Optum delivers cost-effective, high-quality care for CHD patients

For payers and self-funded employers, congenital heart disease (CHD) is a low-incidence but high-cost and clinically complex condition that can take a heavy financial toll. About 40,000 children are born with congenital heart defects every year in the United States, many requiring multiple surgeries and a lifetime of medications to keep their hearts working.* These rare yet high-cost cases drive over $4M in annual charges per 100K members, averaging $493K in billed charges per case.**

This CHD risk can be managed with the market-leading Optum® Congenital Heart Disease Resource Services (CHDRS) product. CHDRS combines a specialized network of the nation’s leading CHD facilities with the best contractual savings in the industry.

Specialized network

CHDRS provides patients and case managers with access to cost-effective, high-quality CHD health care. The CHD Centers of Excellence network of elite CHD programs was developed by identifying best practice CHD programs throughout the U.S.

In addition to developing the network, CHDRS uses the considerable purchasing power and contracting experience of Optum to negotiate significant discounts at these centers.

Our solution

CHDRS helps employers and payers obtain clinically appropriate and cost-effective health care for their congenital heart disease patients. 

Our client services team assists patients, case managers and physicians in making informed decisions about CHD health care. Our clinical resources include account managers and cardiothoracic surgeons.

• Account managers help patients and case managers select providers and gain an understanding of CHD. In addition, based on fetal-echo data provided by clients, they proactively call parents prior to the patient’s birth to prepare the family in advance.
• Our network surgeons are available to discuss clinical issues and potential cases with referring physicians and medical directors.

Optum nurse case managers have an average of 7+ years of CHD experience and an average of 22+ years of nursing experience. The support they provide to employees begins when CHD is identified and includes post-surgery follow-up to reduce complications and ensure the best possible outcomes.