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Solution

Prospective Solutions

Prospective Solutions for risk adjustment is a provider-first model of collaboration, data and technology to help achieve better outcomes.

A new approach to risk adjustment

Optum® Prospective Solutions offers pre-visit and point-of-care support to help improve member outcomes. Our services support early detection and ongoing evaluation of chronic conditions for Medicare Advantage (MA), Affordable Care Act (ACA) and Medicaid members on behalf of health plans.

These services include:

  • Prospective member assessments
  • Digital integration strategy and implementation
  • In-person and virtual support
  • Member engagement campaigns

The Optum field team provides virtual and in-person support

The team is made up of 1,000 Health Care Advocates who work directly with 70,000 providers to manage gaps in care in all 50 states. They deliver wraparound services for providers that are customized to the level and type of support each practice requires. 

We equip providers with actionable clinical insights, personalized member care gap information and administrative support. This helps create a workflow that prioritizes provider and member needs at the point of care and beyond. By reducing administrative burden, providers have more time to focus on clinical activities. In turn, this leads to better outcomes for members.

Collaborative service model for payers and providers

Meet providers where they are with multiple modalities for prospective member assessment submission.

Native workflow integration

Providers can use their own internal tools and preferred resources to develop electronic workflows that fit their needs.

Practice Assist platform

This multi-payer, multi-program platform lets providers manage member care opportunities and program performance.

Integrated EHR applications

Providers can access risk suspects, quality gaps and supporting program documentation all within their native EHRs.

Partnership integrations

Optum partners with best-in-class, third-party technology services to offer providers even more options for digital assessment submission.

I have a caring relationship with my providers, we have the same goals … I’ve made an impact on the people I work with and they trust me.

Health Care Advocate, Optum

Cara Spahr

Learn about Prospective Solutions for providers

In-Office Assessment Program

We partner with physicians to support positive patient outcomes. 

Risk Identification and Capture

Our holistic approach is designed to make it easy for clinicians to accurately document chronic conditions at the point of care.

Related healthcare insights

Case study

A case study on Excel Medical Center

Using digital integration to ease administrative burdens can help you spend more time with patients and deliver positive patient outcomes.

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.

Guide

Making risk adjustment programs work

Learn how three care delivery organizations reduced administrative burden to spend more time with patients and improve outcomes.

Article

Changes to risk adjustment are coming. Are you prepared?

Learn how your practice may need to evolve to proactively anticipate the MA and Part D changes announced in April 2023.

See how Optum can drive better risk and quality outcomes