Unlock the power of integrated solutions
As regulations continue to evolve, it can be challenging for healthcare organizations to keep up. Optum is uniquely positioned at the intersection of payers and providers — and is hands-on with you to help overcome challenges, identify opportunities, support your organization’s goals and improve patient outcomes.
We combine cutting-edge technology, advanced analytics and deep industry expertise to provide a holistic view of patient health. We can help your organization:
- Improve risk score accuracy: Enhance risk adjustment programs with precise member condition documentation and accurate reimbursement.
- Drive quality improvement: Leverage data-driven insights to close care gaps, improve HEDIS® performance and achieve higher Star Ratings.
- Foster member engagement: Develop targeted outreach programs that motivate members to take action, improving health behaviors and outcomes.
- Elevate value-based care outcomes: Meet providers where they are and support their journey to value-based care success by equipping them with insights at the point of care and beyond.
Key benefits
Configurable suite of solutions
Our size, scale and expertise allow us to configure our solutions to meet the individual needs and goals of our clients. Use us where you need us.
Deep knowledge and insights
Our demonstrated success and more than 20 years of experience in the risk adjustment industry allow us to evolve with market demands.
Consultative and tailored approach
Every organization’s data, resources and needs are unique. That’s why we take a customized and consultative approach to risk and quality programs.
Outcomes-driven product design
We prioritize innovations that help improve clinical outcomes and reduce provider abrasion to deliver solutions that are intuitive and impactful.
Trusted customer service model
We take the journey together with you, making decisions based on program performance. Our client service team provides transparency and support.
Market leading technology and AI
We utilize powerful, patented AI models developed from our experience with large clinical and demographic data sets.
Explore our full suite of solutions
Solution suite
Medicaid Risk Adjustment and Quality
Optum has the expertise, breadth and scale to help optimize and support your Medicaid risk and quality programs.
Solution suite
Member Engagement Solutions
Precisely target the right members, understand how to support them and efficiently deliver programs based on the member’s need.
Solution suite
Prospective Solutions
Get tailored pre-visit insights and point-of-care support for better member outcomes.
Solution suite
Quality Solutions
Improve quality with a comprehensive, innovative approach to manage HEDIS® performance.
Solution suite
Retrospective Solutions
Our diverse and deep experience paired with the largest MA database in the industry powers analytics to improve accuracy and completeness.
Service
Risk Analytics
Learn about our comprehensive risk adjustment analytics platform that helps organizations evaluate data to help provide actionable insights.
Service
Risk Adjustment Program Assessment
Leverage our advanced risk adjustment analytics technology and deep subject matter expertise to get a 360-degree view of your program.
Solution suite
Risk Adjustment Service Organization
Optimize the outcomes of your risk adjustment programs by integrating our deep expertise with streamlined delivery and productivity.
Related healthcare insights
Article
Learn how Optum utilizes scale, innovation and strong partnerships to optimize risk adjustment services for both providers and payers.
Article
We provide actionable insights for health plans and providers to adopt a data-driven approach and achieve value-based care goals.
White paper
Unlock new efficiencies with a digital-first, AI-powered approach to empower value-based care and enhance health plan performance.
Report
Learn what insights we discovered by partnering with Frost & Sullivan on a benchmarking survey of payers and providers.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).