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Increasing affordability | Cultivating provider relations | Driving growth at scale | Advancing member health and experience | Guides | On-demand webinars | White papers | Videos
Making health care more affordable
White paper
Discover payment integrity best practices to help you achieve your in-year cost savings goals.
White paper
Find out what is driving abrasion and what health plans can do to alleviate pain points.
E-book
Learn how a comprehensive claim review strategy can help you stop repeat errors and increase payment accuracy across the claim lifecycle.
Better payer/provider relations within health plan markets
White paper
See how prospective assessment programs can reduce administrative burden. Physicians spend less time on paperwork, so they can focus on what matters most: member care.
![Engage Providers to Impact Member Outcomes [Infographic]](/content/dam/optum-dam/images/business/insights/field-team-supports-providers-better-outcomes-1080x720.png)
Guide
Download our infographic to learn how Optum can take the burden off payers to impact provider performance.
Guide
Explore Medicaid best practices for health plans and learn three actions to take and when to take them.
White paper
Learn how combining these steps can help power a holistic workflow between payers and care delivery.
Driving plan growth and diversification at scale
Article
Download this executive summary to learn how these changes may affect your Medicare Advantage plan.
White paper
Perform key actions to manage your Stars performance with a focus on member engagement. Learn how to take control of your Star ratings now.
Advancing member health and experience
White paper
Optum Advisory uncovers disparities in maternal and infant outcomes — commercial vs. Medicaid — identifying key factors.
Latest guides
Case study
An academic medical center is revolutionizing radiology education with cloud-native technology, enhancing case creation, anonymization and remote access.
Article
As health plans address billing, coding and inpatient utilization issues, readmissions have drawn renewed focus as a payment integrity risk.
Article
See if your PBM is giving you the tools and guidance you need to balance savings with improved outcomes.
Latest on-demand webinars
Case study
An academic medical center is revolutionizing radiology education with cloud-native technology, enhancing case creation, anonymization and remote access.
Article
As health plans address billing, coding and inpatient utilization issues, readmissions have drawn renewed focus as a payment integrity risk.
Latest white papers
Case study
An academic medical center is revolutionizing radiology education with cloud-native technology, enhancing case creation, anonymization and remote access.
Article
As health plans address billing, coding and inpatient utilization issues, readmissions have drawn renewed focus as a payment integrity risk.
Article
See if your PBM is giving you the tools and guidance you need to balance savings with improved outcomes.
Latest videos
Case study
An academic medical center is revolutionizing radiology education with cloud-native technology, enhancing case creation, anonymization and remote access.
Article
As health plans address billing, coding and inpatient utilization issues, readmissions have drawn renewed focus as a payment integrity risk.
All healthcare delivery insights
The state of value-based care in 2025: Growth and challenges
Unpack the state of VBC in early 2025 and see where it’s going next. Learn how specialty care will fit into the future VBC landscape.
How Optum supports value-based goals with powerful products
See how Optum’s products help hospitals succeed with value-based contracts, earning appropriate incentives and avoiding penalties.
Achieving health equity: Strategies for payers
Learn more about a comprehensive solution for health payers to address health disparities and achieve health equity.
AI advancements bridge the gap to dual eligibility enrollment
See how AI-powered technology and personalized member engagement are helping to identify and enroll more members into Medicaid programs.
Coding modernization: Leveraging the power of AI
Learn how Optum takes an innovative approach to smarter, more accurate healthcare coding.
How mature is your health plan's payment integrity program?
Discover the five levels of maturity and practical tips to strengthen your plan's performance.
Trends shaping the future of clearinghouses
Discover 5 key trends that can help healthcare organizations streamline processes, minimize errors and deliver faster, more reliable services.
Improve provider engagement mobile query
Respond to query opportunities in real time and get access to clinical and coding decision-making information with our secure mobile app.
Innovation help healthcare workforce crisis
Harvard Business Review Analytic Services and Optum leaders examine human-focused innovations for the health care workforce.
Proactively renew dual eligibles for Medicaid
Learn how Optum uses AI, state-specific logic and robust workflows to help with proactive dual eligible Medicaid renewals.
Revolutionizing cardiology
Discover how Boulder Community Health and Optum Advisory worked together to achieve smart growth and sustainable change.
Symmetry Oncology Analytics
Learn about powerful tools to measure the cost and quality of cancer care.
Payment integrity strategies that help generate savings quickly
This guide can help you optimize your payment integrity program and achieve savings goals within 12 months.
