Optum-izing Healthcare Delivery & Service

Tucked away inside health insurance giant UnitedHealth Group is the company that is changing the future of healthcare delivery and service – Optum.  Optum has been focused on innovating the health-care system from a service offering and over the past five years has grown revenues from $28.6B (2011) to $67.6B (2015) and is on pace to surpass the $80B revenue mark for 2016.

Optum is broken into three distinct business units: OptumHealth , OptumInsight, OptumRx.  The key thread between these businesses is effectively leveraging data, technology, and analytics to make the heath-care system work better for everyone – patients, providers, insurance plans, and governments.

OptumHealth

OptumHealth serves 78 million individuals through its health and wellness programs. This includes services such as: (1) actual care delivery and care management, (2) wellness and consumer engagement, and (3) financial services products.

• The care delivery and care management within Optum is provided by owned and contracted providers. Leading the shift to value-based care in the industry, all contracts are risk-based, meaning that Optum will accept a certain fee and take full responsibility for the health care costs. In order to lower the overall costs and achieve savings, they employ the OptumInsight engine for data and predictive analytics to determine the best interventions.

 

• The wellness piece of the business performs services like pre-deployment screenings for the Department of Defense. In this instance, Optum is bringing mobile technology and units to military bases to perform these services.

 

• The main financial services products are the Health Savings Account and the electronic claims payment service. These 3.8 million HSAs represent more than $4.2 billion in assets under management, and the electronic claims payment system processed $100B in medical payments in 2015. These electronic services are integrating the pieces of the healthcare system that have typically been done very inefficiently.

 

OptumInsight

OptumInsight is Optum’s true technology and analytics engine. The main customers in this area are hospitals, physician practices, health plans, government agencies, and life sciences. They seek applications including performance improvement, efficiency improvement, reduced costs, compliance mandates, and updates to meet new specifications.

For large hospital systems, Optum has developed a Revenue Cycle Management solution to help drive financial performance and meet compliance specifications.

For government agencies, Optum has developed expertise in system integration for public health insurance exchanges, like Healthcare.gov.

OptumRx

OptumRx is one of the largest Pharmacy Benefit Managers in the United States, serving over 66 million individuals. While this market has long been dominated by CVS Caremark and Express Scripts, Optum has brought a data and technology driven approach that is disrupting the space.

This data and technology driven approach focuses first on integrating demographic, medical, pharmaceutical and clinical data. Then, it applies analytics to come up with insights about the care path for each person, resulting in enhanced services for the patients and reduced costs for the clients.

OptumLabs

OptumLabs is a collaborative research and innovation center founded by Optum and Mayo Clinic. Today, there are over 20 additional companies collaborating on this platform. The intent of Optum Labs is to bring together unique partners in the health system in order to accelerate patient care and value by sharing information, technology, knowledge, and expertise. The value of the platform is that it gives partners access to information and proprietary tools. This includes the datable of deidentified information on more than 150 million people.

 

Overall, the importance of leveraging technology and data analytics to improve the heath-care system will only grow over time.  The main challenge for Optum will be to continue to grow its industry partnerships while being so closely linked to the insurance arm. However, with the likely repeal of Obamacare by the incoming Trump administration, Optum is well poised to help the private industry drive costs out of the system.

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Sources:

 

Paul J. Wallace, Nilay D. Shah, Taylor Dennen, Paul A. Bleicher and William H. Crown. Optum Labs: Building A Novel Node In The Learning Health Care System. Health Affairs 33, no 7 (2014): 1187-1194.

Optum Company Website (www.optum.com)

UnitedHealth Group 2011 Annual Report

UnitedHealth Group 2015 Annual Report