ALERT is our outpatient clinical risk management model. This innovative approach utilizes algorithms based on data from the member-completed Wellness Assessment and claims, to identify the member’s individual treatment needs. In this way, Optum works in collaboration with providers to ensure a member receives evidence-based treatment, tailored to their individual needs.
The ALERT process starts when the member completes the one page Wellness Assessment. After reviewing with the member, the provider will fax the Wellness Assessment to Optum. If clinical risk is identified by an ALERT algorithm, the provider will receive a letter advising them of the possible clinical risk along with nationally recognized best practices associated with positive outcomes for member’s with the identified concern. For more significant clinical risk, a licensed clinician from the ALERT care advocacy team will contact the provider to coordinate care.