When choosing a health plan, patients find coordinated care as the focus of Optum’s health care model

The COVID-19 pandemic has offered a reminder that our total health extends beyond just the medical. Feeling isolated after a year and a half of social distancing, seniors also often have social and behavioral health needs, some of which may be best addressed in the home.

Social distancing has exponentially increased demand for “virtual visits” with health practitioners, via video conferencing. And for patients with more complex conditions, home visits have served not only medical, but also vital social functions.

“Seniors have more care needs, on average, and the continuity of that care is really important,” said Dr. Amar Desai, president and CEO of Optum Pacific West. “COVID has certainly created a situation where there’s discontinuity … And so, one of the things we try to do, both with house call programs and virtual options, is to enable that continuity in new ways.”

Key to continuity of care and to a coherent, whole-person approach to overall wellness is the ability of providers to “connect the dots” in a patient’s medical history, treatment, and needs. How does information from a primary care doctor get to a specialist? How does the discharge information after a hospital stay get to the primary care doctor? How do issues related to medications get reconciled in a timely fashion? These are all questions to ask while selecting a primary care provider and a health plan.

Optum, one of the largest and fastest-growing medical groups in California, takes an approach that contrasts with traditional “fee-for-service” models, wherein providers are paid separately for each service provided. Instead, Optum receives a fixed payment to take care of all the needs of a patient. This is accomplished through health plans such as Medicare Advantage.

“What that enables us to do is really think about the total care of a patient and develop clinical models that are best suited to what a patient’s needs are,” Desai explained.

Optum is a leader in this “coordinated care” approach, which helps manage patient care thoughtfully and proactively across the entire health care spectrum. This coordinated care creates sustainable networks to enable truly patient-centered care at every stage of a patient’s health journey.

Seniors tend to value a deep relationship with not only their primary care physician, but also with a complete care team – which may include medical assistants, social workers, and pharmacists – dedicated to their overall wellbeing. Optum roots its service in these relationships, while also recognizing that some patients, such as those with multiple chronic medical issues, will benefit from what they term “wraparound” services, targeted at their specific issues. For example, for someone experiencing congestive heart failure or COPD, Optum will devise an individual disease management program focused on their unique clinical needs.

Operating throughout Los Angeles, Orange, San Diego, Riverside and San Bernardino counties, Optum offers a best-of-both-worlds integration of convenient and community-oriented care backed by the capabilities and technology of a large organization to inform the services at local sites. This enables continuity and individuality of local care, as opposed to impersonal “big box” healthcare, yet with the resources of a leading national medical group (Optum is part of UnitedHealth Group, the largest single health carrier in the U.S.).

“[Patients] get compassionate, convenient, and specialized care and that sense of a team taking care of them that’s part of their local community, but also all the benefits of the best technology and the most robust capabilities to coordinate their care across the region,” said Desai.

Choosing a health insurance plan during open enrollment should begin with communication with a primary care provider familiar with your overall health issues. It’s crucial to align health care needs with health plan coverage; to make an informed decision based on your individual medical situation and the benefit options available in your market.

“After having the right kind of discussion with your doctor about your health care needs, it’s important to then really get connected to an expert,” Desai concluded. “Oftentimes that’s a licensed health insurance agent, to provide patients with a free consultation. We’re happy to connect patients to those types of agents.” For more information on Optum, visit optum.com/california.