Evidence-Based Policies Inform Healthcare Decisions, Reduce ...

OptumHealth revises and updates one to two
policies per quarter. The policies are revised
through monitoring standing queries of
biomedical research on a particular topic.
Evidence-Based Policy Impacts
“One of the high-impact policies for
OptumHealth is a policy that looks at whether
continuing care is likely to be a benefit for
the patient for any particular service,” said
Dr. Kosloff. “This particular policy is used in
98 percent of all of its denials of services. For
clinicians making a judgement that continuing
care management is unlikely to benefit a patient
and may, in fact, interfere with the patient
accessing more effective care, the policy provides
a strong impact.”
“From a fiscal perspective, the policies can also
assist in helping claims to be adjudicated in the
manner intended,” Dr. Kosloff added.
As we move into a healthcare market that
emphasizes individuals making judgements
about their healthcare with health savings
accounts, evidence-informed policies that are
clearly communicated to clinicians and are easily
understood by patients, will support this patientbased
decision-making process and promote
high-value healthcare.
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Reilly BM. The essence of EBM. British Medical Journal
2004; 329:991-992
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What is it How does it work What relevance
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Fretheim A, Oxman AD, Lavis JN, Lewin S. SUPPORT
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OptumHealth Contact Info:
Phone:(866) 427-6845
Email: engage@optumhealth.com
Web site: www.optumhealth.com
About OptumHealth
OptumHealth helps individuals navigate the healthcare system, finance their healthcare needs and achieve their health and wellbeing
goals. The company’s personalized health advocacy and engagement programs tap a unique combination of capabilities that
encompass public sector solutions, care solutions, behavioral solutions, specialty benefits and financial services. Serving nearly 60
million people, OptumHealth is one of the nation’s largest health and wellness businesses, and is a UnitedHealth Group® (NYSE: UNH)
company. More information about OptumHealth can be found at www.optumhealth.com.
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