Payer-provider collaboration: Improving patient outcomes
Tech and value-based care can improve payer-provider collaboration, reduce admin burden and enhance patient outcomes through data sharing.
Trends for health plan quality performance
Learn how health plans can stay ahead of the curve and prepare for key trends likely to impact their quality programs in 2025 and beyond.
VBC 5.0: Mastering the 5 pillars of value-based care success
Explore the 5 pillars of value-based care every health system, health plan and provider needs to succeed.
Shifting to the left: Innovating prospective risk adjustment
Arati Swadi, VP of Risk Adjustment at Optum, shares how Prospective Solutions are paving the way for value-based care.
Improving the provider experience
Learn about a modern and proactive approach to payment integrity for health plans.
Innovating care for vulnerable populations
Join speakers Saad Ahmad and Jared Landis to see how in-home technology helps payers give better care, solve social problems and improve health for people who need it most.
Transform your risk adjustment strategy
A strategic risk adjustment analytics framework guide for health plans.
Help enhance coding accuracy with the HCC Tearsheet 2025
Accurate HCC codes are essential for effective care management and compliance.
The cost of inaccurate data: An overview of risk adjustment audits
As CMS moves to increase RADV audits, payers must understand the implications of RADV and find the right support for a smooth audit process
How CAPs directly impact your Stars performance
Stars performance is in your control. Learn how you can take action now.
Beyond the hype: Real AI use cases to drive payment accuracy
Explore real use cases for using AI to drive payment accuracy and the effective ways health plans are leveraging these emerging technologies.
Navigating the two-midnight rule in the Medicare Advantage world
Watch this on-demand webinar to hear top insights and an analysis of the latest trends impacting the utilization management function since the latest changes became effective.
Is poor market visibility compromising your growth?
Optum offers an infographic to help hospitals better understand true growth potential and the potential impact of physician outreach.
Going Beyond Risk Adjustment in Provider Engagement
Learn innovative techniques for risk adjustment workflows that help emphasize pre-visit chart prep and clinical suspect identification.
Transform underwriting technology
Automation, technology and scalable staffing drive growth.
The missing link to risk adjustment success
Discover how program orchestration helps health plans align systems, vendors and strategies amid regulatory and financial pressures.
Automation and workforce strategies in healthcare
Get 6 key takeaways from a C-suite panel discussion.
Member engagement: Advancing whole-person care
By collaborating with health plans and their members, Optum helps build a more cohesive, supportive system that prioritizes member needs.
Integrated risk and quality programs: A strategic approach
Unlock new efficiencies with a digital-first, AI-powered approach to empower value-based care and enhance health plan performance.
Five step InterQual evidence-based development process
The InterQual Criteria is developed through a rigorous, five-step process by our clinical development team.
Unlock the future of risk and quality in healthcare
Discover how Optum is helping revolutionize the healthcare industry with innovative solutions in risk adjustment, quality improvement and member engagement.
Unlocking new possibilities in risk adjustment
Learn how Optum helps health plans improve performance by using data, AI and smart technology to enhance accuracy, efficiency and integration.
Forging a new frontier in mental and behavioral health
Overcome today's barriers with leadership, collaboration and investment strategies that proactively address mental and behavioral health.
The future of payment integrity
Unpack key trends shaping the future of payment integrity and discover steps you can take to get started on your path to payment precision.
Improving underwriting results with automation
Machine learning coupled with software features and cost-tuning delivered significantly improved predictive value and underwriting results.
Navigating the challenges of outpatient evaluation for patients with acute coronary syndrome
Learn how the InterQual level of care team tackled a content development challenge following updated societal guidelines for acute coronary syndrome.
Navigating the future of addiction treatment with The ASAM Criteria® Fourth Edition
Explore the development of The ASAM Criteria® Fourth Edition and discover tools and programs available to support your transition.
Help your bottom line through UM optimization
An efficient utilization management (UM) program is a must to deliver high-quality patient care while managing costs.
2024 Stars preview: A path forward
Perform key actions to manage your Stars performance with a focus on member engagement. Learn how to take control of your Star ratings now.
Patient education: The secret to success in risk adjustment and VBC
Effective patient education fosters adherence to medical treatments and promotes healthy patient behaviors, in turn facilitating successful risk adjustment and value-based care.
Your guide to digital quality measurement in 2026
Rethinking quality in the digital frontier
Learn about NCQA’s shift to digital quality reporting and how Optum can help your organization stay ahead.
5 provider strategies to improve margins
Discover how healthcare organizations are prioritizing a path to improved financial sustainability and margins.
