This year, as in past years, Healthcare Informatics has designated several vendor companies in healthcare IT as “Most Interesting Vendors,” and is featuring profiles of those companies in its Healthcare Informatics 100 issue, which this year is our May/June issue. The “Most Interesting Vendor” designation is not an award, but simply a recognition.
The trajectories of these companies speak to some of the broader trends taking place in healthcare IT in general and in the healthcare IT vendor market, and are thus of interest to readers. Healthcare Informatics’ Editor-in-Chief Mark Hagland’s profile of Epic can be read here. Below is our profile of Optum.
The healthcare payer industry, much like its provider segment counterpart, is continuing to put more of an emphasis on predictive modeling approaches that will give insurance companies better insights into data they already have. The Minnetonka, Minn.-based UnitedHealth Group is one big-name payer that has forayed into the health IT space, as it offers products and services through two operating businesses, UnitedHealthcare and Optum, both subsidiaries of UnitedHealth Group.
In 2011, United HealthGroup’s health data subsidiary Ingenix rebranded as OptumInsight. In a press release at that time, Optum’s then-CEO said, regarding the unification of UnitedHealth Group’s health services businesses under the master brand Optum, “This step will make it simpler for clients to connect with the broad expertise and innovative capabilities across our businesses, so we can help them improve population health, reduce the cost of care and make healthcare work better for everyone.”
Indeed, OptumInsight, the health data analytics arm of the Optum brand, develops its projections based on claims data covering 170 million lives, clinical data spanning around 80 million lives, data related to 3 million medical procedures, 8 billion laboratory results, and other such diverse data points, according to an April 2016 Market Realist article. In turn, this data enables the company to make accurate financial and clinical projections for its clients. Optum officials further note that the vendor now works with 300 health plans and approximately 80 percent of U.S. hospitals.
For years, Optum has ranked amongst the top companies in the Healthcare Informatics 100—an annual ranking of the top vendors with the highest revenues derived from health IT products and services earned in the U.S.—but in the last three years, the vendor has soared to the No. 1 spot on the list each year, due to Healthcare Informatics now allowing revenue derived from the payer market to be included. Indeed, with a 2016 health IT revenue of $7.33 billion, Optum’s success in helping health plans and provider organizations in the analytics space has become much more well-known. Rick Hardy, who is the chief operating officer of OptumInsight, encapsulates what the company has been able to accomplish into three big areas: moving beyond analytics “for analytics sake”; payer-provider collaboration; and creating modernization.
While analytics, according to Hardy, is “the kernel” of what OptumInsight is and how it started, what its clients—inclusive of payers, providers, life science companies and government entities—are now asking for is that since they have gotten to the point where the analytics are giving them insights into population health issues, and cost and quality insights, it’s now becoming about how to translate those into decision making on the front lines, be it clinical or administrative. “So it’s [becoming] about decisions on how to manage cost, and quality, too,” Hardy says. How we help our clients do that and how do we take our analytics and move them into the workflow of what they do every day? We have success stories in being able to help clients do risk-based contracts being put together by payers and providers, which are underpinned and completely informed by a set of analytics that our people and tools have helped developed,” he says.
Drilling down, Hardy notes that as health systems are now taking on more risk and looking at populations of people that they have to manage as opposed to someone showing up at the front door for an office visit, OptumInsight analytics “are a translation of population health management as well as of financial and risk management.” He says, “We have a long legacy of doing that for payers, and we are translating that into the provider world. This helps them negotiate risk-based contracts, so they now have an idea of how they will win in those contracts.” Hardy adds that the number of health systems that have that skillset of being able to win in a risk-based contract “is still really low.”