Helping Health Care Leaders Thrive Amid . - Optum
Optum Advisory ServicesHelping health care leaders thriveamid unprecedented change
Key questions for health care leaders:1In what ways can we reinvigorate our businessand operating models to ensure financialsustainability?2How do we prioritize changes to our care andservice models to align with evolving expectations?3How can we integrate virtual care into ourdelivery model?4What role can we play in meaningfully reducingthe total cost of care?5How can we leverage partnerships to gainefficiencies, innovate, grow — andmitigate risk?
Optum Advisory ServicesAcross health care, the rules of engagement are being rewrittenHealth care leaders are facing a new world defined by disruption and volatility. COVID-19has ushered in dramatic challenges to the health care delivery and payment model: Extreme economic pressure Uncertainty around future supply and staffing imperatives Widespread adoption of virtual careAnd these developments only accelerate the pre-existing need to meaningfully addressthe crisis of affordability and access to care.How will your organization adapt?Forging a sustainable path forward amid change is a mission-critical priority. It will requireunderstanding both the near- and longer-term market impacts and rethinking how torespond both strategically and operationally.This will mean re-envisioning and managing relationships across the health care continuumand finding your unique role in generating value. Organizations that fail to recognize andprepare for this new reality today are in danger of being left behind.Our team of consultantswill be with you everystep of the way, providingguidance and extra supportto overcome roadblocks.
Optum Advisory ServicesHow we partner with youNavigating the change and complexity of the health carelandscape is a daunting challenge. It requires both a deepunderstanding of numerous external considerations and apragmatic approach to initiating, motivating and managingchange internally across your organization.Our team of consultants will be with you every step of theway, providing guidance and extra support to overcomeroadblocks. And we can lean in where you need it most,whether it’s sophisticated modeling and analytics, servingas an extension of your staff to tackle mission-critical prioritiesor driving sound decision-making.Define your unique strategy withexpert insight and analytical rigorWe begin by assessing your organization’sposition in the marketplace, using theindustry’s largest health care data asset.Our experts will share their deep experienceand take the time to learn from you aboutyour organization and vision. Together,we’ll develop your best pathways for lastingsuccess with actuarial precision.Operationalize your data-driven plan with proven methodsand expertiseWith many years of both consulting and industry experience, our team can helpbring your strategy to life. We work alongside you to implement lasting change bydrawing upon a unique breadth of financial, IT, operations, analytics and clinicalcapabilities. We use proven methods and best practices for change managementand cultural transformation to hardwire success.Accelerate your transformation withinnovative partnershipsAs you navigate your role in the health care ecosystem,we can help you identify and realize new opportunities togenerate value across health care. We are committed todeveloping forward-thinking business and clinical modelsto deliver cutting-edge results.
Our capabilitiesOptum Advisory Services is committed to helping you successfully take on your most pressing challenges: growing andinnovating your business, ensuring financial stability, delivering value to stakeholders and reducing the total cost of care.We bring a broad range of critical capabilities to support health care organizations, with a deep focus on providers, payersand their intersection.Strategyand growthAnalytics Enterprise strategy Managed analytics (sourcing analytics functions) Transition to value-based care Innovation analytics (AI and machine learning) Population health Hospital/acute care analytics Revenue diversification Analytics strategy and program assessments Strategic partnerships and collaboration Targeted analytics: Consumer experience and engagement- Actuarial Digital health- Consumer Applied innovation- Social determinants of health- Value-based care
Optum Advisory ServicesRisk management and growthGovernment programs T rend analytics Medicaid RFP support andstate-based market assessments A ctuarial services, software andanalytics tools for commercial,Medicaid, Medicare, ACA andpharmaceutical New plan launch including MedicareAdvantage, Medicaid and ACA Care management programs andsystems U nderwriting (UW) transformation,including process redesign, auditsand UW as a service Government plans operations G overnment programs bid support P ricing and reservesPayer focusedHealth management and operationsPayer technology service T otal cost of care and quality programs(to reduce administrative and medicalexpense while improving quality) Technology strategy and development Enrollment and eligibility Digital transformation Provider network design and service Implementation and configuration Claims performance management Managed services: technologyapplication and infrastructure Care management: UM/CM/ DMprograms Risk adjustment Quality (Stars, HEDIS) Data strategy and governance