5 AI use cases in payment integrity
A strategic blueprint to modernize your payment integrity program through intelligent, AI-driven health plan operations.
Validating short-stay hospital bills
Prevent inpatient billing errors for outpatient encounters.
Streamlining DME with accuracy and efficiency
Explore how health plans can streamline their DME process to deliver a seamless, connected experience that enhances the payer experience.
Strategies to reduce administrative costs
Strategies to fix payer-provider collaboration, streamline patient financial experience and apply AI technologies for better cost savings.
From data collection to intervention
Learn how you can leverage analytics to address social determinants of health.
Unlock the full potential of your payment integrity office
Discover the 5 key components of a high-performing payment integrity program. Build a structure that helps optimize savings.
Managing risk in value-based care delivery
Watch as Erik Johnson explores models for risk in delivering value-based care (VBC).
Optum revenue cycle solutions
Improve financial outcomes, decrease operational costs, improve efficiency and elevate the patient experience with our revenue cycle solutions.
The criticality of evidence-based medicine
Evidence-based medicine improves quality of care while reducing the cost of care.
Data collection for risk adjustment compliance
Learn the 4 core pillars of a strong data collection process — a strategic imperative for improving healthcare outcomes.
Path to techquity
New research explores how to use technology to advance health equity.
Extracting value-based care insights from claims data
We provide actionable insights for health plans and providers to adopt a data-driven approach and achieve value-based care goals.
Enhancing fraud investigations with AI
Learn how AI is changing the fraud case review process.
Best practices utilization review
Learn best practices of utilization review to help your health system maintain clinical, compliance and revenue integrity.
Pharmacogenomics in medication selection
Enable more effective and targeted treatments that address unique needs for patients with pharmacogenomics.
5 building blocks for an effective member engagement strategy
Learn how to build a holistic engagement strategy to help improve member satisfaction and better achieve your goals.
The state of risk adjustment, quality programs and value-based care
Learn what insights we discovered by partnering with Frost & Sullivan on a benchmarking survey of payers and providers.
Trends shaping the future of payment integrity
Explore the market trends that are shaping the future of payment integrity and learn what they will mean for health plans.
SDOH solutions: Improving population health outcomes
See how to use technology to understand and implement effective health interventions.
Building a connected care model
People feel the disconnect of a siloed healthcare system. Get insights on how to build more holistic care through connected care models.
Claim review: How to adopt best practices
Learn how a comprehensive claim review strategy can help you stop repeat errors and increase payment accuracy across the claim lifecycle.
Risk adjustment Star ratings success
Discover 5 strategies that will help your health plan be prepared to factor risk adjustment data into Star Ratings.
Beyond the pitch: How to evaluate AI vendors with clinical confidence
Learn what to look for in an AI healthcare partner — from clinical rigor to transparency — to support safe, effective implementation.
Viewpoints on the 2027 CMS Advance Notice
The proposed changes contain a mix of both opportunities and challenges. Read the report to learn how these changes could impact your organization.
A new approach to managing genetic testing
Explore ways to better manage genetic testing to ensure the right test is used at the right time to determine the right care.
We follow the science and defend against bias
See how Optum follows the science where it leads, validating the research we find to uphold the clinical integrity of InterQual content.
Payer-provider interoperability to enhance prospective risk management
Payers and providers are using advanced technology in healthcare to create efficient processes that capture chronic conditions and deliver better health outcomes .
Achieving equitable care: The shift to race-neutral equations
Discover how the InterQual team facilitated the timely adoption of new industry guidance for improving health outcomes in clinical practice.
Simplifying provider engagement for health plans
See how Optum can help your providers deliver coordinated, high-quality care for patients.
Streamlining real-time eligibility and claims
Discover how real-time eligibility, benefits and claim status inquiries can improve accuracy and efficiencies for payers and providers.
Emerging trends impacting payment integrity
We take a look at how market shifts, AI innovation and cost pressures are redefining health plan strategies.
Staying current in your core admin platform
Get current, stay current and leverage the newest platform capabilities with ongoing release management.
AI and API integration for reduced denials
Transform claims with AI and API integration to reduce denials, strengthen transparency and drive more efficient, intelligent operations.
Financial case connected care
Get thought starters for assessing how a connected care model can strengthen your financial position.
Patient engagement leader
Everest Group recognizes Optum in its 2023 Patient Engagement Platforms PEAK Matrix® Assessment.
