Helping manage the risk for CHD patients
About 40,000 children are born with congenital heart defects every year in the U.S., many requiring multiple surgeries and a lifetime of medications to keep their hearts working.1
Congenital heart disease (CHD), which includes numerous conditions that vary widely in complexity, is the leading cause of birth defect-related deaths in the U.S.2 Complex CHD cases drive over $13.2M3 in annual charges per million members, average $286K in annual charges per case, and can exceed $5M.4 The greatest opportunity for parent education and referral to an Optum Center of Excellence is through early identification.
Specialized CHD network
CHD is a relatively rare condition. Very few facilities capture enough volume to develop the expertise and experience required to consistently deliver superior outcomes. Out of the medical centers Optum surveys, only 25 have sufficient volume and experience to meet our clinical qualification criteria. In fact, both Optum COE qualification survey data and external clinical studies demonstrate a strong correlation between volume and clinical outcomes.
Program Benefits: better quality, lower cost
Our claims data reveal that COE programs deliver better clinical outcomes while reducing average lengths of stay and overall charges, as illustrated below. This is consistent with our premise that high volumes build expertise to do things better and more efficiently.
Sources and Notes:
2. Complex is defined as those cases that undergo a procedure that falls within the RACHS risk scoring
system, RACHS 1-6.
3. Optum commercial population, 2007-Apr 2008 unique members with CHD RACHS 1-6,
age less than 18, n=615.
4. Tao. United Healthcare commercial population 2011 - 2014. November 2015. Outlier cases exclude based upon LOS for all RACHS categories except RACHS 6 in order to show performance of center rather and to eliminate skews from high-acuity cases.