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Healthcare delivery insights

 

 

Making health care more affordable

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Optimizing your payment integrity program

Discover payment integrity best practices to help you achieve your in-year cost savings goals.

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Best practices for reducing provider abrasion

Find out what is driving abrasion and what health plans can do to alleviate pain points.

E-book

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.

 

 

Better payer/provider relations within health plan markets

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Spend more time with members

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.

Guide

Engage providers impact member outcomes

Download our infographic to learn how Optum can take the burden off payers to impact provider performance.

Guide

Improve medicaid risk adjustment accuracy

Explore Medicaid best practices for health plans and learn three actions to take and when to take them.

White paper

4 steps to optimizing value-based care

Learn how combining these steps can help power a holistic workflow between payers and care delivery.

 

 

Driving plan growth and diversification at scale

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Article

Viewpoints on the 2025 CMS Final Notice

Download this executive summary to learn how these changes may affect your Medicare Advantage plan.

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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.

 

 

Advancing member health and experience

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Maternal and infant health insights

Optum Advisory uncovers disparities in maternal and infant outcomes — commercial vs. Medicaid — identifying key factors.

 

 

Latest guides

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E-book

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.

Article

How AI in pharmacy is powering new innovations

From predicting drug trend to earlier fraud protection, see how we’re leveraging AI to improve operations for clients and members.

Article

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.

 

 

Latest on-demand webinars

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E-book

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.

Article

How AI in pharmacy is powering new innovations

From predicting drug trend to earlier fraud protection, see how we’re leveraging AI to improve operations for clients and members.

 

 

Latest white papers

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E-book

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.

Article

How AI in pharmacy is powering new innovations

From predicting drug trend to earlier fraud protection, see how we’re leveraging AI to improve operations for clients and members.

Article

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.

 

 

Latest videos

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E-book

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.

Article

How AI in pharmacy is powering new innovations

From predicting drug trend to earlier fraud protection, see how we’re leveraging AI to improve operations for clients and members.

 All healthcare delivery insights

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 .

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.

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.

Extracting value-based care insights from claims data

Actionable insights for health plans and providers to adopt a data-driven approach and achieve value-based care goals.

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.

Viewpoints on the 2026 CMS Final Rate Announcement

Learn how the 6 key final changes may impact your organization in 2026.

Transforming care through payer-provider collaboration

Discover the key elements to creating a positive, mutually beneficial relationship.

Financial case connected care

Get thought starters for assessing how a connected care model can strengthen your financial position.

Enhancing fraud investigations with AI

Learn how AI is changing the fraud case review process.

Patient engagement leader

Everest Group recognizes Optum in its 2023 Patient Engagement Platforms PEAK Matrix® Assessment.

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.

Connected communities

A panel discussion examines how to use data-driven, virtual and automated technologies to advance and refine population health strategies.

Managing risk in value-based care delivery

Watch as Erik Johnson explores models for risk in delivering value-based care (VBC).

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.

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.

Staying current in your core admin platform

Get current, stay current and leverage the newest platform capabilities with ongoing release management.

Best practices for reducing provider abrasion

Find out what is driving abrasion and what health plans can do to alleviate pain points.

Optimizing your payment integrity program

Discover payment integrity best practices to help you achieve your in-year cost savings goals.

Validating short-stay hospital bills

Prevent inpatient billing errors for outpatient encounters.

StepWise Application Migration to the Cloud

Learn from health plan leaders on how to accelerate and optimize your cloud-adoption journey.

Automation and workforce strategies in healthcare

Get 6 key takeaways from a C-suite panel discussion.

Improving underwriting results with automation

Machine learning coupled with software features and cost-tuning delivered significantly improved predictive value and underwriting results.

Challenges when financing your EHR

Key themes and insights that can guide your organization toward a successful electronic health record (EHR) transformation.

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.

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.

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.

5 provider strategies to improve margins

Discover how healthcare organizations are prioritizing a path to improved financial sustainability and margins.

