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Payer solutions

We're creating a unified system of growth, affordability and digital strategies that work together for the lowest possible cost of healthcare.

What’s top of mind for payers?

Get insights on driving growth at scale, advancing member health experience, cultivating provider relationships and increasing affordability.

Analyst recognition

Optum continues to be a proven leader across a wide range of services and solutions.

Avasant 2022–2023 RadarView

Optum is proud to be a leader in Healthcare Payor Digital Services by Avasant.

Frost Radar

Optum wins leader in healthcare Payer-Provider Connectivity Solutions in North America, 2023.

Aite Impact report

Optum recognized for our end-to-end Provider Management solution.

Everest Group Peak Matrix

Optum is a proud Leader in Clinical and Care Management Operations.

Explore payer solutions

Service

Consulting services

Best for:
  • Providers
  • Manufacturers
  • Payers
  • Federal government
  • State governments

We help healthcare leaders and organizations create change and drive growth.

Solution suite

Analytics performance

Best for:
  • Health systems and hospitals

Drive growth, financial performance and clinical excellence with actionable data and analytics through technology and managed services.

Financial solutions

Best for:
  • Payers
  • Health systems and hospitals
  • Employers

Explore our tailored solutions for the healthcare industry and learn how we can help you achieve financial health and operational excellence.

Service

Home & Community

Best for:
  • Payers

We deliver personalized, whole-person care to older adults in the comfort of their home or community, supporting aging in place through various coordinated care options.

Solution suite

Health benefits

Best for:
  • Payers
  • Federal government
  • Employers
  • State governments

We empower employees and members to take control of their health and well-being.

Solution suite

Ancillary Benefits Management

Best for:
  • Payers

Reduce the burden of managing ancillary benefits programs separately across the care continuum. Our solutions leverage an affordability framework to close gaps for better care with lower costs.

Service

Epic Payer Platform Managed Services

Best for:
  • Providers
  • Payers

Payer and provider collaboration supporting member care and quality outcomes.

Software

Pharmacy Technology Solutions

Best for:
  • Health systems and hospitals
  • Manufacturers
  • State governments

We support the entire pharmacy claims life cycle, with unparalleled data and insights to optimize pharmacy operations.

Solution suite

Risk adjustment, quality and engagement

Best for:
  • Payers

Reduce worries with sustained financial risk management.

Service

Home Delivery Pharmacy for Payers

Best for:
  • Payers

Our digital pharmacy is designed to meet your needs, simplify the medication delivery experience for patients, and grow alongside your business.

Solution suite

Pharmacy benefit management

Best for:
  • Payers
  • Employers
  • Brokers and consultants
  • State governments

Manage pharmacy spend across a health system.

Solution suite

Payment integrity

Best for:
  • Payers

Improve payment accuracy across the claim lifecycle.

Software

Network connectivity

Best for:
  • Providers
  • Health systems and hospitals
  • Executives
  • State governments

Enhance connectivity and streamline EDI transactions for health care providers, health plans and pharmacies through our nationwide network.

Industry insights

Site-of-Care Decisions: Navigating Safety, Access and Value

Article

Site-of-care decisions: Navigating safety, access and value

Learn about benefits and challenges of the site-of-care shift and how InterQual Site of Service helps organizations navigate the transition.

Optum Recognized as Leader in GenAI Payer Workflow Platforms

Article

Optum a leader in GenAI payer workflow platforms

Optum has been recognized with a Product Leadership Recognition in the North America GenAI payer workflow platform industry by Frost & Sullivan.

Extracting Value-Based Care Insights from Claims Data

Article

Extracting value-based care insights from claims data

We provide actionable insights for health plans and providers to adopt a data-driven approach and achieve value-based care goals.

What’s Next for AI in Pharmacy: An Interview

Article

What’s next for AI in pharmacy?

Two AI experts share insights on how we’re using AI and advanced technology to improve everything from trend prediction to member services.

Ready to create a healthier tomorrow?