AI that makes healthcare better for everyone
Turn AI ambition into measurable results by combining deep healthcare expertise, differentiated data assets, market-ready technology and proven delivery.
Optum has thousands of active use cases — including over 500 generative AI applications — in place today. Our workflow automation and responsible AI-based solutions help healthcare organizations harness the power of AI to improve:
- Efficiency
- Patient experiences
- Health outcomes
Driving real-world outcomes with enterprise healthcare AI
Elevating patient experiences
Optum AI tools modernize contact centers and supplement patient support systems with AI-assisted agents to simplify and streamline the member experience.
Our approach:
- Self-service tools, apps and healthcare chatbots help patients find fast, accurate answers to all their questions.
- AI-assisted agents can also tap into your clinical and financial workflows to give patients access to appointment information, claims status, billing details and payment responsibilities.
Real-world results for patients: Patient Access for Revenue Cycle Management eliminated approximately 300K calls annually through improved patient intent capture and 3,500 fewer agent-to-agent transfers.
Improving care outcomes
We help our hospital and health system partners unlock healthcare data and transform it through a flexible analytics and AI-enabled enterprise platform to help improve care quality.
Our approach:
- Proactively collecting all data points needed at the point of care helps our partners generate predictive insights into care and operating room efficiency.
- AI workflow automation ensures the right data is captured at the right time to help reduce the total cost of care and minimize variation across care settings, procedures, patients and physicians.
Real-world results for care efficiency: Crimson AITM enabled a 83% First Case On-Time Start (FCOTS) rate — a 10% increase compared to 2 years prior — by boosting hospital scheduling flexibility and efficiency.*
Driving financial performance
We focus on modernizing claims, billing and payment cycles for health systems by enabling real-time claim settlement before the patient arrives or at the point of care.
Our approach:
- Real-time exchange of data and payer decisions along with AI-driven automation helps streamline provider-health plan collaboration and decision-making.
- Improving cost management and payment integrity helps health plans lower administrative costs and optimize medical spend.
Real-world results for providers: Optum Real helped enable a 5-fold decrease in denials as well as patient care cost estimation accuracy of 95.6%.
Optimizing the workforce
Optum AI workflow automation helps health plans minimize the workforce constraints and manual processes that limit their ability to scale population health programs and drive efficient risk and quality outcomes.
Our approach:
- AI-driven automation optimizes workforce capacity by reducing administrative burden, boosting productivity and enabling teams to scale without added headcount.
- Workflow automation tools can connect platforms and support operational processes while ensuring documentation and audit-ready reporting.
Real-world results for workforce optimization: Retrieval Services helped enable 99.6% AI precision in retrospective chart retrieval and a 4-fold increase in charts per hour reviewed.
Applying our healthcare AI expertise
Proven AI solutions enable real innovation, simplified operations and improved outcomes.
Expert-led AI integration
We deploy expert teams uniquely skilled in both healthcare and AI to lead every part of your AI transformation.
Connected solutions
Our integrated, tested AI solutions deliver results across thousands of use cases in our own care settings and at partner sites — at scale.
Responsible and human-first
We apply AI responsibly, using deep technical expertise and ethical frameworks, while prioritizing human control and decision-making.
Collaborative partnerships
We work together with you — from problem definition through activation — to deliver a custom solution that’s right for your organization.
Explore solutions powered by
Optum AI innovation
Clinical decision support solutions
Software
Case Advisor
Artificial intelligence (AI) and evidence-based content are combined in this comprehensive utilization management (UM) workflow solution.
Software
InterQual Auth Accelerator
Our evidence-based clinical decision support solution for payers, providers and government agencies helps ensure clinically appropriate medical utilization decisions.
Software
InterQual AutoReview
This medical review automation solution increases utilization management (UM) efficiency and review accuracy.
Service
Hospital Case Management Optimization
We offer real-time data and analytics, applied innovation, and expert guidance and investment in case management to optimize performance.
Data and analytics solutions
Research
Life sciences solutions
Drive results across the drug development lifecycle with real-world data, analytics and clinical expertise — helping you move from concept to impact faster.
Solution suite
Crimson AI
Unlock healthcare data and transform it into robust business intelligence using AI-enabled feedback and suggested interventions.
Software
Crimson AI Provider Review
Streamline physician review management and improve provider engagement with a unified AI-enabled workflow tool.
Software
Crimson AI Surgical Capacity
Optimize surgical scheduling and operating room utilization with data-driven analysis and insights.
Software
Crimson AI Surgical Cost Module
Enhance surgical service line profitability by utilizing data-driven insights to streamline costs and improve efficiency.
Financial solutions
Service
Claim Review
Prevent improper payments, reduce medical spend and minimize provider abrasion with our comprehensive suite of pre- and post-pay solutions.
Service
Third-Party Liability
Identify and validate primary policy coverage with accurate eligibility data.
Software
Optum Integrity One
Unlock new levels of efficiency, accuracy and revenue integrity with our revolutionary end-to-end solution for the middle revenue cycle.
Service
Clinical Language Intelligence (CLI)
Learn how Optum AI products use natural language processing (NLP) to make healthcare work smarter.
Operations and technology solutions
Solution suite
Change Healthcare Radiology Solutions
Improve productivity with an AI-enabled enterprise radiology portfolio to streamline workflow.
Solution suite
Optum Real
Improve transparency and administrative efficiency through real-time payer-provider connection.
Solution suite
Comprehensive coding solutions
Explore a robust suite of AI-driven coding solutions with options to fit healthcare organizations of every size and structure.
Service
Retrieval services
Industry-leading chart retrieval services with a national footprint and continually expanding digital retrieval methods.
Pharmacy benefit management solutions
Solution suite
Smarter Pharmacy Benefits with AI
We’re using responsible artificial intelligence (AI) capabilities to supercharge pharmacy benefit experiences and drive meaningful results.
Related healthcare insights
Case study
See how AI-powered technology and personalized member engagement are helping to identify and enroll more members into Medicaid programs.
White paper
A strategic blueprint to modernize your payment integrity program through intelligent, AI-driven health plan operations.
Article
Learn how Optum takes an innovative approach to smarter, more accurate healthcare coding.
White paper
Transform claims with AI and API integration to reduce denials, strengthen transparency and drive more efficient, intelligent operations.
*First Case On-Time Start (FCOTS) rate measures the percentage of first-scheduled surgical cases in a day that begin exactly at the scheduled time.