Total Care Management
An injured person’s medical treatment often requires more than just a prescription, this is why Optum focuses on Total Care Management.
This approach helps to manage all the possible treatments of an injured person’s care — from the prescription to the leg brace, to physical therapy and more — and helps claims professionals make well-informed decisions that lead to positive outcomes.
Whether you need pharmacy, ancillary, medical or settlement services — or some combination of them all — we'll help you design a program that focuses on your needs and is based on our pillars of Network Management, Clinical Care Management and Client Support & Tools.
The network is made up of these four strategic categories:
Proprietary national network delivers quality, efficiency and accessibility
Affiliate networks expand our reach to non-traditional entities
Network enforcement tools capture out-of-network transactions and convert them to in-network
Bill review services reduce out-of-network transactions to the lowest possible rate
*When all programs in use.
Our solutions fall into the following five categories throughout the life of the claim.
Risk Analytics helps to identify claims with potential inappropriate treatment or risk factors.
Actionable Alerts inform you of emerging risk within a claim and provide recommended actions to mitigate the risk.
Clinical Reviews provide analysis of the treatment(s) to identify appropriate changes in therapy.
Targeted Interventions address specific issues within a claim directly with a provider to drive appropriate clinical change.
Enforcement and Progress Monitoring helps to ensure compliance by both the injured individual and the provider.
Client Support & Tools provide easy access to claim information and real-time insight and reporting when it’s needed most.
We configure our programs to work within your existing workflow to streamline training, identify emerging risk and support faster claim closure.
Support by the numbers
Our Client Support & Tools fall into these four categories:
Portals provide web-based interfaces for you to interact with Optum and get access to claim information
Reporting and Analytics provide insights into your data and the impact on your programs
Service and Support Personnel are dedicated to supporting you at all levels
Electronic Data Interfaces are our capabilities for exchanging data with you to effectively and efficiently support your programs
Coordinated solutions Deliver Multiple benefits
The coordination of our pharmacy, ancillary and medical services, along with settlement solutions, provides multiple benefits, including:
- Broad access to care through our expansive network of providers for savings on all facets of medical treatment necessary for a claim
- Superior delivery of care and service with a focus on the well-being and safety of the injured party
- Optimal clinical and financial outcomes for your business
For more information on the Optum Total Care Management solution and any of our products and services email us at ExpectMore@optum.com.
Pharmacy Care Services
Address industry challenges of pharmacy spend, network penetration, costs, compliance and service quality with clinical expertise and analytical tools.
Provide access to quality care through a broad PPO network while managing clinical outcomes with case management services.
Ensure quality care with vetted providers for discharge planning, transportation, language services, medical equipment and home care.
Receive insight in managing the complexities of Medicare Set-Asides with reporting and clinical tools to ensure compliance and cost savings.
According to NCCI, pharmacy transactions make up only 14% of the costs for work-related injuries. Ancillary services are responsible for 30% of costs and other medical services make up 56% of costs.*
*Source: NCCI (October 2018). Medical Services and How They Contribute to the Cost of WC Claims. Retrieved from www.ncci.com/Articles/Documents/II_Insights-MedicalServicesWCClaims.pdf
Industry specific solutions
With 40 years of experience, Optum has created a comprehensive workers’ compensation program to address federal agencies’ most critical needs in managing pharmacy and ancillary services.
Customized solutions for the auto no-fault industry provide tools for better decision-making. Our quality networks, advanced analytics and clinical expertise promote policyholder satisfaction and retention.
As a leading end-to-end payment integrity organization, Optum specializes in solutions for the Maritime industry to control medical costs.