Transplant Resource Services

Control costs, manage financial risks and improve patient outcomes

Transplant costs can be extremely unpredictable for employers. With more than 123,000 Americans on waiting lists for lifesaving organ transplants, the need is high. So is the cost. The average billed cost for a transplant episode is $586,064, but depending on the circumstances, it can rise to $1 million or more.

Because of this unpredictable price range and rising demand, transplants represent an extraordinary financial risk for your organization’s health care costs. Optum can help you control costs, manage financial risks and improve patient outcomes for organ transplants.

Reduce treatment costs

The Optum transplant Centers of Excellence network allows us to drive deep, contractual savings, with discounts based on the high volume of patients we refer. We also cut costs by reducing the number of unnecessary procedures with our quality assurance model, resulting in a combined average savings of 53% per transplant episode.

Improve clinical outcomes and the consumer experience

Optum offers treatment practices based on quantitative evidence. We analyze clinical outcomes and stay abreast of medical advancements and industry standards to identify opportunities for improvement. We share new best practices with our Centers of Excellence (COE providers) and monitor their performance for adherence to guidelines. The results speak for themselves:

• Better survival rates. Between January 2011 and June 2013, the one-year survival rate for adult heart transplant patients was 92% within the COE network, versus 87% for patients treated out of network.
• Shorter hospital stays. Between 2002 and 2008, transplant patients within the Optum network spent 16% fewer days in the hospital than out-of-network patients.
• Lower incidence rates. Over the same period, the incidence of transplants was 12% lower for patients treated within the Optum network than for patients in the United States as a whole, a difference achieved through better diagnosis and more appropriate treatment judgments by Optum network specialists.
• Lower mortality rates. Discharge mortality rates (inpatient deaths) for facilities in the Optum congenital heart disease COE network are 65% lower overall than those at out-of-network institutions.

The value of our nationwide transplant network

Optum Centers of Excellence — high-quality, cost-effective solutions for complex medical conditions. Optum curates a group of quality health care providers called the Centers of Excellence by applying:

High standards. To secure positive outcomes for complex medical conditions, Optum requires medical providers in our COE network to have:

• Established and proven track records
• The most experienced physicians and staff
• Verified clinical judgment and technical skill
• A high volume of procedures with positive outcomes*
• A lower number of inpatient days and fewer complications*

Continual quality assurance. Once established as a COE, a center's performance is regularly monitored by Optum clinical experts using:

• Annual surveys and evaluations of all programs
• On-site visits at least every five years
• A continuous focus on improving: 
  • Quality of care
  • Processes for handling serious events
  • Response to member complaints

This is a proven process that makes a difference — in both the cost and quality of care for patients. After selecting the centers, Optum establishes contracts that improve overall provider quality, provide significant value to our clients and maintain strong geographic access.

163 high-quality, clinically superior Centers of Excellence

Designed for self-insured employers, our transplant resource services are built on a network of 163 high-quality, clinically superior Centers of Excellence. In circumstances when a patient can’t travel to a COE, we offer a Transplant Access Program (TAP) to non-COE providers to expand our geographic coverage.

Our managed transplant program provides first-dollar coverage for virtually everything related to the transplant process for solid organ and blood/marrow transplants, with an unlimited lifetime benefit. We carry the cost risk and pay claims that result from transplant cases. Patients are assigned a dedicated case manager who guides them through the entire transplant process.

In addition, we offer a ventricular assist device program and congenital heart disease resource services.

Ventricular assist device (VAD) program

Offered through 49 COEs nationwide, this program enhancement gives participating organizations the ability to take advantage of deep contractual discounts and effective cost controls. We provide access to top-quality providers for VAD implantation and valuable support in the pre- and post-surgical process. By utilizing our contracts with preferred VAD durable medical equipment and supplies vendors, we help clients manage ongoing VAD maintenance costs.

Congenital heart disease (CHD) resource services

There is a close link between CHD and referrals for pediatric heart transplants. We offer a specialized, nationwide network of 18 COEs that provide CHD services. Employers benefit from the best contractual savings in the industry and education for families about the benefits of receiving care at a COE.