CLINICAL SUPPORT PROGRAM

Unexplained variation in clinical decision-making among providers is a well-documented issue and is an important factor associated with suboptimal quality and the increasing cost of health care services.

Through the efforts of the Clinical Support Program, which seeks to increase providers’ adoption of current best clinical evidence, OptumHealth can:

• Save clients 15 to 20 percent when compared to an unmanaged network
• Ensure that health care consumers obtain consistency in the quality, outcome and cost of their care experience

The cornerstone of the program is outreach and communication with participating providers. Our approach focuses on provider accountability and the adoption of evidence-informed approaches at the individual patient level. In addition, we are a leader in our unique approach of collaborating with cross-functional industry experts in the development of program policies and guidelines. The highlights of the program include:

• A peer-to-peer approach to utilization management
• A standardized health care record for each patient
• Peer review of treatment requests, with outreach on an individualized patient basis, as well as aggregate provider data sharing
• Peer-to-peer educational efforts to assist in the adoption of evidence-informed treatment approaches to increase the quality of patient care and reduce unexplained variance
• 24/7 access to a comprehensive provider web portal, giving providers the opportunity to obtain information on evidence-informed health care, complete administrative functions and compare their aggregate treatment data with those of their peers