StepWise Application Migration to the Cloud
Learn from health plan leaders on how to accelerate and optimize your cloud-adoption journey.
Tailoring Medicare plans for specific populations
Learn some of the best practices and strategies for serving your members effectively through special needs planning and beyond.
Risk adjustment solutions: The impact of medical innovations
Explore the influence of key innovations on risk adjustment solutions. Learn how these technologies are shaping the future of healthcare.
Innovating risk adjustment strategies
Read this blog to learn how Renown Medical Group empowers clinicians and improves patient outcomes.
Analytics in action: Building a strategic framework for risk adjustment
Explore how to harness the power of analytics to shape your 2026 risk adjustment strategy.
Driving innovation with new revenue cycle services
One organization decreased uncompensated care, increased loyalty and patient satisfaction, and connected patients with more funding sources.
The impact of CAPs on Stars ratings
Learn more about the impact and implications of a Corrective Action Plan and how Stars and these corrective actions are interconnected.
The perfect blend: AI and human validation in condition capture
In the ever-evolving landscape of healthcare, the need for complete and accurate risk adjustment has never been more critical.
Challenges when financing your EHR
Key themes and insights that can guide your organization toward a successful electronic health record (EHR) transformation.
Optum a leader in GenAI payer workflow platforms
Optum has been recognized with a Product Leadership Recognition in the North America GenAI payer workflow platform industry by Frost & Sullivan.
Unlock the power of pharmacogenomics with Optum® Precision Script
Integrate PGx data into pharmacy claims to support safer prescribing, smarter medication management and better patient outcomes.
Solutions to simplify Medicare compliance
Discover solutions that help you efficiently and consistently comply with CMS-4201 and CMS-0057 requirements.
Managing the high costs of complex conditions with Centers of Excellence
How to build a resilient benefits strategy that drives access and improves outcomes sustainably.
Social Care Assistance helps member assessment
Optum helps health plans address member needs through screening and community-based organization (CBO) referral services.
Stay current on core claims systems releases
Stay current on core claims systems releases See how upgrade as a service from Optum helps health plans stay up-to-date on admin and core claims platform releases.
AI is helping build a better, more human health care experience
As rising costs, administrative friction and uneven access continue, the need for smarter and simpler solutions remains urgent.
Creating a seamless durable medical equipment experience
Discover how a digital-first DME strategy can enhance efficiency and transparency for health plans, clinicians and members.
Best practices for efficient medical record retrieval
Medical record retrieval is an essential task for healthcare providers and insurers, but it can often be a complex and time-consuming process.
Site-of-care decisions: Navigating safety, access and value
Learn about benefits and challenges of the site-of-care shift and how InterQual Site of Service helps organizations navigate the transition.
Developing evidence-based tools for accessible and quality care
Explore how evidence-based tools like The ASAM Criteria® Navigator and InterQual® Substance Use Disorders Criteria are helping payers and providers efficiently and effectively navigate the complex substance use disorder landscape today.
Optum is the leader in payer-provider collaboration
Optum has been named the market leader in the Frost Radar™: Healthcare Payer-Provider Collaboration Solutions in North America report by Frost & Sullivan.
Digital integration and the path to interoperability
Creating a connected system to improve risk and quality outcomes.
Promises and pitfalls: AI and clinical decision-making
Learn more about why evidence-based criteria and clinician insight are needed for informed and trustworthy decisions while leveraging AI.
Filling revenue cycle resource shortfalls
Learn how to identify and overcome common revenue cycle challenges despite current labor market issues.
Transforming CDI and coding with advanced analytics
Banner Health partnered with Optum to pair AI-powered technology with advanced analytics, enabling an expanded focus on quality and risk-adjustment initiatives.
The future of quality reporting
Learn how AI, interoperability and ECDS are transforming healthcare quality reporting and the solutions that can help you stay ahead.
Symmetry EBM Connect
Increasing compliance with evidence-based standards to enhance care.
Chargemaster consolidation and optimization
Learn more about improving charge capture and revenue assurance for EHR implementation.
Opening digital doors for all consumers
Digital gateways are the new social determinant of health. Read this strategy guide on expanding access and health equity.
Assessing your Annual Enrollment Period performance: A checklist
You made it through the Annual Enrollment Period (AEP). Assess how things went so you can strategically plan for the 2027 AEP.
7 key trends in risk adjustment
Examine the trends reshaping risk adjustment and learn how your organization can stay ahead in 2026.
Best practices for identifying overpayments
Learn how a multi-tiered approach to data mining helps maximize savings and achieve payment accuracy earlier in the claim lifecycle.
