Solutions for payers
We'll be your trusted advisor
We prioritize patient care, through proactive insights that empower informed decisions and control costs — without compromising excellence.
Personalized video series, on-demand virtual visits and other tools help patients get more from their treatment.
Our unique care model connects patients with a team of expert clinicians specially trained in their condition.
Our commitment to payer support
Our care management model is supported by data and analytics, and focuses on caring for the person’s whole health according to their own unique needs. We utilize real-time critical data to help payers validate quality, consistency of care and cost management controls.
A payer's dedicated account team is available for prior authorizations support, and works directly with providers to support the process.
To patients, we offer:
- Innovative engagement tools
- A safe and cost-effective approach to infusion
- Expert care teams who are well versed in a person’s condition
- Financial assistance support for patients who can’t afford their medications
- Connections to health care resources that go beyond a person’s specialty condition and prescription
- Proactive partnerships with providers to optimize care and get people started on their treatments as soon as possible
What makes us different?
In this video, Optum Specialty Pharmacy CEO Michael Zeglinski explains our services, our patient care model, and the unique approach we use to drive lower costs and better outcomes.
Mike Z (00:16):
Hello, I'm Michael Zeglinski, senior vice president and CEO of Optum Specialty and Infusion Pharmacy. I'm very happy today to have the opportunity to share with you what makes us different as a specialty and infusion pharmacy, and the services that we offer that are unique to us as a specialty pharmacy, and that we will be providing to patients. Why choose Optum Specialty and Infusion Pharmacy?
Mike Z (00:43):
Our mantra is that we care for people. And we're not doing it the way we want to do it for people, it's really being done their way. So, working with patients, assuring that they are receiving the treatment from us in a way that is conducive to how they want to live their lives, and how they need to live their lives according to their particular conditions that they're dealing with is important, and not having us dictate to them that this is how they have to do it.
Mike Z (01:15):
Of course, we provide expertise. We provide, not just advocacy, but also make sure that we're working with them to have accessibility to the medications. And we're also helping them with their affordability. We have access to many medications that are frequently only available to small numbers of pharmacies, and assuring that we have those in stock, and that we are able to have the patient have them when they need them so that they have adequate supply. To be adherent and persistent is very important.
Mike Z (01:47):
When we look at things such as affordability, many times, people are unable to take their medications because they can't afford their copay, they can't afford their out-of-pocket. So, making sure that we provide solutions for them in order to afford their medication is key. Lastly, being advocates for them. The healthcare system at times could be complicated and difficult. And in order to assure that we can help people navigate through that, we frequently are serving as advocates for them.
Mike Z (02:20):
I'd like you to meet Rachel. Rachel is an example of one of our patients. And she is very much like somebody that many of us know. I'm sure you all have had experiences with people in your family, maybe yourselves, maybe neighbors down the street, or people in your community who you know have a chronic condition, a chronic disease. In Rachel's case, she has cancer, and she also has rheumatoid arthritis. She's been dealing with that rheumatoid arthritis for years. And she recently received a diagnosis of stage two breast cancer. She's on multiple medications. She has some other conditions she's also dealing with.
Mike Z (03:03):
This is a very typical example of a person with many comorbidities. Most people who have specialty pharmaceuticals that they're receiving have multiple other conditions they're also having to treat, diabetes, mental illness, hypertension. And it's important for us, as the specialty pharmacy, not just to look at Rachel for the drug we're providing or the disease that she has, but looking at her as a whole person. The rheumatoid arthritis, for instance, may be under control, and she may not be dealing with any problems or having any side effects from it. And the thing that bothers her more might be one of her other conditions that she's dealing with every day, and having side effects from certain medications. It's important to understand that while we are providing treatment for her on her specialty needs, she has other things that she's dealing with that she may need more of our time and attention for.
Mike Z (04:05):
The healthcare system is fragmented. When you think about Rachel and all the different conditions she has, the medications she's taking, the providers who she is seeing, it's a dizzying array of coordination and complexity that she's having to put all together herself. Hopefully, she has a caregiver, but many people we know are taking care of themselves, and don't have caregivers around them to provide them with that support. And in Rachel's case, she is seeing many physicians for all of the different conditions she has. It's really important that we, as Optum Specialty, are able to help her make these connections, make the healthcare system work easier for her, and assure that she's able to receive the treatment outcomes that we expect her to from her different therapies that she's being provided.
