In-Office Assessment Program helps payers & providers work together
The Optum® In-Office Assessment Program helps health plans improve risk adjustment and quality performance by bringing member-specific insights into the provider visit.
- AI-enabled analytics help providers identify suspect conditions and quality gaps before appointments, helping providers address opportunities at the point of care.
- Providers receive insights through their preferred workflows, including EHRs, portals, tablets and data integrations.
- Coding support, reporting and business intelligence helps payers monitor outcomes and identify opportunities for improvement.
Provider engagement and field support
Optum field teams work directly with participating providers to support program adoption, training and ongoing engagement. Through virtual and in-person support, they help practices use the program effectively, while reducing administrative burden and supporting documentation efforts.
Get to know how Optum Health Care Advocates support providers:
Key benefits
Identify and address care opportunities
Use AI-enabled analytics to help identify suspect conditions and quality gaps before visits, and deliver insights through providers’ preferred workflows for timely action when it matters most.
Support complete documentation & submission readiness
Strengthen documentation and coding and quality reviews with submission-ready outputs based on documented conditions and closed gaps.
Gain clearer performance visibility
Access reporting and business intelligence to monitor population health, provider performance and program outcomes.
In-office assessment FAQ
In-office assessments bring risk insights closer to the point of care. When providers can review potential conditions during a visit, they have more opportunities to:
- Validate, document and address a member’s health needs
- Help support documentation accuracy and risk adjustment performance
Health plans need ways to connect analytics with care delivery. In-office assessments help surface documentation and care opportunities before visits, making it easier to support:
- Risk adjustment
- Quality initiatives
- Performance improvement across provider networks
Adoption typically improves when programs fit naturally into provider workflows. Several approaches can help increase participation and long-term engagement, including:
- Reducing administrative effort
- Delivering actionable insights at the right time
- Providing ongoing education and support
Suspect conditions are data-driven indicators of potential health conditions that may warrant provider review as part of a prospective risk adjustment strategy. They help prioritize opportunities for evaluation during a patient encounter, but providers ultimately can determine whether a condition is clinically supported and should be documented.
Quality opportunities are often most actionable during a patient visit. By highlighting open gaps before or during the encounter, in-office assessment strategies can help providers address preventive care needs, documentation requirements and quality measures more effectively.
Health plans often face challenges such as:
- Provider workflow variability
- Documentation inconsistencies
- Administrative burden
- Limited performance visibility
Addressing these barriers can help support more consistent program outcomes.
Highly effective programs balance accuracy with ease-of-use. This can help providers focus more on patient care while supporting documentation objectives with programs that can:
- Deliver insights within workflows
- Minimize manual processes
- Provide clear guidance
A strong strategy typically combines three elements:
- Actionable clinical insights
- Provider-focused workflow support
- Meaningful performance reporting
Together, these capabilities can help health plans support risk adjustment and quality goals while improving visibility into program performance.
Industry insights
Article
Learn how Optum utilizes scale, innovation and strong partnerships to optimize risk adjustment services for both providers and payers.
Guide
Download our infographic to learn how Optum can take the burden off payers to impact provider performance.
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In-Office Assessment Program Overview
Learn how the Optum In-Office Assessment Program can help your organization improve better risk and quality outcomes.
Complementary solutions
Prospective Solutions
Retrospective Solutions
Risk Analytics
*Source: 2025 In-Office Assessment program.