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Robust proprietary provider network and integrated pharmacy care services create unique success formula for the new Optum physical therapy program

May 3, 2021 · Clinical Team

When injured persons receive physical therapy early in the claim, multiple industry data sources show use of opioids and other pain medications and surgeries are reduced along with time away from work.

A Workers’ Compensation Research Institute (WCRI) study of low back pain-only claims found when physical therapy started after 30 days of injury vs. within 3 days of injury, the claims were:

47%

More likely to have an MRI ordered

46%

More likely to receive opioids

89%

More likely to have low back surgery

58-69%

Higher average of temporary disability

Source: WCRI: The Timing of Physical Therapy for low back pain: Does it matter in Workers’ Compensation September 2020 – claimants with more than seven days of lost time and three or more physical therapy visits during the first year of treatment. 

Exclusive network is THE difference for Optum physical therapy program

The unique link Optum Workers’ Comp and Auto No-fault has to UnitedHealthcare and Optum provides access to their established, wholly-owned national network of vetted physical medicine providers.

The network has a 30-year track record in physical health with the industry’s largest team of physical medicine clinicians130,000 providers and 215+ musculoskeletal experts designing clinical programs.

Unparalleled oversight for proper care and better outcomes

Our best-in-class network offers compliance and management unmatched by other physical medicine provider organizations. The Optum network oversees duration of care and outcomes by conducting peer comparisons to look at how diagnoses and treatments compare to multitudes of other providers – any deviations from protocol trigger alerts. This oversight helps to ensure proper care and better clinical and financial results.

Credentialed providers adhere to evidence-based treatment guidelines that follow the injury and not the claim type. 

Pharmacy care collaboration unique in marketplace

As an industry-leading pharmacy care services provider, Optum has the unique ability to integrate an injured person’s pharmacy and physical therapy data. This combined perspective gives Optum providers a holistic view of the necessary and appropriate treatment for the best results. 

Client support & tools for ease of use

Highly-utilized provider portal for better and faster data availability

To comply with their Optum contract, network providers are required to complete a Patient Summary Form to document treatment and progress. Providers submit this information through a Provider Care Portal – with 94% compliance – for standardized, accessible reporting of physical therapy treatments.

Easy access & customer service tools

The streamlined client process makes it easy to submit physical therapy referrals through the VitalPoint® data management portal, which also simplifies access to claim information on both the pharmacy and ancillary side. To further enhance the experience, specially-trained customer service teams handle physical therapy claims.

Our Clients share feedback

Optum validated its new physical therapy solution through a pilot program started in July 2020 with several insurance clients. Leadership at Society Insurance expressed they are enjoying doing business with Optum and are pleased with the level of responsiveness. They noted, the roll out and continued operation of the physical medicine program have gone very smoothly. 

A Society adjuster shared her positive experience: “The referral process through VitalPoint® was absolutely seamless and made the whole process much quicker than anything I’ve experienced with other companies. The communication with Optum on the referral status, appointment information, etc. has been excellent.” 

The adjuster added, “I especially appreciate that Optum has made timely requests for additional authorizations for therapy when the initial amount expired, rather than make the request several visits after the fact and then have to play catch-up.”

Another Society adjuster said, “The set-up is very easy and I have regularly been receiving records. I appreciate having the customer support team. Thank you!”

An additional insurance company rolled out the program in October 2020. A couple of their adjusters offered feedback:

“Optum service has been top notch ― setup and communication without over-communication.”
And another adjuster added, “The referral process was easy.”

The Optum Physical Therapy program offers:

  • Broad geographic access for injured persons
  • Analytics and processes to continually identify the best providers
  • Peer-to-peer clinical oversight  
  • Existing partnerships ensuring superior pricing and clinical cooperation

Want to know more? Click to learn additional information about the Optum Physical Therapy Program and find out how superior network management, leading clinical care management and proven client support and tools can make a difference in how you manage your physical therapy referrals.


Physical Therapy Program

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