Provider enterprise servicesHospital performance improvement Health system and medical groupgovernance and organizational structure Administrative cost optimization Patient access and experience Care management Provider alignment and referral integrity Clinical variation reduction Service line, co-management andpartnership models Inpatient cost-per-case reduction Medical group growth includingmerger and acquisition opportunities Medical group management & operations Physician compensation design Value-based care design andimplementation Advanced/alternative pricing models Service line rationalization Operating room (OR) optimizationand cost per case Supply and purchased services costmanagement Workforce productivityProvider focusedRevenue cycle management Charge capture improvement Inpatient and ambulatory CDI Denials prevention and management HIM/coding optimization Interim leadership Patient financial experience Shared services centralization Revenue cycle EHR risk mitigationand optimizationProvider technology services EHR go-live, personalizationand stabilization EHR specialty optimization IT implementation planning IT managed services IT strategy development IT vendor selection Risk adjustment optimization Preventive services optimization
Optum Advisory ServicesExamples of our workAddressing care variation with clinical care redesignOur consultants collaborate to bringdiverse expertise and a multilayeredperspective to projects across thehealth care ecosystem. We partnerwith a wide variety of organizations— from stand-alone hospitals andmultistate health systems to regionalhealth plans and national payers —to address both near- and long-termchallenges. These are snapshots ofour work in selected areas.Challenge: Leadership of five-hospital integrated delivery system wanted to growthe cardiovascular service line into high‑performing heart institute model.Solution: Optum consultants assessed performance to identify highest priorityopportunities for achieving high-reliability care and reducing variation in quality andcost. They implemented a unified program and provided in-depth support whilebuilding a culture of improvement.Results*: 10.5M in savings from more than 10 initiatives implemented acrossyear oneOptimizing the EHR to drive chronic condition documentationChallenge: A multihospital health system wanted to assist providers in more accuratelyidentifying and documenting chronic conditions.Solution: Optum consultants helped the provider organization by implementing aholistic program around an EHR-enabled workflow to document hierarchical chronicconditions (HCCs), alongside clinician-focused training and analytics and reporting.Results: 43.7M in expected improvement in care funding over two years frommore appropriate codingLeveraging analytics to develop a data-driven strategic roadmapChallenge: An academic medical center in the Northeast using Optum analyticsplatform sought to leverage it for improving performance across portfolio ofvalue-based contracts and the health outcomes of their at-risk populations.Solution: Optum consultants evaluated the client’s positioning, considering bothinternal capabilities and external market dynamics. Building on prior investmentsanalytics and care management, OAS developed a future-state roadmap and tacticalplan to transform the health system into a sustainable, data-driven, and value-orientedhealth system.Results*: In less than two years, the health system cited increased revenue fromvalue-based care contracts as a contributing factor in its return to profitability.* These return on investment figures reflectactual historical client results but are not apromise of future results.
Streamlining clinical authorizations to reduce costs and improve NPSChallenge: A large national payer sought to reduce internal and external clinical costs while optimizing the authorization process.Solution: Optum consultants reviewed authorization team structure and operations to identify best practices to be leveragedacross the care services. These included authorization requirements, site-of-service requirements and authorization processesand technologies.Results*: 25% increase in automated authorization decisions50% decrease in medical costs when site of service used22% increase in NPSResolving data gaps to improve Medicare Star RatingChallenge: A regional health plan received 3.5 overall Star rating for Medicare Advantage HMO and PPO contracts for twoyears, yet suspected rating did not truly reflect performance.Solution: Optum conducted initial assessment, revealing underperforming Part C HEDIS measures and confirming existenceof a data gap, but not a care gap. Further analysis pinpointed 40 issues in data accuracy and completeness. Consultantspartnered with business and IT leaders to close all identified data gaps and implement improved, sustainable processes.Results*: 4 Star rating achieved for both plans within 15 monthsOptimizing business processes to improve health plan operating rigorChallenge: Regional health plan ( 200K Medicaid/Medicare members) needed help improving medical loss ratio (MLR) in mainproduct lines.Solution: Optum conducted end-to-end operational and technology assessment to identify 20 opportunities across multiplebusiness functions including enrollment, provider data management, claims, medical management and supporting technologyapplications. Consultants redesigned claims process and other business-related initiatives, created functional and configurationdesign and enhanced/developed business processes, delivered operational playbooks, and established integrated operationaldecision governance structure.Results: 4.9M in expected payment recoupments 12M in expected medical savings* These return on investment figures reflect actual historical client results but are not a promise of future results.
