Reduce Costs
Health care costs are going only one direction, up, and no expects that to change anytime soon. In fact, reform and other market influencers are creating even more financial pressure.
Issues and challenges
- Health plans must find new and sustainable ways to reduce medical costs and meet MLR goals.
- While difficult to accurately estimate, dramatic savings opportunities exist with the reduction of health care fraud and abuse.
- New delivery models, payment methodologies, performance guidelines, are driving new opportunities for improving health outcomes and reducing costs.
- Health plans must cost-effectively adopt new protocols (ICD-10) and meet new regulations (STARS/HEDIS).
Opportunities
Coding Billing and Reimbursement
Improve coding accuracy and efficiency. Accurately calculate reimbursement. Stay up to date with the latest HIPAA 5010 rules and ICD-10 mandates.
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Network Operations Efficiency
Reduce processing, intermediary, and connection costs with a one-stop portal for providers.
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Network Performance Improvement
OptumInsight evidence-based solutions focus on health, not just health care. Our innovations let you measure, analyze, and control health care costs while improving the quality of care provided to your members. We do this by helping you target the right members at the right time with the right interventions across the entire health care continuum.
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Payment Cycle Management
Assess, design, and implement claims processing techniques to improve efficiency, effectiveness, and resource allocation. Automate PPS regulatory content updates to more accurately process claims. Comply with HIPAA 5010 and ICD-10 mandates.
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