Strategies to reduce administrative costs

Strategies to fix payer-provider collaboration, streamline patient financial experience and apply AI technologies for better cost savings.

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.

Symmetry EBM Connect

Increasing compliance with evidence-based standards to enhance care.

Symmetry Oncology Analytics

Learn about powerful tools to measure the cost and quality of cancer care.

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.

Innovation help healthcare workforce crisis

Harvard Business Review Analytic Services and Optum leaders examine human-focused innovations for the health care workforce.

Path to techquity

New research explores how to use technology to advance health equity.

How CAPs directly impact your Stars performance

Stars performance is in your control. Learn how you can take action now.

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.

Best practices utilization review

Learn best practices of utilization review to help your health system maintain clinical, compliance and revenue integrity.

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.

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.

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.

Transform underwriting technology

Automation, technology and scalable staffing drive growth. 

4 steps to optimizing value-based care

Learn how combining these steps can help power a holistic workflow between payers and care delivery.

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.

Risk adjustment Star ratings success

Discover 5 strategies that will help your health plan be prepared to factor risk adjustment data into Star Ratings.

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.

SDOH solutions: Improving population health outcomes

See how to use technology to understand and implement effective health interventions.

Achieving equitable care: The shift to race-neutral equations

Discover how the InterQual team facilitated the timely adoption of new industry guidance for promoting health equity in clinical practice.

Viewpoints on the 2025 CMS Final Notice

Download this executive summary to learn how these changes may affect your Medicare Advantage plan.

Health plans system modernization

Learn how technology and infrastructure investments enable growth and help with evolving regulatory requirements and increasing competition.

Social Care Assistance helps member assessment

Optum helps health plans address member needs through screening and community-based organization (CBO) referral services.

Viewpoints on the 2026 CMS Advance Notice

Go inside the latest changes to the 2026 program.

Improving the provider experience

Learn about a modern and proactive approach to payment integrity for health plans.

Digital integration and the path to interoperability

Creating a connected system to improve risk and quality outcomes.

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.

Innovating risk adjustment strategies

Read this blog to learn how Renown Medical Group empowers clinicians and improves patient outcomes.

Help enhance coding accuracy with the HCC Tearsheet 2025

Accurate HCC codes are essential for effective care management and compliance.

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.

Meet consumer expectations while addressing provider frustrations

Learn how Patient Access and Engagement streamlines the end-to-end care journey.

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.

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.

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.

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.

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.

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

From data collection to intervention

Learn how you can leverage analytics to address social determinants of health.

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.

Filling revenue cycle resource shortfalls

Learn how to identify and overcome common revenue cycle challenges despite current labor market issues.

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.

Developing a best-in-class middle revenue cycle for hospitals

Explore the six focus areas for improving performance to create a best-in-class middle revenue cycle for your hospital.

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.

Achieving health equity: Strategies for payers

Learn more about a comprehensive solution for health payers to address health disparities and achieve health equity.

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.

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.

Revolutionizing cardiology

Discover how Boulder Community Health and Optum Advisory worked together to achieve smart growth and sustainable change.

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.

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.

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.

Aligning with CMS: Medicare Content Navigator and InterQual Transparency

Discover how to meet the latest regulatory requirements for Medicare Advantage plans.

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.

Connected care

See the whole picture for whole-person health.

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.

Five step InterQual evidence-based development process

The InterQual Criteria is developed through a rigorous, five-step process by our clinical development team.

Achieve claim pricing accuracy and efficiency

Learn how to create a framework that drives payment accuracy on the first pass.

Develop your growth strategy

Optum Market Advantage helps you choose your own path forward.

Choosing an accounts receivable partner

Selecting a strategic accounts receivable partner requires careful evaluation.

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.

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.

Driving innovation with new revenue cycle services

One organization decreased uncompensated care, increased loyalty and patient satisfaction, and connected patients with more funding sources.

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.

The criticality of evidence-based medicine

Evidence-based medicine improves quality of care while reducing the cost of care.

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.

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.

See how Optum can help you improve outcomes and lower costs for your members

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