geographically, but where they are in their care journey, is another way to focus collaboration efforts. There’s no better place to be present for the 133 million people facing chronic diseases than when they are facing the devastating physical, emotional and financial effects of a disease such as cancer.

Keeping patients at the center of care, the Optum progressive oncology care model ensures higher quality care, a better experience and lower costs. The Cancer Guidance Program connects and empowers oncologists through a real-time decision-support technology to determine if a proposed treatment plan follows the recognized standard of care.

Employed at the new OptumCare® Cancer Center in Las Vegas, this approach accelerates care decisions and approvals, so physician teams and patients can focus on their health journey. This approach has decreased inpatient admissions by 6%.

Another element of this model includes decoupling drug payments from physician compensation. Initial estimates show the cost of cancer medicines used in this center decreased by 30% over three months, while physician satisfaction rose.

 

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Common touchpoints

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Coordinating care by activating at common touchpoints

Complex conditions require a higher level of care coordination

Connecting care is critical to the success of an individual's health, especially when they have multiple or complex conditions. Pharmacy services is a common touchpoint that shows a broad view of an individual’s conditions.

In this real-life example, Jason benefits from six points of coordinated care for his rheumatoid arthritis and coronary heart disease. When he was released from the hospital after a surgery, a series of actions by his pharmacy care team helped him stay healthy.

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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.
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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

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