Optum launches Specialty Fusion in bid to simplify care, lower costs

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Optum has announced the launch of a specialty medication management solution called Specialty Fusion, the goal of which is 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 by the company's estimates, Optum has tapped into a potential market opportunity, with health plans and care providers seeking ways to ensure people get needed treatments more affordably.

It's now available to all large health plans.

Harnessing a combination of data and clinical expertise, Specialty Fusion provides payers and care providers real-time insight into the most effective specialty treatment at the lowest cost to the patient, said Optum. 

Results include a simpler experience for providers and faster treatment approvals for patients, while delivering 17% total cost savings in medical and pharmacy spend, an internal analysis showed.

WHAT'S THE IMPACT?

Specialty Fusion was designed to streamline and simplify the medication management process – keeping in line with the insurer's efforts to improve transparency and better connect pharmacy and medical benefits across healthcare.

Utilizing the solution, care providers can initiate the approval process for specialty drugs requiring prior authorization using a single portal, the company said. Treatment options are then compared against dozens of clinically appropriate, lower-cost options across benefits in a few seconds. 

Specialty Fusion eliminates the need for a cross-benefit prior authorization process – a burden for providers – and secures treatment approval in real time, said Optum. This reduces administrative hassle and results in an expected 50% faster access to therapy for patients, while lowering costs, according to internal data.

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. 

The solution also 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 networks.

THE LARGER TREND

A number of different organizations have been partnering with Optum in recent months on revenue cycle management. MarinHealth Medical Center became the latest in January; the two companies will focus on operational efficiency for the health system, the organizations said. To do this, MarinHealth will employ Optum technology to streamline nonclinical administrative processes and simplify experiences for patients and providers. Optum also will provide revenue cycle management services and supporting technologies.

MarinHealth is just the latest health system to form a strategic partnership with Optum. Others include SSM Health, John Muir Health, Boulder Community Health, Bassett Healthcare Network and Dignity Health.

In May, Optum announced a similar partnership with Bassett Healthcare Network in Cooperstown, New York. 

Optum collaborated on clinical and operational performance, providing a range of services, including revenue cycle management, advanced data and analytic capabilities, and information technology. 

In 2019, John Muir Health and Optum announced a collaboration in which Optum would manage key nonclinical functions, including information technology, revenue cycle management, analytics, purchasing and claims processing.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com