Optum Introduces New Business Process Outsourcing Services for Payers, In Partnership with HealthEdge

Technology-enabled outsourcing services designed to help payers adapt to market changes, reduce costs and transform core administrative operations

Optum Introduces New Business Process Outsourcing Services for Payers, In Partnership with HealthEdge

Optum today launched a new portfolio of technology-enabled business process outsourcing services to help health care payers transform their core administrative operations, reduce costs and adapt to market changes. Optum will combine its own business process outsourcing and payment integrity capabilities, along with the HealthRules® integrated financial, administrative and clinical technology from HealthEdge, to deploy these services.

At a time of great change in health care, Optum and HealthEdge are helping payers achieve greater efficiency and cost savings, improve transparency and customer service, and enhance their ability to participate in new health care business models. Optum’s comprehensive core administration outsourcing services span group setup, enrollment, claims processing and payment, and contact center services. Services also include industry-leading software and analytic capabilities, systems integration expertise and scalable technology management support.

“The health care market is at an inflection point,” said Rob Gillette, chief executive officer, HealthEdge. “A combination of social, regulatory and economic forces has created the need for a once-in-a-generation business transformation. The partnership between HealthEdge and Optum brings together Optum's deep expertise in health plan operations and analytics with the award-winning technology of the HealthRules platform. This provides an exciting new answer for payers on a quest for operational excellence.”

“It’s a pivotal time for payers who are under increasing pressure to improve efficiency and reduce costs across the organization,” said Eric Murphy, president, Payer Solutions for Optum.“One of the ways payers can improve efficiency and reduce costs is to modernize their operations and deploy resources more effectively, saving time and money while increasing operational flexibility.”

Optum’s new business process outsourcing services are designed to help payers realize the following benefits:

The flexibility of the HealthRules platform enables Optum to help payers accelerate implementation of new products and benefit designs, and rapidly participate in new business models such as accountable care organizations and health exchanges.

Optum’s integrated approach enables payers to rely on a single source to streamline functions that are typically performed by a mix of external vendors and internal resources. This simplification creates greater efficiency, minimizes duplication and missed process steps and lowers overall cost. Optum manages the core administration platform on behalf of the health plan, making upgrades and integrating complementary technology and analytics capabilities. With Optum’s scale, expertise and pre-integrated technology assets, health plans can reduce initial implementation costs by up to 50 percent and realize up to a 40 percent reduction in related technology and operational run-rate expenses.

Most health plans that deploy these capabilities will achieve industry-leading auto-adjudication rates exceeding 90 percent, meaning claims will be processed automatically with no manual intervention or rework. Optum’s comprehensive claims editing, fraud and abuse prevention technology and services drive pre-payment claims accuracy and reduce the administrative expense and provider friction associated with claims adjustments and overpayment recovery.

Optum will integrate its powerful clinical analytics, clinical decision support, provider data and care management systems to improve workflow integration and efficiency for payers. The result is better management of member care, provider network quality and reimbursement.

“By combining the core administration capabilities of HealthRules with its own BPO and payment integrity capabilities, Optum has created a framework that can help payers reduce burdensome administrative tasks while focusing on strengthening their core competencies,” said Janice Young, program director of IDC Health Insights.

These new capabilities are now available from Optum and can be scaled for national and regional health plans serving commercial, Medicare and Medicaid members. More information can be found at .

Optum () is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. Optum comprises three companies — OptumHealth, OptumInsight and OptumRx — representing more than 35,000 employees worldwide who collaborate to deliver integrated, intelligent solutions that work to modernize the health system and improve overall population health.

HealthEdge® provides the only integrated financial, administrative and clinical software platform for healthcare payers. The HealthRules® platform, built on modern, patented technology, delivers for the first time, a suite of software products that enables payers to leverage new business models, improve outcomes, drastically reduce administrative costs and connect everyone in the healthcare delivery cycle. An award-winning company, HealthEdge delivers disruptive technology that makes the new healthcare economy work. For more information, visit .

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