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ARTICLE Optum's Care Flex Offers Options for TPAs

While many large employers have successfully managed health care costs through integrated employee education, plan design, program analytics and comprehensive care management, small- to mid-sized employers have typically found similar programming to be out of reach.

In June, OptumHealth introduced Care Flex™, a population health management solution that offers flexible benefits to third-party administrators (TPAs) and mid-sized customers through competitive program pricing, streamlined administration and proactive member engagement strategies.

This package of services equips smaller employers with the tools most frequently deployed by larger corporations, and supports employees across the health care continuum in areas such as:

  • Case Management – Targets complex or catastrophic cases
  • Disease Management – Identifies members who are affected by the top seven conditions that drive the majority of medical claims costs for employers
  • Maternity Management – Offers preconception counseling, prenatal education and follow-up support throughout pregnancy
  • Health and Wellness – Provides educational materials, action plans, one-on-one coaching, gym reimbursement and health screenings
  • Utilization Management – Monitors all cases from initial notification through discharge, and refers high-risk cases to appropriate case management or disease management channels

Value-added services also include NurseLineSM, a Web portal, on-site screening, gym reimbursement and participation incentives.

UnitedHealthcare's own research shows that when disease management, case management and utilization management are implemented together, employers can expect to see a 3:1 return on investment (ROI).1

Care Flex allows us to serve a market that previously did not have access to our services, helping deliver on the mission to expand access to quality care.

1. UnitedHealth Group Internal Analytics, 2011