WEBVTT

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The curious case of the
costly complication.

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A medical device company cleared
a major hurdle with FDA approval

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for their new product,
but they hit a snag

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when commercial payers refused

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to provide a medical coverage
policy for the device.

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When this happens it can
be difficult and costly

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for patients to access treatment
even if it's the best available.

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In order to be covered,
the device company needed

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to prove their device
was more cost effective

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than the current
standard of care.

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But how? Enter Optum®,
a leading health services

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and innovation company
with years

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of proven experience helping
clients find solutions

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to difficult problems.

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Optum had the keys to unlock the
answers with a massive amount

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of de-identified, real-world
patient data from claims

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and electronic health records
and the technology and expertise

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to integrate, sort,
and analyze that data.

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Like all surgical procedures,
the current standard

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of care comes with
possible complications.

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After hearing the
device company's story,

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Optum began to dig deeper into
the data and quantify the costs

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of those complications.

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If the newly approved
device could avoid

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or minimize complications
and associated costs,

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the device company would
have the proof they needed

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to differentiate their solution.

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The first step was to compile
a list of "complication codes".

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This required close
collaboration

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between the Optum
Medical Director

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and the device company's
Medical Director,

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a practicing physician familiar
with both the current standard

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of care and his company's
solution.

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Optum data identified patients

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who had undergone the surgical
procedure during a seven-year

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period, and included
the associated diagnosis

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and procedure codes.

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The Medical Directors were able
to cross-reference the codes

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and determine which ones pointed
to complications post-procedure.

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Armed with that knowledge,
Optum zeroed in on the medical

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and pharmacy costs associated
with the complications,

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looking at key variables,
at 90 days, one year,

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and three years post-procedure.

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The Optum data provided
other clues around;

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condition diagnosis,
prescriptions for medications,

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and condition-related
health care utilization.

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The company soon discovered
exactly what they needed.

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Optum's cost analysis
gave them actionable data

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to drive discussions
and impact decisions.

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Another case closed.

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Now on to the next one.