When it comes to assessing the big picture on health, Dr. Sumit Dutta has a unique perspective. Dr. Dutta earned his medical degree from Michigan State University and completed his internship at the University of Chicago Hospitals and Clinics and residency at Rush Medical Center. He subsequently practiced Internal Medicine at New York University Health Center before assuming various leadership roles at Medco and Catamaran. Now, as Chief Medical Officer of OptumRx, he is tasked with helping to make the health system work better for everyone.

We recently talked with Dr. Dutta about what OptumRx is doing to help solve health care’s biggest problems.

  1. What is your role here at OptumRx?

    My role at OptumRx is to answer the question “how do we drive better outcomes and care for patients?” Within Optum we have the widest variety of health related capabilities in the industry. They include care delivery assets such as surgical centers, urgent care centers and primary care practices. We have total population health tools like condition management programs in asthma, diabetes and heart disease among others. We have nurses that visit patients in their homes through House Calls. We provide analytics support and tools for hospital systems, where we aggregate their data and provide insights back to them. Obviously, we have pharmacy care service through OptumRx. So my role is to put all these pieces together to deliver novel services through our PBM business, improve health and lower overall health care costs.

  2. Can you expand a little on the concept of synchronization?

    Synchronization is really about taking disparate areas in health care, uncoordinated areas in health care, and making them work better together.

    The pharmacy benefits management area has been traditionally focused on drugs in a silo. Traditional PBMs focus on where you obtain a drug, like retail pharmacies or mail service. PBMs drive down the price of a drug. Synchronization allows us to impact more than just the drug. Now we can impact the medical care the patients receive or behavioral health through sharing information and prioritizing opportunities, which traditional PBMs do not impact. This is why we refer to our work as Pharmacy Care Services because our efforts are more than just Pharmacy Benefits Management.

  3. In addition to synchronization, what else are we doing to improve health outcomes?

    A couple of things stand out. One is that we are partnering with stakeholders including pharmaceutical companies and retail pharmacies. I like to say “Nothing gets done in a silo” and pharmaceutical companies that create new innovative drugs and retail pharmacies that engage patients are important partners that we can innovate with in order to improve healthcare.

    Another area of focus is empowering physicians. One way we are doing this is to increase the transparency of information to the doctor. They do not have all the information they need to make the best decisions today. Often the doctor is not sure of the cost of the medications they prescribe. Our solution to this opaque situation is an innovative platform called Script Connect. It sends information electronically through EMRs directly in to their workflow. This way doctors can see real-time information on eligibility, drug cost, alternative drug costs and clinical programs like prior authorization to do the job better.

  4. How does this increased integration and transparency translate in a real world setting?

    A good example is opioids. To me the most troubling statistic around use of opioids is that more people are now killed by opioid-related overdoses than automobile accidents. So we absolutely need new approaches to this serious problem.

    Measures we are taking include claim system enhancements to reinforce CDC recommendations on how doctors should prescribe these medications. We are requiring lower days supply for the initial Opioid prescription and making sure that doses are below a daily average of 50 “morphine equivalent doses” because we know that abuse is much more likely when the doses are higher.

    Finally, unlike traditional PBMs we are in a position to coordinate behavioral health programs with pharmacy utilization management techniques. So, our ability to craft solutions that go beyond the pharmacy makes us unique in the industry.

  5. What would this look like from the patient's perspective?

    People don’t think of themselves as a retail patient, specialty patient or a mail service patient. These are labels that the industry created. Patients think of themselves as human beings dealing with health conditions. Our job is to put together a set of capabilities to help people in ways that have never been thought of before so that they can lead healthier lives. The way that looks and feels to a patient is engaged, healthy, seamless and fulfilled.