OptumHealth Care Solutions - Complex Medical Conditions offers products for:
Transplantation
Cancer
Chronic Kidney Disease
Bariatric
Women's Health Services
- Congenital Heart Disease
- Infertility
- Neonatology
- Pregnancy
VAD
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Centers of Excellence Networks

The truth is, not all health care providers are created equally. For complex medical conditions, the disparity is especially high. Through a rigorous evaluation process, Optum has developed Centers of Excellence networks that provide access to clinically superior, cost-effective health care.

The Optum Transplant Centers of Excellence network was developed in 1986 and has grown to be the largest network of its kind in the world, managing more than 14,300 transplant referrals annually.1 Today, we offer products and services that promote safe, successful and cost-effective treatment options for many other complex medical conditions, including cancer, congenital heart disease and infertility.

Optum's Stringent Evaluation Process

Optum has been identifying health care providers experienced in treating costly, complex and catastrophic medical conditions for over 20 years. Each year we conduct a rigorous evaluation process of medical centers throughout the country. We invite only the most experienced and statistically successful health care providers to be part of our Centers of Excellence networks. There is different criteria and a separate Center of Excellence network for each condition we support (bariatric, cancer, congenital heart disease, infertility and those that lead to transplantation). Find out more about our evaluation criteria and process.


How Optum Benefits Your Members/Employees

By choosing an Optum Centers of Excellence network medical center, your members/employees will be more likely to receive: 

  • More accurate diagnoses
  • Higher survival rates
  • Health care that is planned, coordinated and provided by a team of experts who specialize in your condition and regularly work together
  • Appropriate therapy (neither too much nor too little)
  • Fewer complications
  • Shorter length of stay
  • Decreased out-of-pocket costs


Cost Benefits for Payers

More than 3,000 payer groups, representing more than 62 million lives already use Optum's products and services. This purchasing power, along with our contracting expertise, results in the most aggressive cost savings in the industry. Through our comprehensive contracts, clients receive significant savings, such as 53% off of standard industry charges for transplantation.2 In addition, higher quality health care results in fewer complications, shorter length of hospital stays, faster recoveries and fewer readmissions.

 

Sources:
1. Optum re-priced claims (Facets) 2013
2. Optum re-priced claims (Facets) 2011-2013
NCQA has reviewed and certified Optum's Credentialing and Utilization Management functions only. Date granted: 7/1/2014. Expiration date: 7/1/2016. For complete details on the scope of this review, visit www.ncqa.org.