Provider financial risk enablement

In order to manage risk-based membership successfully, providers are organizing the required capabilities by blending traditional payer functions with core provider capabilities. Aligning the right people with processes and technologies powered by industry-leading analytics, health care providers that address every point in the risk and quality management continuum below in their business model will be set-up to more successfully manage risk within their organizations. 

 

Payer contracting and finance

Optimize revenue and proactively manage risk.

The Optum payer contracting and finance team brings unparalleled expertise, backed by a powerful suite of unified administrative and clinical analytics solutions to give you the support you need to execute tactical, operating, strategic and financial plans that will ensure a smooth transition to risk-and quality-based health care. Through financial modeling, you will be able to review optimal payer mix analyses and partner more effectively with health plans to ensure that accurate funding is available for patient care.

Network management and development

Maximize network performance to improve quality and cost of care, patient outcomes and satisfaction, and risk management.

Optum can help assess your provider network and develop strategies to more closely align the coordination of care with the current and anticipated needs of your patient populations. By monitoring and improving network performance, your organization can enhance patient experiences while also optimizing contract performance and improving health care quality.

Risk-based care delivery and management

Understand risk, engage patients and deliver higher quality care.

By converting health information to health intelligence, Optum can support you with both analytic tools and services as well as support services. Through analytics, you can access the industry’s most advanced integrated data and implement proactive approaches to care delivery. Your organization can leverage these health insights to pivot knowledge into targeted action at the point of care. Our fully trained clinical support, using a broad range of experience, is prepared to bolster planning and support for clinical, after-hours triage and treatment, in-home assessment and overall care coordination. By combining analytics and support services, you can ensure that patient health conditions are completely and accurately assessed, documented, coded and managed.

Risk-based operations

Close gaps in care and increase patient satisfaction with expertise and support from Optum. Coupled with user-friendly tools that help improve administrative efficiency, support comprehensive management of referrals, help direct patients to the appropriate venue for care and simplify billing and contract management, you can create and maintain your ideal operations infrastructure.

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Thank You for Contacting Us

An Optum professional will contact you within one business day. If you have additional questions, please contact us at 1-800-765-6619 or discover@optum.com.

In the meantime, please enjoy reading our infographic, Health Care Risk Challenge.