How we are differentHolistic, exclusive focushealth careWe have deep relationships acrossthe industry and are committedto making the health care systemwork better for everyone.9 out of 10hospitalscount on us to designand deploy solutions100Kprovidersand practices andother health carefacilities are servedby our teams4 of 5health plansare servedby our teams
Optum Advisory ServicesUnparalleled data assetsWe are uniquely positioned to align providers, health plans and consumers using deep health care intelligence. Ourcombination of curated data, leading analytics and applied expertise allows us to extract value from data across theecosystem to best serve patients and advance organizational goals.216M222M lives of clinicaland claims datalives ofconsumer dataOptum Advisory Services 24,000analytics experts,spanning clinical, financial, actuarialand technology domains Health care strategy and operations Health care deliveryAs part of Optum, the Advisory Services teamis able to draw on wide-ranging experts,resources and capabilities across: Pharmacy care servicesInnovative, end-to-endsolutions and partnershipsCombination of real-world and consulting experienceOur services range from strategyand capabilities assessments toimplementation support andtechnology, as well as outsourcedanalytics and managed services.We work with you to design acustomized, integrated suiteof solutions.We view ourpartnershipsas long-termcollaborationsand are committed to performancetransparency and accountability. Life sciences Population health management1,400 experts125 actuaries50 cliniciansOur team brings together both consulting expertise andextensive background in positions at provider and payerorganizations and includes data scientists, finance andC-suite executives, process engineers, clinicians and theonly actuary practice in the United States dedicated to thehealth system.
Optum Advisory ServicesOur recognitionTop ranked by Modern HealthcareRanked #2, for the third year in a row,Optum Advisory Services is the second largesthealth care management consulting firm inthe U.S.
Optum Advisory ServicesMeet our expertsTushar Mehrotra, MBACraig Savage, MBASVP, AnalyticsOptum Advisory ServicesSVP, Payer PracticeOptum Advisory 12-428-6633craig.savage@optum.comKeith Shah, PhD, MBA, FACHEJohn Simon, MHASVP, Strategy and GrowthOptum Advisory ServicesSVP, Provider PracticeOptum Advisory 7-4908john.d.simon@optum.com
Provider-focusedJohn Johnston, CPA, MHAJohn Kontor, MDVP, Hospital Performance ImprovementOptum Advisory ServicesSVP, Provider Technology ServicesOptum Advisory 1206kontorj@optum.comMichele Molden, MBAEileen Russo, PhDVP, Provider PracticeOptum Advisory ServicesVP, Revenue Cycle ManagementOptum Advisory 861russoe@optum.comDavid ChennisiNathan FunkPayer-focusedVP, Payer TechnologyOptum Advisory ServicesSVP, Government ProgramsOptum Advisory 3-439-5908nfunk@optum.comMallory Van Horn, MPH, MBAGreg Warren, FSA, MAAAVP, Health Management and OperationsOptum Advisory ServicesSVP, Chief ActuaryOptum Advisory Services1-405-833-3957mallory.van omLearn how OptumAdvisory Services can helpyou determine and reachyour organization’s goals.Contact ryservices
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Optum Advisory Services is committed to helping you successfully take on your most pressing challenges: growing and . Optum consultants evaluated the client’s positioning, considering both . Optum consultants reviewed authorization team structure and operations to identify best practices to be leveraged across the care services. These .
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