The CIO’s role in payment accuracy CIOs are agents of change: • Enabling payment accuracy success by connecting analytics, technology and operations • Empowering data scientists with needed tools and access • Engaging with fellow C-Suite partners to provide the right technology CONSUMER VP INFORMATICS CHIEF EXECUTIVE OFFICER CHIEF MEDICAL OFFICER CHIEF COMPLIANCE OFFICER CHIEF INFORMATION SECURITY OFFICER CHIEF STRATEGY OFFICER CHIEF FINANCIAL OFFICER VP CLAIMS CHIEF MARKETING OFFICER CHIEF OPERATIONS OFFICER C I O CIOs play a pivotal role in successful payment accuracy WHAT ARE THE SAVINGS POSSIBILITIES? OPTUM BREAKS IT DOWN BY THE NUMBERS WHAT SAVINGS ARE YOU MISSING OUT ON? 1 in 5 medical claims submitted are processed incorrectly Up to $15.5 billion in unnecessary administrative costs could be saved by payers if insurance companies would improve their claims processing accuracy. 7 A loss of $6 per claim That’s the cost to payers with 1 million members to reprocess a claim. 6 What percentage of your claims require reprocessing? 3–7% inaccurately paid claims Between 3 percent and 7 percent of health care claims are inaccurately paid, with reasons ranging from mistakes to intentional fraud. 5 Administrative cost savings up to $47 billion By using predictive modeling to pre-score claims for coordination of benefits, upcoding, subrogation, fraud and medical management prior to payment. 9 $362 billion annually in medical cost savings If payment integrity efforts were improved and overpayments decreased through a comprehensive payment integrity strategy. 8 Payment accuracy is the low risk, high speed on-ramp to modernization Administrative and medical expense savings possible with a comprehensive payment integrity strategy. The savings realized can be utilized to fund system-wide modernization initiatives. These savings can be achieved through: $272+ million saved and recovered with a comprehensive payment integrity strategy 4 $4 billion in annual savings recovered 3 70% reduction in UR admin cost savings 2 $158 million savings with a prepay strategy 1 Adopting a cloud-based infrastructure Integrating disparate data Breaking down silos across the claims life cycle 1 2 3 Payment accuracy is at the intersection of analytics, operations and technology. A modern API, cloud-first strategy makes it possible to enhance value at the lowest price point. How is your organization implementing data and analytics into their payment integrity strategy? Payment accuracy gives CIOs an opportunity to self-fund transformation. Explore our viewpoint by visiting optum.com/CIOLibrary Sources 1. Optum observed client experience. 2. Optum observed client experience. 3. Optum observed client experience. 4. Optum observed client experience. 5. Optum observed client experience. 6. Optum observed client experience. 7. Stern A. U.S. doctors say 1 in 5 insurance claims mishandled. Reuters; June 14, 2010. 8. UnitedHealth Group. Health care cost containment. UnitedHealth Center for Health Reform & Modernization Working Paper 2; 2009. 9. Dorn C, Choffin M. Proactive payment integrity is a strategic investment. Optum white paper; 2013. 11000 Optum Circle, Eden Prairie, MN 55344 Optum ® is a registered trademark of Optum, Inc. in the U.S. and other jurisdictions. All other brand or product names are the property of their respective owners. Because we are continuously improving our products and services, Optum reserves the right to change specifications without prior notice. Optum is an equal opportunity employer. © 2018 Optum, Inc. All rights reserved. WF604983 04/18 optum.com