TREATMENT DECISION SUPPORT

OptumHealth’s Treatment Decision Support program is designed to help offer guidance on health care decisions, delivering better health outcomes at reduced costs.

Up to 30% of care delivered in the U.S. may be unnecessary, and the impact on health outcomes and medical costs is dramatic. Treatment Decision Support leverages a predictive model to identify individuals facing a surgical decision and connects them with a nurse “coach” who guides them through the treatment decision process.

To maximize health outcomes and cost savings, we focus our efforts on conditions that are prevalent, costly, and have widespread treatment variation. Experienced nurses proactively engage identified individuals by phone in a shared decision-making dialogue. They explore the consumer’s diagnosis; provide objective, evidence-based information on a range of treatment options; and connect the consumer with a quality-designated provider. Treatment Decision Support has a demonstrated 3:1 ROI¹.

Treatment Decision Support services:

• Leverages a powerful predictive model
• Focuses on nine conditions (back pain, knee and hip replacement, benign prostate disease, prostate cancer, breast cancer, benign uterine conditions/hysterectomy, coronary disease, CABG and angioplasty, and bariatric surgery).
• Connects consumers with experienced nurses who engage consumers by phone to:
  • Explore the diagnosis and treatment recommendation
  • Provide evidence-based, objective information on a range of treatment options
  • Make connections with quality-designated physicians
  • Prepare individuals for treatment and follow-up care

The Treatment Decision Support program has the following results:

• Twenty-nine percent of enrolled individuals shifted to a more conservative treatment option than was initially planned
• Six percent of individuals shifted to an in-network, quality-designated provider
• 3:1 ROI

¹ source: National Accounts Book of Business study period: July 2001-June 2008