The average billed cost for a transplant episode is $471,8571, but depending on the circumstances, it can rise to $1 million or more.
OptumHealth’s transplant programs operate the nation’s leading Centers of Excellence (COE) transplant network. We develop and maintain the transplant network using a process of qualifying, contracting and case management consulting unique to the industry. There are two programs available, Transplant Resource Services (TRS) with an enhanced Ventricular Assist Device (VAD) program and the Managed Transplant Program (MTP). The Congenital Heart Disease (CHD) program is an extension of the overall Transplant Solution.
Transplant Resource Services
Our transplant services are built upon a network comprised of high-quality, clinically superior COEs. OptumHealth invests more resources than any organization in the country to identify and qualify the programs that deliver superior outcomes. Once a program is qualified clinically, OptumHealth leverages unparalleled purchasing power to drive deep contractual savings. Clients save an average of 51 percent2 per transplant episode, in addition to the cost avoidance achieved through the statistically superior clinical outcomes realized through COE network programs. In addition, OptumHealth offers Transplant Access Program (TAP) providers to ensure broad access in the event a patient cannot travel to a COE, TAP programs must meet minimum statistical clinical criteria, as well as agree to the same aggressive and predictable pricing as that for COEs.
Ventricular Assist Device
The VAD program, the latest enhancement to the TRS product, delivers a greater value for organizations by offering superior clinical quality, broad national access, deep contractual discounts, and by controlling cost variation. Our comprehensive approach provides individuals requiring VAD treatment with information and support to help patients make the right decision to achieve the best possible outcome for them. OptumHealth’s VAD program identifies and qualifies the top VAD centers in the nation and provides access to quality providers for VAD implantation as well as guides pre- and post-surgical support.
Managed Transplant Program
Transplant costs can be extremely unpredictable for employers. OptumHealth manages the clinical and financial aspects of your transplant cases through our “carveout” product. We can help advance your strategy for controlling costs, mitigating risk and improving patient outcomes. MTP provides first-dollar coverage for virtually all transplant types, with an unlimited lifetime benefit. OptumHealth takes all of the risk for transplants, for a simple standard monthly premium. OptumHealth pays claims that result from transplant cases. Individuals in need of a transplant services have access to expertise through the OptumHealth Transplant Centers of Excellence network. At the same time, a transplant nurse case manager will help guide patients through every aspect of the transplant process.
Both transplant programs include transplant nurse case managers to help guide patients through every aspect of the transplant process, including evaluation, pre-transplant, transplant, post-transplant, transportation arrangements, lodging and aftercare. Our transplant nurse case managers assist patients in making informed decisions about their transplant care through education and access to our quality network.
Congenital Heart Disease Resource Services (CHDRS)
Congenital Heart Disease (CHD), which includes numerous conditions that vary widely in complexity, is the leading cause of birth defect related deaths in the US3. CHDRS is an excellent complement to the OptumHealth Transplant programs, since 50% of pediatric heart transplant referrals have CHD and CHD surgery is often done in lieu of transplant. Like the transplant programs, CHDRS combines a specialized network of the nation’s leading CHD facilities with the best contractual savings in the industry. In addition, CHDRS provides resources and services to help clients identify complex CHD cases and educate families about the benefits of receiving care at a qualified COE.
1 Milliman 2011
2 OptumHealth data, 2011