February 17, 2022
Optum Launches Specialty Fusion to Simplify Specialty Care and Lower Costs
First-to-market solution helps health care payers manage the increasing cost of specialty medicines, delivering up to 17% savings across medical and pharmacy spend
EDEN PRAIRIE, MINN. (Feb. 17, 2022) – Optum today announced the launch of Optum® Specialty Fusion™, a first-of-its-kind specialty medication management solution, to simplify care for patients with complex conditions and lower the cost of expensive specialty drugs.
With specialty drug costs projected to reach $505 billion by 2023, health plans and care providers are seeking ways to ensure people get the treatments they need more affordably. Using Optum’s data and clinical expertise, Specialty Fusion provides health care payers and care providers real-time insight into the most effective specialty treatment at the lowest cost to the patient. Results include a simpler experience for providers and faster treatment approvals for patients, while delivering 17% total cost savings in medical and pharmacy spend1.
In line with Optum’s commitment to develop solutions that provide more transparency and better connect the pharmacy and medical benefits across health care, Specialty Fusion was designed to streamline and simplify the medication management process. Using Specialty Fusion, care providers can initiate the approval process for specialty drugs requiring prior authorization using a single portal. Treatment options are then compared against dozens of clinically appropriate, lower-cost options across benefits in seconds. Specialty Fusion eliminates the need for a cross-benefit prior authorization process – a burden for providers – and secures treatment approval in real time. This reduces administrative hassle and results in an expected 50% faster access to therapy for patients, while lowering costs.
For example, when a provider prescribes an immunosuppressive drug on the medical benefit, treatment may cost $1,200. Using Specialty Fusion, a provider can see coverage recommendations and select a therapeutically equivalent treatment for $700 less, on average. Informed by Optum data and insights, Specialty Fusion provides savings options such as preferred products, dosage management policies, best sites of care and additional cost-control levers such as available discounts and pharmacy networks2
"Managing specialty drugs at the earliest possible moment is critical to improving care, clinical outcomes and the patient experience," said Sarah Dye, senior vice president, Optum Health. "Optum Specialty Fusion uniquely partners with the provider to change the status quo of prior authorization, reduce their administrative pain and ultimately help them provide better care for their patients."
Optum Specialty Fusion is now available to all large health plans. Additional information is available here.
Keith Meyers:
Our first joint partnership was with Opelousas General Hospital. In four years, Ginger and her team of nurses had built a home health agency that had earned the lion share of the market. And the hospital had a home health agency and they were thinking about closing the agency down.
Ginger Meyers:
That home health was known so well in the community as the hospital was. And they did a beautiful job with what they could. It was like, why should that go away?
Keith Meyers:
Proactively, I mean, we reached out to the hospital and said, "What about if we combined the two home health agencies and become partners?"
Dr. Wyatt W. Decker:
Our focus at LHC Group on excellence, clinical excellence, and this is objectively measured by this organization. So they provide some of the highest quality home care that's available in the country today. So now we'll be able to take the skills and offerings of LHC Group and offer them to Optum Health patients much more broadly. We have over four million patients in value-based arrangements. And we're very excited to be able to offer the services of LHC Group to these individuals.
Ginger Meyers:
I'm most proud of how many people that LHC Group can reach out to and really make a difference. In the elderly or in the hospice patients, we can actually make the final years of people's lives the finest years of their life.
Dr. Wyatt W. Decker:
As a practicing emergency physician, I've seen firsthand how healthcare can work amazingly well and I've seen firsthand what happens when someone doesn't have access to primary care or home care and ends up in an emergency room in a crisis. At Optum, we're constantly challenging ourselves to say, how can we do more to serve the patients and people who need healthcare? And we've recognized that we have an opportunity to be able to provide more care in the home. Particularly as people age, many prefer to age in place, how can we serve their healthcare needs? As people return from a hospital setting, how can we help them get back on their feet more quickly by providing that care in the home? So it's honestly a perfect match. Both organizations have a deep commitment to excellence and service of others. And LHC Group brings this comprehensive set of capabilities that helps to care for people in the home and fits in very nicely with our already established home and community care offerings.
About Optum
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Optum is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. With more than 180,000 people worldwide, Optum delivers intelligent, integrated solutions that help to modernize the health system and improve overall population health. Optum is part of UnitedHealth Group (NYSE: UNH). For more information, visit www.optum.com
Optum Media Contact:
Jennifer Statham
(952) 205-7747
jennifer.statham@optum.com
- Optum internal analysis. 2021. Actual savings will vary depending on client programs in place.
- Optum internal analysis. 2021. Actual savings will vary depending on client programs in place