Insight by Optum Serve

Delivering on federal missions to modernize health care

This content is provided by Optum Serve.

One of the most essential functions the government fulfills in serving its citizens is providing health care to millions of Veterans and underserved communities across the country. As technology puts more data and capabilities at the disposal of federal health agencies, new possibilities for accomplishing that mission arise. However, actually putting that data to use and implementing those capabilities are often a challenge for agencies with strained IT...

READ MORE

This content is provided by Optum Serve.

One of the most essential functions the government fulfills in serving its citizens is providing health care to millions of Veterans and underserved communities across the country. As technology puts more data and capabilities at the disposal of federal health agencies, new possibilities for accomplishing that mission arise. However, actually putting that data to use and implementing those capabilities are often a challenge for agencies with strained IT budgets, technical debt and difficulties competing with the private sector for talent. That is why they often turn to private sector partners for help.

Optum Serve is the federal health services business of UnitedHealth Group, a health care enterprise ranked fifth in the Fortune 500. Optum Serve provides federal agencies with access to health services, health information technology, consulting and preparedness and emergency response. It has a history of providing these services to the departments of Veterans Affairs (VA), Department of Defense (DoD), Health and Human Services (HHS), including the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control (CDC), the Food and Drug Administration (FDA), as well as the Federal Emergency Management Agency (FEMA).

Optum Serve health services include beneficiary management, claims administration, health assessments and care management, provider management and health care administration. For example, Optum Serve has helped provide health care to millions of Veterans through VA’s Community Care Network and the Veterans Benefits Administration’s Medical Disability Examinations.

It also manages DoD’s Military Health System (MHS) Nurse Advice Line, which provides 24/7 access to triage services, health care advice, appointment scheduling, and care coordination to 9 million members of the MHS. As agencies leaned into remote capabilities during the pandemic, they provided those services via phone, web, and video chat.

The Optum Serve health information technology services help agencies modernize, including enterprise and cloud applications, cloud migration and DevSecOps. It can help agencies develop applications and systems architectures and manage their data better.

CMS turned to Optum Serve to improve its ability to detect, identify and deter fraud, waste, and abuse. Optum Serve helped implement CMS’ One Program Integrity, which has saved the federal government billions of dollars each year, generated more than 3 million reports, and has a 96.5% user satisfaction rating. Optum Serve also manages CMS’ data services hub, which handled 29.3 million enrollments in 2021, and processed more than 600 million transactions. On top of that, it supported nine new marketplace enrollments for healthcare.gov.

Health care services are more than technology;  that’s where Optum Serve consulting services can support by providing analytics and skills to help decision-makers develop and strengthen health care programs and make informed policy choices. These solutions are performed through program design, strategy and management consulting.

For example, Optum Serve helped CMS investigate new models for making payments to healthcare providers, in order to both lower costs and improve services. Toward that end, it helped CMS introduce value-based payments, including assistance with both back- and front-end system design. That system has thus far analyzed more than 100,000 beneficiary episodes.

Optum Serve also helped both the VA and the DoD implement new evidence-based clinical practice guidelines to improve clinical outcomes. Toward that end, it manages work groups of experts who produce clinical care guidelines that allow the departments’ health systems to evaluate, treat and manage individual needs.

Optum Serve is also out in the field, building connections within communities. In its preparedness and emergency response services, it helps foster health equity and resilience in underserved communities, connecting them with federal agencies to build preparedness, provide early warnings, respond to emergencies and mitigate crises.

One example of how Optum Serve helps federal agencies accomplish that mission is COVID-19 response. Optum Serve provided federal agencies with data and analysis from the frontlines of the pandemic to help them respond more efficiently and effectively. Optum Serve was responsible for more than 2,000 end-to-end testing locations in 31 states, more than 9 million administered tests and more than 1 million vaccines administered. It did that by partnering with FEMA, states, territories, numerous local governments, as well as local commercial and private entities.

Federal agencies that provide health care services to American citizens have one of the most important missions in the public sector. They should be able to focus on accomplishing that mission, not worrying about whether they have the resources or expertise they need to do so. That’s where Optum Serve comes in; it has experience and expertise in the technology federal health care agencies need, and their consulting services can help federal agencies decide which solution is the right fit for their situation, develop a plan to implement it, and train federal employees as necessary. Optum Serve is transforming health care by bridging the gap between federal agencies and the communities they serve.