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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

Payment integrity solutions for health plans

Improve payment accuracy and maximize medical expense savings across the claim lifecycle.

Claims Edit System

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

Emergency Department Claim Analyzer – Facility

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

Laboratory Affordability Products

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

Managed Transplant Program

Manage the risks of complex medical conditions.

Musculoskeletal (MSK) Solutions

Manage escalating utilization and spend.

Oncology Solutions

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

Specialty Pharma Solutions

Manage specialty medical drug expenses.

Specialty Fusion

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

Transplant Resource Services

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

Transplant Solutions

Get significant savings and statistically superior outcomes.

Related healthcare insights

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Article

3 ways to deal with escalating drug costs

Explore innovations custom built for today’s specialty challenges.

White paper

4 myths: Carving out specialty pharmacy

Integrating specialty pharmacy means better care, lower costs.

E-book

Slowing specialty pharmacy carve out stampede

Discover specialty medication management strategies to help you slow carve-out and stop member attrition.

Find out how Optum simplifies complex care delivery