Mike Z (04:58):
With all of the medications that people who typically are on a specialty medication are taking, they frequently are managing upwards of seven conditions at a time. That really is a true challenge for people. And if they don't have somebody in their home who's able to help them, they may feel overwhelmed. And it can lead to issues with depression and anxiety over, how are they going to manage all of these conditions, let alone afford the medications?
Mike Z (05:28):
Speaking of affording medications, a typical specialty medication might cost $52,000 a year on average. Most of that is covered by the payer, but frequently, people have copays or cost shares that come from that, and they not only have to pay for that specialty medication, they also have to deal with all the other medications and the copays that come with those. Working with Rachel to help her manage this very fragmented system is something that is core to what we do at Optum Specialty. What we really work to do at Optum is take all that complexity that you just saw, and work to organize it, and to make it less complex, less fragmented, and work to create for Rachel a very simple process.
Mike Z (06:17):
What we do is take our clinicians within Optum Specialty, work directly with the providers, and work with Rachel. The more we could do with her physicians to link ourselves and them together, create care plans, create treatments that are going to be most effective for her, ones that she could tolerate, have few adverse events and few drug interactions with, we could coordinate all of that behind the scenes for Rachel, and provide her with a treatment path that takes all of the diseases that she has, all of the medications that she has, working with all the physicians that she has, putting that all together in a very organized fashion so that she could be successful at the therapies that she is receiving, not just her specialty ones, but everything else as well.
Mike Z (07:05):
Core to what we do is making sure that we have that relationship with Rachel that creates trust. We will frequently be talking to her every month, either through phone calls, via texts, or some other way digitally on a portal. However we do that, it's important to Rachel that she knows we're there when she needs us, however she needs us. If she wants to call us, if she wants to text us, if she wants to go on a portal and do the refill herself, it's important that the process is simple, that it's repeatable, and that it's reliable for her. By providing her with this service so that she can manage this very expensive medication, this complex disease that she has, and work through and achieve the outcomes that her providers are seeking her to have, it helps her make sense of this healthcare system that we are all in, and make it a lot easier for her in order to get the treatment that she needs.
Mike Z (08:05):
As I mentioned before, one of the core services that we offer is advocacy. And the advocacy from our patient care coordinators comes in the form of financial assistance that we provide. We on average are providing about $6,000 a year per patient, per oncology patient, financial assistance, whether that is copay cards through manufacturer or financial assistance programs through foundations.
Mike Z (08:34):
In the past year, we have provided over $58 million of financial assistance for oncology patients. And when you factor in all of the other diseases that we provide treatments for, we are well over a hundred million dollars a year in assistance that we are providing to patients. It's really important that we give them these options and alternatives for financial assistance, because many times, they don't know on their own that these are available, and they may not even present the prescription to be filled. They may go through the entire process, and at the end, not get it filled. They may get it filled once and never refill it. And we have a lot of people who are able to sit and work with patients, and lay out a financial plan for them, one that they could afford, and one that they are able to remain adherent to their medications.
Mike Z (09:31):
Factoring in our services from the clinical side are our therapy solutions programs. Many of these diseases are rare. There are ones that most clinicians, physicians, pharmacists, nurses have never experienced before in their careers. And we are taking care of those people regularly, every day. As a result, our clinicians are specially trained. They are focused on specific disease states, whether that might be oncology, hemophilia, cystic fibrosis. They know the therapies, they know the physicians, they know the patients. The service that they're providing creates such high levels of satisfaction and trust that people go to these clinicians frequently, not just for their specialty diseases, but whenever they need other services or have other care needs. That allows us to be the ones who are connecting the patients to other providers, other benefits that they might have, such as behavioral health benefits that they may not even know that they have. Our clinicians serve as counselors, but also as liaisons to other aspects of the healthcare system for that patient.
Mike Z (10:44):
We have seen, more and more, that people want to be able to self-serve. They want to be able to create a refill whenever they want to. They want to be able to communicate with us in ways other than phone calls. What we created was Optum Connections, a series of digital tools that are there for the patient when they need them, whether that is communicating via two-way texts, whether that is a video consult between the pharmacist and the patient, or whether that is a series of videos that we provide to the patient about their disease, about the drugs that they are on, or other patients that have the disease and the experiences that they are having, dealing with multiple sclerosis or rheumatoid arthritis or any other disease.
Mike Z (11:34):
It helps the patient to make sense of this disease they were just diagnosed with by their provider, and understand the therapy, and what their treatment path is going to be like. It has created a great amount of success from the standpoint of patients achieving their outcomes, whether that's cancer remissions, whether that's reductions in hospitalizations, or reducing the number of flare-ups that a multiple sclerosis patient might have in their treatment journey.
