UnitedHealth’s Optum has launched Optum Real, a real-time claims system designed to streamline the claims and reimbursement process by providing instant coverage validation for providers.
“Optum Real transforms the pre-service experience in real time by delivering greater clarity and certainty to every interaction,” UnitedHealthcare CEO Tim Noel said in an Oct. 21 news release. “That means providers and patients can spend less time navigating logistics and more time focused on delivering and receiving care.”
Becker’s spoke with Puneet Maheshwari, senior vice president and general manager at Optum Real, and Dave Ingham, DO, chief digital and information officer at Minneapolis-based Allina Health, about the initiative that aims “to eliminate complexity and administrative waste.”
Allina is piloting the multi-payer platform for outpatient radiology and cardiology, and is reporting fewer administrative errors. A McKinsey study found AI solutions could save $150 million to $300 million in administrative expenses for every $10 billion of payer revenue.
“We reduced our denials within the radiology and cardiology spaces by 1%, which doesn’t sound like a ton, but every one of these denials is a bad experience that we prevented,” Dr. Ingham said. “I think that’s a pretty meaningful reduction.”
The test follows Allina transitioning its IT and RCM functions to Optum in February 2024.
Mr. Maheshwari said Optum Real is already live with a few providers beyond Allina, but scaling remains a challenge.
“That two-sided, chicken-and-egg problem in a hyperlocal market is a challenging problem to solve,” he said. “The good news for us, being Optum, is that we could get the first domino to fall with UnitedHealthcare, the scaling partner and payer that’s coming to the table and opening up transparency to a multiplayer infrastructure that we are launching.”
Security is another concern as Optum builds out proactive, real-time tools, especially considering the cyberattack on UnitedHealth subsidiary Change Healthcare in 2024.
Despite this, Mr. Maheshwari emphasized Optum Real’s commitment to data security and the program’s unique value proposition.
“How do we create transparency and apply AI to enable that transparency in a safe and secure way?” he said.
