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Member health and care management

Optum Specialty Management

Simplify specialty care with medical and pharmacy solutions that deliver enhanced analytics to inform strategy and lower costs.

We simplify the care path for patients with complex needs

Every patient deserves the simplest path to care. At Optum, we’re reimagining the healthcare experience with leading-edge solutions across medical and pharmacy needs. We're also removing barriers to getting the right care — even for patients with the most complex needs.

Grounded in deep clinical expertise and backed by the latest technology and data, we deliver innovative tools and integrated capabilities to address specialty needs in oncology, rheumatology, cardiovascular and transplant care. And by layering on rich analytics and reporting, we provide actionable insights to improve specialty strategies and augment savings along the way.

Specialty management solutions 

Solution suite

Payment integrity

Best for:
  • Payers

Improve payment accuracy across the claim lifecycle.

Software

Claims Edit System

Best for:
  • Payers

Achieve clean claims and maximize medical spend savings with our flexible, real-time claim editing software.

Software

Emergency Department Claim Analyzer – Facility

Best for:
  • Payers

Control rising emergency outpatient facility costs with automated, consistent and defensible E/M coding evaluation.

Software

Laboratory Benefit Management

Best for:
  • Payers

Reduce your lab spend and improve patient outcomes with our comprehensive approach.

Solution suite

Managed Transplant Program for Health Plans

Best for:
  • Payers

Health plans can better manage risk, control costs and improve transplant services.

Solution suite

Musculoskeletal (MSK) Solutions

Best for:
  • Payers
  • Employers

Manage escalating utilization and spend.

Solution suite

Oncology Solutions

Best for:
  • Payers
  • Employers

Our solutions address complex challenges and help manage cancer costs while improving outcomes and quality of care.

Solution suite

Specialty Pharma Solutions

Best for:
  • Providers
  • Payers

Manage specialty medical drug expenses.

Software

Specialty Fusion

Best for:
  • Payers

Experience a specialty drug management solution that does more by bringing medical and pharmacy benefits together at the point of care.

Solution suite

Transplant Resource Services

Best for:
  • Payers
  • Employers

We offer a high-quality nationwide provider network of transplant centers and significant discounts.

Solution suite

Transplant Solutions

Best for:
  • Payers

Get significant savings and statistically better clinical outcomes.

Industry insights

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3 Ways to Deal with Escalating Drug Costs

Article

3 ways to deal with escalating drug costs

Explore innovations custom built for today’s specialty challenges.

White Paper: 4 Myths on Carving Out Specialty Pharmacy

White paper

4 myths: Carving out specialty pharmacy

Integrating specialty pharmacy means better care, lower costs.

Revolutionizing Specialty Medication Management [E-book]

E-book

Revolutionizing specialty medication management

Get an in-depth assessment of the ways Specialty Fusion™ is revolutionizing specialty drug management.

Find out how Optum simplifies complex care delivery