Federal Health Programs by Agency

Since 2018, Optum Serve has managed the Military Health System Global Nurse Advice Line (GNAL), which provides timely access to health care services for more than 9 million MHS beneficiaries worldwide.

From helping military families with health care concerns to making acute care appointments, the GNAL provides full nurse triage services, health care advice, appointment scheduling and care coordination for beneficiaries. In 30 seconds or less, GNAL users can reach a nurse directly for advice or a care coordinator for customer service. The GNAL averages about 1,200 patient encounters per day.​

Optum Serve supports all 66 Military Entrance Processing Commands as part of the USMEPCOM Medical Referral Services contract, which provides specialty health consultations and diagnostic tests for U.S. military applicants. ​

If an MEPS physician identifies a potential concern during a routine examination of an applicant, they will refer that applicant to a network provider for a specialty consult or diagnostic testing. The provider assesses the applicant and provides feedback to the MEPS physician that will assist in their determination of the applicant’s medical qualifications to serve. ​

Specialty physician consultations include allergy, audiology, cardiology, dermatology, gynecology, neurology, ENT, podiatry, optometry, psychology, psychiatry, internal medicine, ophthalmology, orthopedic, pulmonology and urology, as well as medical and laboratory diagnostic testing services.​

Clinical Practice Guidelines (CPGs) are designed to inform shared decision-making by clinicians and patients regarding diagnosis, treatment and other care management. In particular, evidence-based CPGs are informed by a rigorous methodology including systematic reviews of evidence and assessment of the benefits and harms of alternative care options. ​

For a joint program between the VA and DoD, Optum Serve leverages an interdisciplinary team of clinicians, health services researchers and health informaticians to facilitate and provide technical and managerial support on more than 20 CPGs, including guidelines on asthma, chronic kidney disease, concussion/mild traumatic brain injury, diabetes, hypertension, low back pain, post-traumatic stress disorder and acute stress reaction, and opioid therapy for chronic pain. ​

Properly implemented, evidence-based CPGs support high-quality care, reduce errors, improve patient outcomes and promote health care system accountability. 

Optum Serve is honored to support the CDC’s World Trade Center Health Program and William Street Clinic. The program provides care to individuals who were present in the New York City (NYC) Disaster Area from September 11, 2001, to July 31, 2002.

Eligible individuals who were exposed to environmental contaminants during the attacks have access to services such as health assessments, diagnostic testing, cancer screening, focused treatment, pharmacy benefits, and case management. The programs serve more than 6,000 participating members who reside in the New York Metro Area.

Optum Serve is a proud partner with the Centers for Medicare and Medicaid Services (CMS), helping to maintain the CMS One Program Integrity (PI) system. One PI is the CMS enterprise resource created to identify, deter and prevent all fraud, waste and abuse activities across the agency. One PI supports more than 2,100 users requesting over 54,000 monthly data requests, resulting in millions of dollars of savings and program integrity improvements.​

Additionally, the One PI system established an online interactive mapping tool to identify Medicare Part D opioid prescription claims within the U.S., allowing users to view opioid claims at the local level to understand how the epidemic is impacting communities. 

Optum Serve supported efforts by CMS in the way the agency compensates Medicare providers and assigns identification numbers to 60+ million Medicare beneficiaries. 

Specifically, Optum Serve provided support to CMS for the Social Security Number Removal Initiative (SSNRI) to protect citizens’ identity against fraud and theft by removing Social Security numbers from their Medicare cards and replacing them with Medicare Beneficiary Identifiers (MBI). 

As part of this effort, Optum Serve deployed technology and program management experts and rigorous management for oversight and facilitating decision-making.

Optum Serve also provided support to CMS for Quality Payment Program (QPP) initiative that replaces the Sustainable Growth Rate (SGR) formula, which previously drove the reimbursement schedules for clinicians participating in Medicare. 

This program incentivizes providers to move from volume to quality-based payment models that improve patient outcomes and reduce costs. As part of this effort, Optum Serve served as business, technical and product management integrator to transition CMS from Waterfall to Agile and successfully create the QPP portal to accept and score performance data from the medical community.

