Case Study: Uniontown Hospital defends revenue and boosts payer collaboration with Optum360 On-Site Physician Advisor

Uniontown Hospital defends revenue and enhances collaboration through On-Site Physician Advisor program

Uniontown Hospital, a 145‑bed community hospital recognized for award‑winning cardiac and stroke care, needed a more efficient utilization review process to secure fair reimbursement and fund innovation. To strengthen medical necessity reviews it was already using Optum360 Physician Advisor Services remotely and in 2017 invited Optum360 to place a full‑time On‑Site Physician Advisor (OSPA) at the hospital.

Optum360’s on‑site physician advisor applied evidence‑based reviews, prioritized urgent cases, led peer‑to‑peer appeals and advised on which cases to challenge, improving outcomes measurably: peer‑to‑peer success rose from 33% to 53%, completed peer‑to‑peer reviews increased from 21% to 90%, and physician response rates were 95% with the OSPA versus 57% without. Optum360’s OSPA also sped reviews, strengthened payer collaboration, increased physician engagement and helped protect the hospital’s reimbursement.

Uniontown Hospital

Janet Georgiana

Director of Case Management