DIRECTIONAL CARE

Our Medical Strategies are designed to navigate the Patient Journey from Directional Care to Care Insights to Cost of Care. Opus’ mission is to help people get to the Right Place at the Right Time for the Right Care at the Right Cost to ensure our clients’ needs are addressed throughout each step of the journey. Our Directional Care Strategies are designed to ensure patients start at the Right Place at the Right Time for all medical events.

StandbyMD™

StandbyMD

Opus MedStrategies engages with Patients, Plans and Payers during a medical event to ensure patients gain convenient access to quality care at a fair price.

When a patient is away from home, Opus MedStrategies provides dedicated resources to navigate the healthcare system. We deliver a program developed by on-staff medical practitioners that leverages Milliman Medical Guidelines to cost-effectively treat medical situations through escalating levels of provider engagement.

Our StandbyMDTM program provides real time clinical support with medical assistance to the member.

  • We provide direct access to varying levels of support and it is customizable by client and employer group. Support may include:

    • Provider lookup and referral
    • Tele-health
    • Non-urgent care facility
    • Personalized doctor visit
    • Urgent care facility
    • Emergency department

FAIRChex™

FAIRChex

FairChexTM is an online healthcare consumer guide that ranks hospitals clinically and financially for elective procedures. FairChexTM blends objective and comprehensive cost and quality data to ensure Plans, Payers and Patients are aware of the value of their provider choice.

Opus’ FairChexTM platform supports Medical Management, Advocacy Teams, Patients and Plans in determining choices available for inpatient and outpatient medical procedures across the US.

In addition to the actionable financial and clinical data provided by platform, Opus can secure a pre-negotiated reimbursement rate prior to care at the chosen facility with FairChexTM PLUS. FairChexTM PLUS incorporates medical management, benchmarks and sign-off to mitigate facility expenses.

With huge variations in cost and quality in the US healthcare system, knowing where to purchase care is a decision with important consequences.

Primary Network Access

Opus conducts a detailed analysis of demographics and claims history to recommend an optimal primary network solution as well as an out-of-area network solution that optimizes savings and ensures access to preferred providers. We offer personalized solutions to the family or individual to ensure best outcomes are attained.

We deliver maximum value in assessing the quality of a network through detailed claim analytics, including quality of care and cost-based benchmarking.

Opus manages network enrollment and claims flow to hit high notes on operational efficiency.

International Assistance

Opus MedStrategies provides medical access to ex-patriots residing or traveling within the US, as well as international medical access for Americans traveling outside of the US. We uniquely support providing access to quality care, case management and cost controls to manage entry to medical services anywhere in the world.

Our International Assistance program incorporates medical access as well as case management services.

Medical Second Opinion

When a patient receives a recommendation for surgery, Opus MedStrategies has optimized a Medical Second Opinion process including a full case review and recommendation from a board-certified specialist.

Our process ensures that a procedure is in fact required, the highest quality of care is recommended (at both the physician and facility level), and the cost of care is considered and addressed through education and negotiation prior to services.

Medical Second Opinion integrates board certified specialists, case review and FairChexTM facility cost and quality data. Payers can opt-in to FairChexTM PLUS for negotiated bundled rates for care.

Consultative Analytics

Our consultative analytics process aims to answer your important questions, such as – What is the quality of care delivered? What do other payers reimburse for the same services? What is the actual cost to the provider rendering the service? What is the value of the cost containment strategy utilized?

And, at every measure, we are assessing our value with actionable insights for improvements along the way.

Opus assesses plan experience and presents analytics in a way that is meaningful and actionable.

SPD Recommendations

With one simple submission, Opus reviews claims experience and summary plan documents to deliver a concise summary of opportunities to reduce costs through better healthcare utilization and claims management, as well as SPD improvements to better support plan initiatives.

Plan design must hit the right key for a program to successfully address healthcare costs.