Predictive analytics and informatics at Optum

The longer a claim remains open, the more expensive it becomes and the greater the risk for medication misuse, abuse, or  addiction. Predictive analytics detects high-risk claims sooner, while our comprehensive suite of reporting tools provides you with timely, actionable insights on multiple levels.

Identifying high-risk claims early is the right thing to do

At Optum, our clients appreciate our years of investment in data infrastructure. This data is utilized by our team of statisticians to identify long-term, expensive claims before they develop, so we can apply intervention tools sooner. The result is more control over costs, improved therapeutic results, and better guidance for clinical decision-making.

We do this by predicting the expected pharmacy cost for each injured worker, which is derived through a patent-pending two-stage multivariate regression model that weighs and measures all the factors with the potential to lead to a high-cost pharmacy claim. The expected pharmacy cost, along with evidence-based medicine, medical guidelines, and the experience of our clinicians, determines when an intervention would be beneficial.

This integrated, systemic approach identifies the 10% of claims responsible for 90% of your long-term therapy costs. Concurrently, the injured person receives the right medication at the right time, enabling a faster return to daily activities.

Timely, detailed reports give you the insight to do what’s right

Optum provides a suite of reporting tools designed to give you the deep insight you need to do the right thing for both your business and for the injured people. Our comprehensive reports:

  • Guide your business forward with regular business reviews that outline the performance of your pharmacy program. This includes network and mail order penetration, clinical oversight, outcomes, and industry trends with the potential to impact your program.
  • Monitor program performance with real-time, on-demand access to a variety of standardized and customizable reports that reflect the overall performance of key program components, along with drill-down capabilities that identify key drivers.
  • Access claim-specific reports within the Optum electronic adjudication system to assist with overall decision-making.
Our reports also include the positive financial impact of early intervention, analytic insight, clinical interaction, minimized misuse/abuse, and operational efficiencies that allow you to see beyond simple transaction costs.