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.
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.
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
Article
Learn how Optum utilizes scale, innovation and strong partnerships to optimize risk adjustment services for both providers and payers.
White paper
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.
On-demand webinar
Learn innovative techniques for risk adjustment workflows that help emphasize pre-visit chart prep and clinical suspect identification.
White paper
Learn how combining these steps can help power a holistic workflow between payers and care delivery.
Article
In the ever-evolving landscape of healthcare, the need for complete and accurate risk adjustment has never been more critical.
Product information and resources
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Prospective Risk and Quality Overview
Optum offers pre-visit and point-of-care support to help improve member outcomes.
Complementary solutions
Retrospective Solutions
Our diverse and deep experience paired with the largest MA database in the industry powers analytics to improve accuracy and completeness.
Member Engagement Solutions
Precisely target the right members, understand how to support them and efficiently deliver programs based on the member’s need.
Risk Analytics
Learn about our comprehensive risk adjustment analytics platform that helps organizations evaluate data to help provide actionable insights.