As a trusted partner to CMS, Optum Serve provides design and operational support and technical assistance to implement new value-based payment models. These models are designed to transform health care delivery and positively impact the health of millions of people.

Optum Serve also conducts independent evaluations to determine whether the models meet CMS goals. Through learning systems and collaborations, Optum Serve enhances knowledge sharing and facilitates the dissemination and adoption of best practices. Some examples include:

• State Innovations Model All-Payer Operations: Optum Serve provides design and operational support and technical assistance for All-Payer Model work within the Center for Medicare & Medicaid Innovation’s (CMMI) State Innovation Models Group (SIM). The purpose of these state models is to test whether transformation efforts will produce greater results when implemented in the context of an all-payer rate setting system.
• Evaluations: Optum Serve conducts evaluations of several bundled payment models for CMS. Bundled payment models link the payments for physician, hospital and other health care provider services for an episode of care to incentivize all providers involved in that episode to coordinate services across all delivery settings.
• Learning Systems: Optum Serve has more than a dozen learning system contracts with CMS, many of which focus on value-based purchasing, including the Maryland Primary Care Practice Model, the Comprehensive Joint Replacement Learning System, the Center for Medicare & Medicaid Innovation Cross Model Learning Network and the Home Health Value-Based Purchasing Model Technical Assistance. 

Optum is a proud partner with the VA through its Community Care Network (CCN). We are the third-party administrator for the VA CCN for Regions 1, 2 and 3, encompassing 36 states, Puerto Rico, the U.S. Virgin Islands and the District of Columbia. 

Through the CCN, Veterans have access to regional networks of high-performing, licensed health care providers who work together with the VA to ensure Veterans receive timely, high-quality care in the right setting. Through this network, VA medical staff can authorize and schedule care from a community care provider with the Veteran’s approval. 

To support this contract, Optum leverages its extensive network and relationships across UnitedHealth Group and beyond to provide a robust provider network for the VA in these regions. This includes medical, behavioral, chiropractic, skilled nursing, vision, pharmacy, dental and other complementary and integrative health services like hypnotherapy and Tai Chi. In addition, Optum processes claims from providers who see Veterans as part of CCN.

Under the Veterans Benefits Administration Medical Disability Examinations program, Optum Serve assists the VA in providing quality compensation and pension examinations to Veterans seeking benefits for service-connected health issues. Clinical findings from the examinations are delivered to the government to facilitate timely disability award determinations.

In 2023, Optum Serve performed more than 1.27M+ compensation and pension examinations for Veterans. This includes medical, audio, mental health, vision, traumatic brain injury and dental exams for Veterans.

Learn more about medical disability examinations

Clinical Practice Guidelines (CPGs) are designed to inform shared decision-making by clinicians and patients regarding diagnosis, treatment and other care management. In particular, evidence-based CPGs are informed by a rigorous methodology including systematic reviews of evidence and assessment of the benefits and harms of alternative care options. 

For a joint program between the VA and DoD, Optum Serve leverages an interdisciplinary team of clinicians, health services researchers and health informaticians to facilitate and provide technical and managerial support on more than 20 CPGs, including guidelines on asthma, chronic kidney disease, concussion/mild traumatic brain injury, diabetes, hypertension, low back pain, post-traumatic stress disorder and acute stress reaction, and opioid therapy for chronic pain. 

Properly implemented, evidence-based CPGs support high-quality care, reduce errors, improve patient outcomes and promote health care system accountability. 

The Optum Health Claims Data Warehouse receives and analyzes health claims from more than 100 plans supporting OPM’s Federal Employees Health Benefits Program and the state insurance exchanges. This data warehouse provides extensive analytic tools to OPM for the analysis of the Affordable Care Act.​

Optum Serve is proud to support the Department of Education’s Education Central Application Processing System (EDCAPS), a platform that includes some of the mission-critical systems that support various Department of Education Programs. 

The EDCAPS contract supports the department with the maintenance, operation and enhancement of the EDCAPS systems, including Financial Management Support System, Grants system G5, and Contracts and Purchasing Support Software. 

The program also helps the agency improve efficiency, save costs, support compliance with regulations (e.g., HSPD-12, DATA Act, CARES Act, etc.) and integrate new functionality into the system. It is available to all federal agencies.