Optum Assistance Alternative Resource Study: Claims Data Correspondence with Self-Reported Diversions from Medical Service Utilization [EAP 1995]

Abstract

When OPTUM Assistance [EAP] clients say they would have gone to a medical provider for service had OPTUM not been available to them, how accurate is this information? Did they end up going in to see a medical provider anyway? This study was conducted to test the validity of this self-report information. The data is based on 1,140 OPTUM EAP callers from six United Healthcare (UHC) health plan accounts during the time period of February 9, 1995 through May 30, 1995. The statistic in question is that 24% of callers reported to a counselor at their first or second call that had they not called OPTUM to discuss their problem, they would have instead utilized one of three alternative medical resources. The medical claims history was examined for those callers who said that OPTUM was an alternative resource to other medical care services. Of the 273 clients in this group, 138 (51%) were identified in the UHC COSMOS claims database. The results revealed that 92% of clients who said they avoided using a medical facility did in fact not use one of these three medical services the same day that they called. About 85% of these clients did not use one of these three medical services within 7 days following their call to the EAP. Thus, the outcome of self-reported avoidance of other medical services by use of OPTUM member assistance service is valid for the vast majority of clients. This validation finding has implications for ROI and cost-savings analytical processes for EAPs.