United Healthcare 2011 Annual Report Download - page 8

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consulting, and outsourcing services focused on hospitals, integrated delivery networks, and physician practices. These
solutions help providers establish efficient administrative and clinical workflows, improve patient care, and meet compliance
mandates and are organized around hospital and physician practice needs for:
• Financial Performance Improvement: Provides comprehensive revenue cycle management technology, coding solutions,
and full business process outsourcing for hospitals and physicians practices that drive higher net patient revenue and
lower operational costs;
• Compliance: Delivers real-time medical necessity reviews and retrospective appeals management services to nearly
2,000 hospitals in all 50 states;
• Clinical Workflow and Connectivity: Provides high-acuity and ambulatory clinical workflow and electronic medical
records software that makes hospital departments and physician practices more efficient, improves patient experience,
and enables sharing of clinical data in integrated care settings. OptumInsight Health Information Exchange (HIE)
solutions power 11 statewide HIEs and 36 regional and hospital integrated delivery network HIEs, and are used by more
than 370 hospitals, more than 50,000 physicians and 165,000 health care professionals; and
• Accountable Care Solutions: Working with early adopters of Accountable Care Organization models to build the
administrative, analytics, compliance, and care management infrastructure to succeed in outcomes-based payment
models.
Payer. OptumInsight's Payer business serves clients that offer commercial health insurance or privately administer health
insurance programs on behalf of federal or state governments (e.g., Medicare Advantage or Managed Medicaid). The business
offers technology, services and consulting capabilities that supplement OptumInsight's clients' existing operations, as well as
fully outsourced solutions. The business addresses diverse needs for payer clients, serving four primary areas:
• Network Performance: Comprehensive offerings to enhance performance of provider networks and improve population
health, including network design, management and operation services, as well as analytical tools that support care
management;
• Clinical Quality: Services that align clinical quality and performance with financial outcomes for payers, such as
Medicare risk adjustment services and quality improvement consulting;
• Operational Efficiency and Payment Integrity: A spectrum of offerings focused on improving the efficiency and cost-
effectiveness of payer operations. Solutions assist in addressing a wide variety of operational improvement opportunities
such as process improvement and automation, fraud and abuse, claims payment accuracy and coordination of benefits;
and
• Risk Optimization: Solutions help payers to grow and improve financial performance through predictive analytics and
risk management services. Offerings include actuarial services, rating and underwriting products, and membership
population modeling, as well as analytics and consulting.
Government Solutions. OptumInsight Government Solutions helps state and federal governments improve the efficiency and
quality of health and human services programs by offering a broad range of solutions including:
• Program Integrity: Improves the accuracy and efficiency of provider payments through prospective and retrospective
analysis of claims transactions, driving detection of fraud and abuse and checking payment accuracy;
• Health Management and Population Analytics: Measures and identifies opportunities for improvement in cost, network
performance, and care management for populations of covered members. Also includes health policy advisory services;
and
• Data Warehousing and Business Intelligence: Builds and manages health care specific data model and warehouse
solutions for Federal and State based programs. Applies business intelligence to analyze and drive decision making to
improve cost, clinical outcomes, and member satisfaction.
Life Sciences. The Life Sciences business addresses the changing global economic and regulatory competitive landscape by
assisting life sciences clients in identifying, analyzing and measuring the value of their products. The Life Sciences business
consults with clients by working across both research and development and brand/marketing so they can improve market access
and product positioning. OptumInsight utilizes extensive real world data assets, scientifically-based research design and
analytics to support the global life sciences industry and its markets through:
• Market Access and Optimization: Utilizes real-world evidence to drive increased drug revenues and decreased
commercialization costs through health economics and outcomes research, pricing and reimbursements strategies, data
and informatics, and late phase/Phase IV research studies;
• Strategic Regulatory Services: Focuses on design and execution of multi-national regulatory strategies to help clients
speed regulatory approval and maintain compliance with dynamic regulations across geographies;