Care Select Flashcards
What is the main function of Optum’s CareSelect Imaging solution, and how does it help providers?
CareSelect Imaging integrates clinical guidelines for advanced imaging directly into the EHR ordering process to ensure providers choose appropriate imaging studies. It delivers point-of-order recommendations based on expert-approved Appropriate Use Criteria, assigning an appropriateness score to each order and suggesting alternatives for low-scoring orders . This helps establish a standard of care and curbs unnecessary scans – studies show 20–50% of high-tech imaging could be avoidable without such guidance . By using a CMS-qualified decision support mechanism, CareSelect Imaging also helps providers comply with PAMA federal requirements for consulting imaging criteria, reducing denial risks and streamlining prior authorizations  .
How does CareSelect Lab improve laboratory test utilization in a health system?
CareSelect Lab is a decision support tool focused on lab test stewardship. It continuously audits lab orders in real time within the EHR, comparing each order against Mayo Clinic’s evidence-based lab testing guidelines . If a test is unnecessary (for example, a duplicate test done too soon or a test without proper indication), the system can alert the provider or provide guidance at the point of order . All lab orders are recorded and scored to build a picture of ordering patterns. This means clinicians receive immediate feedback on their lab ordering, and administrators get analytics to identify trends of overutilization . By following these prompts, hospitals have reduced inappropriate lab tests (one analysis found about 7.7% of lab orders were inappropriate, translating to ~12% of lab spending wasted) . In short, CareSelect Lab optimizes test ordering by ensuring each lab test adds clinical value, thereby saving costs and improving patient care (avoiding unnecessary blood draws or false positives).
What does CareSelect Risk Assessor do, and who benefits from it?
CareSelect Risk Assessor automates breast cancer risk assessment in clinical workflows. It is essentially a BRCA risk calculator embedded in the EHR that pulls a patient’s personal and family history data to calculate her risk of developing breast cancer and the likelihood of a BRCA1/2 mutation  . Using the Tyrer-Cuzick model, it provides an accurate 10-year and lifetime breast cancer risk percentage . The primary beneficiaries are women with significant family or personal risk factors – the tool flags high-risk patients who may need genetic counseling, genetic testing, enhanced screening (like MRI), or preventive measures. For clinicians (especially primary care and OB/Gyn), it ensures that no high-risk patient slips through the cracks – eligible patients are identified and can be referred for appropriate interventions per guidelines . It also benefits care teams by saving time (auto-populating data vs. manual risk scoring) and helps justify further care (the risk score can support insurance approval for genetic tests or prophylactic treatments).
How are the CareSelect solutions integrated with EHR systems, and why is this integration important?
All CareSelect solutions (Imaging, Lab, and Risk Assessor) are embedded directly into the electronic health record workflow. This means providers don’t need to switch to another app or website – the guidance appears in their normal ordering or charting process. For example, CareSelect Imaging displays appropriateness scores and recommendations right in the imaging order entry module , and CareSelect Lab runs in the background of lab order entry to flag issues without disrupting routine orders . Similarly, Risk Assessor pulls information from the patient’s chart and mammography records automatically . This tight integration is crucial because it ensures decision support is delivered at the point of decision-making. Providers get timely advice within seconds, which increases the likelihood they will follow recommendations (as opposed to ignoring a later report or having to recall guidelines from memory). It also minimizes extra clicks and preserves efficiency – only orders that need intervention get pop-up feedback, otherwise the workflow is unchanged. Essentially, EHR integration makes these tools user-friendly and effective, weaving best-practice guidance into everyday care seamlessly.
What are the distinguishing features and benefits of Optum’s CareSelect suite as a whole?
Across the board, the CareSelect suite focuses on improving care appropriateness and reducing waste through evidence-based, EHR-embedded guidance. Each solution targets a different area (imaging, labs, risk assessment) with content tailored to that domain – e.g. Imaging leverages AUC from multiple medical societies , Lab uses Mayo Clinic’s lab test criteria , and Risk Assessor uses the Tyrer-Cuzick breast cancer risk model . A unifying feature is robust analytics: all three solutions collect data that health systems can use to monitor performance and outcomes (whether it’s imaging utilization rates, lab ordering patterns, or the identification of high-risk patients). By implementing the CareSelect suite, organizations benefit from more consistent, high-quality care – providers follow the latest guidelines, leading to fewer unnecessary tests and more targeted use of resources. In practical terms, this means lower costs (by avoiding redundant or low-value services), improved patient safety (avoiding needless exposure or procedures), and better compliance with regulations and quality standards (from PAMA in imaging to USPSTF recommendations in risk assessment)  . The distinguishing factor of CareSelect solutions is that they achieve these gains within the clinician’s workflow in real time, which is a powerful approach to change practice behavior. Each tool addresses a specific appropriateness gap, but together they promote a culture of evidence-based decision making that enhances efficiency and patient outcomes across the care continuum.