NEJM Catalyst Q&A: Value-based care
Dr. Wyatt Decker discusses the path forward for value-based care, including implementation challenges, benefits and keys to success.
Empowering providers to focus on patient care
Our provider performance team partners with your providers to reduce administrative burden and drive positive patient outcomes.
Aligning with CMS: Medicare Content Navigator and InterQual Transparency
Discover how to meet the latest regulatory requirements for Medicare Advantage plans.
Addressing the Root Causes of Mental Health Disparities
Discover steps and strategies to reduce disparities among vulnerable populations and remove barriers for more equitable mental health care.
Beyond payment integrity: An AI-driven approach to affordability
Medical costs are rising, and health plans need solutions. See how an AI-driven, enterprise-wide approach may be the key to affordability.
Risk adjustment coding 101 for providers
Learn actionable strategies and best practices for effective implementation of coding programs for provider organizations.
Develop your growth strategy
Optum Market Advantage helps you choose your own path forward.
Opportunities in the DSNP market: Essential insights for MA leaders
Join speakers Cori Leech and Jared Landis as they discuss how to meet the challenges facing health plans in the D-SNP market right now.
Innovation Without Compromise: Navigating Faster Turnaround Times with Responsible AI
Discover what to ask AI vendors and how to build a strategy that supports accelerated decision-making, reduces administrative burden and maintains clinical integrity.
Health plans system modernization
Learn how technology and infrastructure investments enable growth and help with evolving regulatory requirements and increasing competition.
Trends and perspectives for health plans
Together, we are driving toward the same things for our healthcare system — better quality, lower cost and higher consumer and provider satisfaction.
Achieve claim pricing accuracy and efficiency
Learn how to create a framework that drives payment accuracy on the first pass.
Best practices for reducing provider abrasion
Find out what is driving abrasion and what health plans can do to alleviate pain points.
Transforming care through payer-provider collaboration
Discover the key elements to creating a positive, mutually beneficial relationship.
Meet consumer expectations while addressing provider frustrations
Learn how Patient Access and Engagement streamlines the end-to-end care journey.
Frequently asked questions about risk adjustment audits
Preparing for and undergoing an audit can be a massive task. Optum provides support every step of the way.
Optimizing your payment integrity program
Discover payment integrity best practices to help you achieve your in-year cost savings goals.
Connected communities
A panel discussion examines how to use data-driven, virtual and automated technologies to advance and refine population health strategies.
Developing an industry-leading middle revenue cycle for hospitals
Explore the six focus areas for improving performance to create an industry-leading middle revenue cycle for your hospital.
4 steps to optimizing value-based care
Learn how combining these steps can help power a holistic workflow between payers and care delivery.
A forward approach to medical coding accuracy
Our coding software can systemize aspects of your middle revenue cycle, resulting in a seamless and cost-effective workflow.
Establishing trust to improve value-based care outcomes
Gain insights into how supporting providers can help increase engagement and reduce administration burden for better patient care.
Beyond change management: Real digital transformation
Digital transformation fails when change management is an afterthought. Learn how to address the problem, people and culture for success. c
Choosing an accounts receivable partner
Selecting a strategic accounts receivable partner requires careful evaluation.
The new AI approach to eliminating contract-based errors
Learn how we're leveraging AI to help minimize payment errors associated with manual contract reviews.
Viewpoints on the 2026 CMS Final Rate Announcement
Learn how the 6 key final changes may impact your organization in 2026.
The AI-driven health plan
This white paper offers expert perspectives on leveraging AI to optimize health plan operations efficiency, growth and member experiences.
Improving transparency in payer-provider connections
Explore how real-time connections can enable more accurate claim submission to create a more efficient healthcare payment system.
Transforming payer operations with Steve Yurjevich
Optum payer market CEO Steve Yurjevich discusses opportunities to streamline operations and deliver more value across the health system.
Quality innovation: A member-first approach
Learn how Optum uses a member-first digital approach, advanced analytics and AI to enhance quality for clients and health plan members.
Strengthening risk adjustment with payer and provider collaboration
Learn how Optum utilizes scale, innovation and strong partnerships to optimize risk adjustment services for both providers and payers.
Fix readmission vulnerabilities before they become overpayments
As health plans address billing, coding and inpatient utilization issues, readmissions have drawn renewed focus as a payment integrity risk.
Guide to achieving seamless digital integration
Optum offers digital solutions in 3 key areas: data acquisition, insight sharing and enhanced functionality.