Optum Launches Specialty Platform Aimed at Better Care, Lower Costs

Today's Featured Story Optum Launches Specialty Platform Aimed at Better Care, Lower Costs by Angela Maas Optum, Inc. recently unveiled Optum Specialty Fusion, a specialty drug management solution that’s focused on streamlining care for people on those products and lowering medication costs. According to the company, which is part of UnitedHealth Group, the approach has the potential to deliver 17% total cost savings in health plans’ medical and pharmacy spend. Optum seeks to address many issues Specialty Fusion was created to address multiple issues within the specialty pharmaceutical space. “The volume of new specialty drugs and treatments coming to market is outpacing the human ability to keep up,” says Sarah Dye, senior vice president at Optum. “Providers are overburdened and do not always know the best quality treatment to choose or which option may reduce cost.”  Providers are able to request prior authorization for specialty agents via a portal, which then compares treatment options, including their costs, across both the medical and the pharmacy benefit.  The solution narrows down treatment options to the ones or one that “makes the most clinical and financial sense” and provides approval for that treatment in real time, regardless of the benefit the agent falls under. Specialty Fusion arrives on the market amid an outgrowth of other trends, including “the value of the PBM aligned with the payer” and the combination of artificial intelligence and health care analytics, Ash Shehata, national sector leader for health care and life sciences at consultancy KPMG, tells RSP sister publication Radar on Drug Benefits. The ability to provide “real-time insights” during prescribing could prove attractive to potential users, he says. Tool will provide options within seconds With the tool, “when a provider initiates a treatment request, they will simply submit a diagnosis, and in less than two seconds, Optum will analyze treatment options including use of health plan formularies across both the patient’s medical and pharmacy benefit,” Dye explains. Asked what happens if providers don’t choose the lowest cost option — for example, if they want to administer a drug themselves to boost adherence or monitor potential side effects — Dye replies that “providers are empowered to choose the best clinical and financial treatment option for each patient. If the provider wishes to proceed with a nonrecommended option, the case will be pended for peer review, and a specialized clinician will review the case and reach out to the provider to discuss treatment options.” The platform also “looks at all clinically appropriate sites of care, by condition and by drug, such as infusion suites, ambulatory clinic, and the home, to recommend the most effective location(s),” says Dye. Multiple studies have shown that care provided in an outpatient hospital department setting is reimbursed at much higher rates than care provided in physician offices or in patients’ homes. Bill Sullivan, longtime industry expert and executive editor of the Anton Rx Report, writes in a recent blog that “since so many patients…shoulder coinsurance for infused medications, a shift in therapy can make a huge out-of-pocket difference for a patient. Also, patients have been known to skip scheduled infusions because they can’t handle their financial share.” From Radar on Specialty Pharmacy Subscribers may read the in-depth article online. Learn more about subscribing to AIS Health's publications.