Dynamic Approach to Medicaid Management

By CIOReview | Thursday, May 12, 2016
Larry Renfro, CEO, Optum

Larry Renfro, CEO, Optum

EDEN PRAIRIE, MN: Optum teams up with Medecision and TriZetto to launch new offering for healthcare sectors ‘Medicaid Management Information Systems (MMIS)-critical IT foundation of the public health program to identify the needs of the low income people.

The Optum Medicaid Management Services (OMMS) solution is a Software-as-a-Service (SaaS) and Business Process-as-a-Service (BPaaS) model, which provides comprehensive data base administrative, health care management and clinical data analytics capabilities for fee-for-service (FFS) populations of any size. To manage the Medicaid programs, Optum solution provides three types of services—business services, analytics and data warehousing services, and health services.

Medicaid Business Services (OMBS) services include: claims processing, provider and member enrollment, call center services, service authorizations and operations reporting. “To gain operational insights and drive efficiency- Optum Triple Aim Analytic Services (OTAAS)—a comprehensive analytics and data warehouse services delivers a cost–effective program, which provides enriched data assets and analytics capabilities,” asserts Larry Renfro, CEO of Optum. In addition, timely quality care to member category and individual need is fulfilled through Optum Medicaid Health Services (OMHS), which includes set of health plans and care management programs, while reducing unnecessary, inappropriate and fraudulent expenses.

With Optum’s new solution, states will structure their request for enhanced Financial Fair Play (FFP) Regulations, which pay 90 percent for MMIS implementation and 75 percent for ongoing operations. Optum has also received certification from CMS as a “Quality Improvement Organization (QIO)—a designation that enables it to perform quality improvement initiatives, and review cases and analyze care related patterns for quality measures and medical necessity.

“Our deep understanding about diverse needs of healthcare participants enable us to deliver collaborative solutions that provide insights for building sustainable health communities,” concludes Renfro.