Mike Z (12:06):
All of these tools that we are providing, and continue to generate, allow people to receive the care they want their way, and work with us in ways that is most effective for them. Our pharmacy is part of Optum. And by being part of Optum, we are able to leverage the power of Optum. What does that mean? Well, different parts of Optum have different services, whether that is Optum care in our physician provider offices, whether that's our behavioral health program, or maybe our physical therapists. All of these people who are part of the Optum care team are accessible by our clinicians, our pharmacists, and nurses.
Mike Z (12:47):
And we frequently are connecting, whether that's through the data that is coming through an electronic medical record, whether we are receiving feeds of claims that are prompting us to take a certain action. All of this information and being connected within Optum helps our clinicians respond and help provide service to patients in ways that would not be possible if we were a standalone pharmacy outside of the system. Leveraging the power of Optum is one way for us to take everything that we're doing and connect it for the patient behind the scenes, and make that healthcare system work better for that patient.
Mike Z (13:27):
As we've been talking about specialty pharmacy, which is primarily seen on the pharmacy benefits side of a patient's healthcare plan, we can't forget to talk about the medical side of the benefit, and all of the specialty medications that we are seeing spend for on that side. Typically, on the medical side, that includes anything that is being infused from a specialty pharmaceutical's perspective. They might be infused at a hospital. They might be infused at a doctor's office, but frequently, it is done in the home via home infusion.
Mike Z (14:01):
Our home infusion pharmacy is able to provide these therapies in a very safe, effective, and positive way. It allows people to receive the care they want their way in their home, and not have to go out or travel in order to get their infusions. This was particularly helpful during the COVID pandemic, when physician offices and hospitals were closed to patients coming in to their facilities. We were able to transition many patients to home infusion so that they can continue to receive their medications, stay adherent to their therapies, and receive the treatment that they needed in order to achieve their outcomes.
Mike Z (14:40):
What does this mean for Rachel and her story? Well, with all of the conditions that she's been dealing with, what this means is, six months later, after she's been on her medication, she's in remission and on a maintenance medication for her cancer. This means that this complexity, this feeling of being overwhelmed, of not being able to make sense of everything she's going through, has been simplified. She's back to enjoying her life. And she's certainly increased her confidence. She's been able to deal with her diseases on her terms.
Mike Z (15:15):
She's been able to communicate with us and other providers, self-service wise, through digital tools, and knows that whenever we are needed, that we're there for her, and she could reach out to us however. It goes back to the key focal points that I mentioned at the beginning of accessibility, affordability, and advocacy. And she knows that we're there for her whenever she needs us. All of these things, coupled with the power of Optum, allow us at Optum Specialty and Infusion Pharmacy to provide the care to Rachel that she needs her way.
Mike Z (15:52):
Thank you very much for the opportunity to tell you today about Optum Specialty and Infusion Pharmacy. If you should have any further questions, please be sure to reach out to your account representative for more information on how we can make a difference with your members and patients. Thank you.
Learn more about how we help
At Optum, we simplify a fragmented care system. Our care management model treats a patient’s whole health. We also coordinate care between the patient, their providers, pharmacists and payers.
We're dedicated to providing care for people, their way. This includes offering a variety of support and resources available to patients when and how they want them.
- Virtual visits with pharmacists, clinicians and care coordinators
- Video series explaining conditions and treatments
- Comprehensive patient portals
- Texting programs to support medication adherence
Optum® Therapy Solutions teams provide full-service support for patients with specialty-centric therapy needs. Through this approach to care, we see an improvement in the overall patient experience.
Each patient is connected with a clinical care team made up of experts who provide comprehensive treatment according to their unique needs and life circumstances. These care teams include clinicians such as:
- Physical therapists
- Behavioral health specialists
Optum Therapy Solutions has a 99% patient satisfaction rate1 and nearly 30% fewer adverse events with our Optum Therapy Solutions for oncology care model.2OR
We understand that a patient's needs may change throughout their treatment journey. We help them to get what they need when they need it, taking a hands-on approach to their therapies by offering guidance, education and compassion.OR
We work with providers to deliver individualized plans that care for patients their way. Through patient-centric services, convenient tools and a commitment to accessibility, our dedicated team supports providers and advocates for patients throughout the course of treatment.OR
- 2018 Optum survey
- Internal retrospective analysis comparing Adverse Events (AE) identified by a multicenter specialty pharmacy network to historical AE rates cited in medication prescribing information; specialty pharmacy AE rates for selected specialty medications were obtained via spontaneous reporting and patient interviews in 2017