If you haven’t seen this way of outsourcing hospital revenue cycling and employees, here’s the latest from the Optum 360 group.  It’s a company owned by both Untied and Dignity Health with Optum/United Healthcare being the controlling party.  You could certainly assume this provides some revenue for Dignity Healthcare and as they have recently been hit with employees suits stating their pension funds are not adequate.  So add on Optum 360 and bump a bunch of folks off the pension plan right?  That’s basically what has occurred as Optum 360 was rolled out through the Dignity Healthcare system of hospitals first.

Dignity Health Gets a Temporary Reprieve on Pension Plan Lawsuit–Employees Claim As Being Under Funded

A judge just recently gave Dignity a bit of a reprieve on the pension issues, but it’s not over yet.  Optum itself without the 360 combined Dignity Health subsidiary has been at the center of revenue cycling for years and if I’m not mistaken, Cerner still licenses their software modules so every time a Cerner system is sold, there’s Licensing royalty payments to be made to Optum, one more way they make money and of course they own a few other subsidiaries in the medical records business as well.

Dignity Health also has a big fine to pay so they are looking for revenue streams I could guess and this partnership company with Optum as they gain more hospital contacts to gain business with outsourcing revenue cycling to them should help their income.  Mayo is just the latest to outsource to Optum 360.  Employees are no longer employed by the hospitals and I could guess some get hired back.  On one of the job boards one employee commented about how their benefits plan under Optum 360 really sucked compared to what they had provided formerly by Dignity and said it was all about greed.  Here’s the link on the initial announcement of the company and a couple of former Medicare employees told me they about fell over seeing this. 

United Healthcare Adding Yet One More Subsidiary to the Very Large Number of Subs They Already Own/Operate-Optum and Dignity Healthcare (A System Wide Cerner EHR Client) Form New Venture Called Optum 360–Subsidiary Watch

Dignity Health is already a partner in the Optum Labs group and I believe most of their hospitals do use Cerner medical records so some of the revenue cycling coding and software may already be in place. 

You can watch the  CEO of Mayo doing somewhat of a solicitation for United Labs too in the Harvard Review, that’s where the data selling with Humedica rolled in there will take place, another subsidiary of the giant United conglomerate.  In addition this week there was also news about Optum/UHC buying a chain of urgent care centers and of course that gets rolled right in here to with Optum 360.  As a matter of fact if you visit the website of the new subsidiary, they want to talk to doctors who might want to sell their practices too so this subsidiary goes after the doctors while the Optum 360 subsidiary goes after the hospitals.

Optum (United Healthcare) Buys MedExpress Urgent Care Business- 141 Full Service Clinics In 11 States–Company Advertises They Are In the Market to Buy Your MD Practice, As A “Too Big To Fail Insurer” Moves Forward With More Acquisitions

So this again is another cost cutting effort and revenue gaining proposition for Optum and is allowing huge additional market exposure.  Optum has already opened up 9 of their own urgent care centers in Texas as an example.  If you look at the job sites, you’ll even see “admitting clerks” as part of the job listings that Optum 360 is looking for.  In the OC where I am, United owns some of the biggest IPAs (doctors groups) so they used that power as well to cut payments to MDs and many of which through very complex contracts here in the southern California area of getting paid at rates less than Medicare, which doesn’t make them very happy.  Keep in mind too now that Medicare is also run by a former United Executive who got his start in life as a Goldman Sachs banker.  That’s doesn’t seem to make anyone feel very good does it? 

United and Optum love complexities as that’s what helps make money for them so don’t look for the company to make anything any simpler for you the patient to deal with as it’s not on the agenda as the whole focus here is to shift more money over to the consumer to pay.  I might add that your premium payments with United and other insurers also go to fund stock buy backs as those cost money to facilitate as well.  Look at Walgreens as another example and their record $8 Billion dollar debt/bond issue they had last year to raise money, so they could also keep buying back their stock. 

Here’s a little bit more about the Optum Labs operation at the link below, that makes money for their founding members such as Dignity, Mayo and of course Optum by selling data and allowing companies to use apps to research the medical records that hospitals like Mayo, Dignity, McClaren and more provide, your medical records with claim data tied in.  So far, in a couple years nothing earth shattering out of the labs as they all proclaimed the research would end up with some real life saving stuff, yet to be seen.  It’s more about making money from those who pay to use the data. 

UnitedHealthGroup and AARP Get Cozier, AARP Still Gets Paid for Marketing Use of AARP Name As AARP Becomes an Optum Labs Data Selling Promoter Amidst Doctor Complaints Received Relative To United Firing of 5500 MDs–Subsidiary Watch

Anyway it sounds like a bunch of Mayo folks are about to lose jobs and get rehired by Optum 360 as they join the outsourcing revenue cycling company.  It is interesting on how Mayo’s participation will end up providing income for Dignity Healthcare, another company of hospitals in the west.  By the way, United has a subsidiary that helps device and drug companies get their products approved from the FDA too.  I thought this was kind of interesting after we read the news articles about how United is going to control strict authorization of C-Sections now.  They kind of walk both sides of the street here, you think?

United Healthcare (Optum) Owns A Consulting Firm for FDA Drug and Device Approvals, Clinical Trials–CanReg - Subsidiary Watch

Again, just look at any job market page and see what positions Optum 360 is advertising for and you’ll get the picture of what parts of the hospital revenue cycling and then maybe even more they are taking over.  They have to keep those infamous Ingenix fraud detection algorithms running too.  Do pay attention to all the Quants that are being hired throughout United and other insurers as those are the folks now designing the insurance policies you buy too and you kind of wonder how many former bank and high frequency trader quants they are hiring as quants do change industries as their work is all math and models beyond just stock markets.  One more note worth a short mention, Optum wants to be your medical records consultant, integrator and more so pop that in here with the Optum 360 subsidiary and what are they leaving untouched?

United Healthcare (Optum Insight Subsidiary) Wants To Be Your Allscripts, Epic And GE Centricity EHR Consulting Service Starting With Implementation And Beyond

So what is the behemoth not doing?  Here’s a couple links where you can view some very lengthy lists of subsidiaries as listed with the SEC for UnitedHeatlhGroup and United Healthcare.  Look now before the individual names go away as they are incorporating most all of them under the Untied or Optum name.   There’s even a listing for their tax haven company that has no officers in the mix.  BD 


WAKEFIELD, Mass. & ROCHESTER, Minn., Apr 14, 2015 (BUSINESS WIRE) -- Optum360 and Mayo Clinic announced today that they are partnering to develop new revenue management services capabilities aimed at improving patient experiences and satisfaction while reducing administrative costs for health care providers.

Optum360 and Mayo Clinic will collaborate on enhancing and redesigning specific elements of the revenue cycle to increase efficiency while creating a convenient, accurate, transparent and personal experience for patients. A key focus is improving the interaction between the provider and payer by opening channels of communication early in the care process. The partnership includes a next-generation patient cost estimator, streamlining prior authorization/pre-certification, enhanced claims editing functions and administrative simplification of billing activities associated with pre-care packaged pricing.



Post a Comment