Care Predict: High-Risk Patient Outreach and Intervention
Optum® Care Predict® is a high-risk patient outreach program that coordinates care, decreases costs and improves outcomes for those who have the greatest potential to drive substantial future health care costs. Care Predict's proactive approach stands apart from traditional case management and disease management programs, which tend to be reactive -- identifying individuals after an acute episode when costs have already been incurred.
Care Predict Process
Identification
Care Predict uses three tools to help identify the highest risk individuals.
- Predictive Model:
Our predictive model analyzes medical, pharmacy, lab and ancillary service claims from both facilities and physicians to identify individuals who are at risk for future health events. Referral criteria to case management include, but are not limited to, those individuals identified based on calculated risk score or a percentage of population from the predictive model.
- High Cost Claimants:
Referral criteria to Care Predict include, but are not limited to, claims paid totaling greater than $50,000 over the last 12 months.
- Triage Tool:
Predictive Model results and claimants more than $50,000 are fed into Care Predict's triage tool (NurseLineSM and health risk assessment referrals are also available), which "scores" and stratifies individuals based on four fundamental areas.
Assessment
Once high-risk individuals are identified, their health care needs and behaviors are evaluated using online assessment tools. Optum's assessment tools are brief, goal oriented tools which enable us to gather information necessary for the development of an individualized health care action plan based on the assessed health care needs.
Intervention
Based on assessment outcomes, Optum nurses create a health care action plan based on an individual's unique needs. They then proactively implement, coordinate, monitor and evaluate the options and services required to meet an individual's health needs. Their goal is to provide the correct balance of support, encouragement and information to motivate patients to seek assistance, learn new skills and make lifestyle or behavior changes that improve their health.
Reporting
Optum provides a robust reporting package to complement its Care Predict services. The reporting interprets in-depth clinical data on the individuals we manage and tracks the specific areas and activities of our clinical interventions. An Optum partner conducts comprehensive patient satisfaction surveys to help capture the personal, more qualitative outcomes and stories behind the services. Tailored reports are also available based on specific needs.
Care Predict: A Proactive Approach
High-risk individuals don't necessarily need to become high-cost patients. Care Predict steps beyond traditional disease management and case management programs to accurately predict who may become your most costly patients without the proper intervention.
© 2007 Optum
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