Complex Medical Conditions – Centers of Excellence Networks |
| Managing complex medical conditions is a time-consuming, costly and highly specialized process. OptumHealth’s comprehensive suite of Complex Medical Conditions programs provides high-quality, cost-effective services to meet the unique challenges of organ transplant, cancer, kidney disease, congenital heart disease, women's health services and bariatric surgery. |
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Solutions:
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Bariatric Resource Services | |
Obesity is the second-leading preventable cause of death in the United States.1 Bariatric Resource Services (BRS) was developed with significant input from a panel of top clinical experts in the weight management and obesity field. Our clinically rigorous program designs build on the behavioral change model, which is proven to show a significant chance of success.
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Cancer Resource Services | |
Cancer Resource Services (CRS) from OptumHealth provides information to help patients make informed decisions about their cancer care and where to receive it. CRS focuses on uncommon and complex cancers where practice variability and expenses tend to be high, but also offers assistance with any other type of cancer. |
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Cancer Support Program | |
Cancer is the second most common cause of death in the United States, exceeded only by heart disease.1 OptumHealth's Cancer Support Program (CSP) is a source of information for members suffering from cancer, especially rare and complex cancers. In addition to assisting in finding quality providers, Cancer Nurse Advocates work with patients to improve their clinical outcomes as well as their quality of life through education and ongoing support.
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Congenital Heart Disease Resource Services | |
One out of every two pediatric heart transplants is a Congenital Heart Disease (CHD) case. To help improve treatment and outcomes, OptumHealth has developed Congenital Heart Disease Resource Services, complementing the expertise within the Transplant Resource Services Centers of Excellence network. |
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EnvisionCare | |
EnvisionCare from OptumHealth Care Solutions has been a leader in the case management industry since 1990. We provide case management services to meet the exacting needs of our payer clients while promoting clinically superior, cost-effective outcomes through interventions and available network resources for our patients. |
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Healthy Pregnancy Program | |
OptumHealth’s Healthy Pregnancy Program is a perinatal wellness program designed to provide members with additional support and education during their pregnancy and is a powerful resource to combat increasing maternity and neonatal intensive care unit spending. |
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Kidney Resource Services | |
The Kidney Resource Services (KRS) program from OptumHealth Care Solutions has been designed to attack costs related to end-stage renal disease (ESRD) while optimizing patient outcomes. The KRS program provides patients with access to top-performing dialysis centers through a kidney Centers of Excellence network. |
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Neonatal Resource Services | |
Neonatal care is required for one in every 10 live births. In the United States, hospital charges for all infants totaled $36.7 billion in 2003. Premature or low birth-weight babies accounted for nearly half of that, $18.1 billion.1 OptumHealth’s Neonatal Resource Services (NRS) helps control and reduce the cost of neonatal care.
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ParentSteps® | |
In the United States, 10 to 15 percent of couples are infertile1. ParentSteps is a discount program organizations may offer to individuals who either do not have infertility benefits, or have exceeded their infertility benefits.
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Reproductive Resource Services | |
In the United States, 10 to 15 percent of couples are infertile1. Reproductive Resource Services (RRS) offers education, support from experienced and specialized RRS nurses, guidance, and access to some of the best infertility treatment Centers of Excellence in the country.
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Specialized Physician Review | |
The Specialized Physician Review (SPR) program provides independent, expert physician opinions to assess the appropriateness of a proposed treatment or procedure. |
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The Managed Transplant Program, Payer Solutions | |
Transplant costs can be extremely unpredictable for managed care organizations. The average billed cost for a transplant episode is $427,0001, but depending on the circumstances, it can rise to $1 million or more. OptumHealth manages the clinical and financial aspects of your transplant cases through our transplant reinsurance “carveout” product: The Managed Transplant Program (MTP). We can help advance your strategy for controlling costs, mitigating risk and improving patient outcomes.
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Transplant Resource Services | |
Transplants represent extraordinary risk to organizations. Transplant Resource Services (TRS) from OptumHealth Care Solutions provides unparalleled clinical and economical value to organizations managing the catastrophic care of transplants. |
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Contact OptumHealth: 866-427-6845 8 a.m. - 6 p.m. CST, M-F |
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