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Risk adjustment, quality and engagement

Member Engagement Solutions

We offer healthcare member engagement services to help health plans precisely target the right members and efficiently deliver programs based on member needs.

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Drive enrollment and better member outcomes 

Today, there are more than 66 million Medicare beneficiaries1 with 37% living at or below the federal poverty level2, and only 12.2M are dual-enrolled in Medicare and Medicaid3. This represents a significant opportunity to identify more dual eligible and drive more enrollments.

There are several potential barriers to enrollment and participation, including lack of awareness, burdensome application process, hard to reach population, misconception about the purpose of the program and potential asset reporting. 

Optum offers a full suite of solutions to help health plans improve their members’ quality of life by identifying and providing access to assistance they may need, including:  

  • Eligibility and enrollment: Services to help identify and enroll members in valuable government and social programs
  • Engagement and outreach: Multichannel outreach solutions deliver health education and care assistance

Member Engagement Solutions

Smart Connect and Smart Appointment Scheduling

Services designed to engage members throughout their health care journey on behalf of payers.
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Community Connector

Assess SDOH (social determinant of health) needs and provide referrals to community-based organizations equipped to address those needs. (136)
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Dual Enrollment Advocate and Recert Complete

Our consumer-centric solution bundle helps health plans improve member satisfaction by helping members obtain and retain added benefits.
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Community Connector helps member assessment

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

  1. Centers for Medicare and Medicaid Services (CMS). CMS Fast Facts. March 2024. 
  2. Kaiser Family Foundation. Distribution of Medicare Beneficiaries by Federal Poverty Level. 2022.  
  3. CMS. Medicare-Medicaid Enrollee State Profiles. September 2023.