SPECIALIZED PHYSICIAN REVIEW

Provides independent, expert physician opinions to assess the appropriateness of a proposed treatment or procedure.

OptumHealth’s Specialized Physician Review (SPR) program provides independent, expert physician opinions to assess the appropriateness of a proposed treatment or procedure.

OptumHealth’s network of reviewers consists of more than 60 board-certified specialists in current practice at leading medical institutions worldwide. We match each case with the specialist most qualified to review it. Expert opinions are supported by the most up-to-date scientific evidence, medical literature and standard-of-care criteria.

On average, one in four cases reviewed by SPR are deemed inappropriate.1 At a cost of more than $217,000 per transplant, this can translate to over $52,000 of savings per review.2

1 SPR historical data (2005-July 2008)
2 Milliman, 2008. Calculation: $427,000 less 49 percent (average OptumHealth transplant discount) = $217,770; $217,770 x 24 percent = $52,265

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OptumHealth recently released a new white paper highlighting the success of the GOh! Healthy Employee Program.