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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 and explore hospice solutions.

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

Article

Drug pipeline insights: Treatments poised to make an impact

From GLP-1s to oncology, learn which new and upcoming drugs could become additional sources of pharmacy spending.

Article

Beyond the pitch: How to evaluate AI vendors with clinical confidence

Learn what to look for in an AI healthcare partner — from clinical rigor to transparency — to support safe, effective implementation.

Article

New pharmacy benefit solutions to help bend the cost curve

In this conversation, get a peek into upcoming solutions and technologies designed to address high-cost medications.

Article

The big picture on pharmacy

Meet Dr. