A variety of toolkits are available on Optum’s providerexpress.com to help you address the behavioral health needs of your older adult patients.

Effective July 1, 2025, there will be changes to how authorization requests are submitted through the UnitedHealthcare Provider Portal for oncology Part B drugs under the Optum Cancer Guidance Program and specialty (non-oncology) Part B drugs.

The changes consolidate authorization pathways through MBMNow. Additionally, the visual experience for non-oncology submissions will be different and certain non-oncology drugs may be eligible for auto-approval.

We’re conducting targeted outreaches to our plan members throughout the year to stress the importance of certain activities, including getting needed health screenings and tests. We’ve developed postcards and emails to deliver reminder messaging to those due for the following activities.

As a companion to these efforts to close gaps in care, we’ve also designed a personalized health profile of the activities a member may be due for, presented in an easy-to-read chart format.

CMS has phased in its V28 hierarchical condition category (HCC) model and 100% of the model is in effect for 2025 dates of service for 2026 payment. The prior model, V24, has fully phased out.

CMS evaluates the historical costs of health care services based on patterns of utilization for Medicare populations and develops HCC models to predict future costs. 

Annual kidney disease testing and monitoring is crucial for people with diabetes, as diabetes is the leading cause of chronic kidney disease. Yet fewer than 50% of patients with diabetes receive both eGFR and uACR tests—those recommended under the Kidney Health Evaluation for Patients With Diabetes quality measure developed by NCQA and the National Kidney Foundation.

Encourage patients with diabetes, ages 18 to 85, to receive a kidney health evaluation.

Socioeconomic factors such as physical environment, economic stability, community and social contexts, education, nutrition, and health care accessibility can negatively affect patient health outcomes. When possible, it’s valuable to review these factors as part of patient evaluation and care coordination.

The Peoples Health Supportive Care Program is available to help your Peoples Health patients be active at home in addressing and managing the acute symptoms of a serious illness or condition. Our clinical team works with a patient’s primary care provider to identify self-management interventions to enhance quality of life and engages with other providers to arrange needed services, including in-home services when required.

We value wellness exams and assessments because of the potential to improve overall health and well-being. Medicare annual wellness visits (AWVs) are an important way to enhance patient engagement and experience, because they offer valuable opportunities for patients to connect with you, ask questions and receive personalized guidance for their health journey.

Peoples Health collaborates with Elara Caring on a Healing at Home Program for your Peoples Health patients. The program is designed to create an effective post-acute system of care that maximizes patient experience and improves quality of care and health outcomes.

We are transitioning to enhanced claims processing and provider portal platforms through UnitedHealthcare on Jan. 1, 2024.

Claims with dates of service on or after Jan. 1 will process through the UnitedHealthcare claims processing system.

Peoples Health collaborates with Elara Caring on a Healing at Home Program for your Peoples Health patients. The program is designed to create an effective post-acute system of care that maximizes patient experience and improves quality of care and health outcomes.

Cultural education for health care professionals is an important component of improving the delivery of care to diverse patient populations.

Resources are available to help address racial and ethnic disparities in health care. These include provider materials from various agencies, such as the U.S. Department of Health and Human Services Office of Minority Health, which offers cultural competency education modules.

We want to work with you to help your Peoples Health patients better manage their health. One way we do this is by offering them health evaluations at no cost through our Comprehensive Wellness Assessment Program. The assessment helps us better understand health needs, and it helps us better work with you to coordinate the care of your Peoples Health patients.

The changing demographics of our country create new challenges for the provision of care. We see this occurring in our local communities.

Research shows that socio-cultural differences between patients and health care professionals influence many aspects of the medical encounter and can impact patient satisfaction, adherence and health outcomes.