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Solution

Prospective Solutions

Improve risk adjustment accuracy and quality performance by delivering actionable pre-visit insights and point-of-care support.

A leader in prospective risk adjustment

Optum Prospective Solutions is a tailored suite of services designed to help health plans improve member outcomes through integrated, flexible provider engagement strategies. Optum leverages extensive EHR integrations and a strong digital footprint to deliver actionable insights at the point of care — whether in-office or at home. Supported by AI-driven analytics and our dedicated field team of more than 750 healthcare advocates, we partner directly with providers to deliver clinical insights that drive better outcomes.

Explore our solutions

Driving better risk and quality outcomes

In-Office Assessment Program

Proactively support early detection and ongoing assessment of patient health conditions. With actionable data, interactive technology and a supportive field team, health plans can offer this program to providers to strengthen relationships and help improve patient outcomes.

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Meet members where they are

Integrated In-Home and In-Office Assessment Program

Our integrated assessment program offers flexible visit options — in-home, in-office or virtual — tailored to each member's needs. A unified data set enables health plans to better manage care, improve quality and achieve more accurate reimbursement.

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Pre-visit insights for more impactful care

Advanced Pre-Visit and Clinical Planning

Enhance provider engagement and patient care with AI-driven pre-visit planning. Our solution identifies potential conditions from clinical data and EHRs, streamlines workflows and supports comprehensive care management planning.

Key benefits

Personalized support and engagement

Our dedicated field team of more than 750 health care advocates support over 70,000 providers.

Actionable insights and data-driven decision-making

We help you achieve your goals using AI-driven analytics from a large MA reference database.

Streamlined provider experience

Simplify multiple payer portals into one access point, with 24/7 support.

Proven expertise and scalable solutions

Leverage our more than 18 years of experience pioneering risk adjustment with a nationwide presence.

Outcomes management and accountability

Client outcomes managers align resources to achieve payer goals.

Comprehensive solutions and partnerships

Flexible partnerships adapt to evolving health plan needs and goals.

Industry insights

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Strengthening Risk Adjustment with Payer and Provider Collaboration

Article

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.

White Paper: Help Physicians Spend More Time with Members

White paper

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.

Beyond Risk Adjustment: An Approach to Provider Engagement

On-demand webinar

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.

4 Steps to Optimizing Value-Based Care

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.

The Perfect Blend: AI and Human Validation in Condition Capture

Article

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.

Product information and resources

  • PDF

     

    Placemat

    Prospective Risk and Quality Overview

    Optum offers pre-visit and point-of-care support to help improve member outcomes. 

    Download placemat

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See how Optum can drive better risk and quality outcomes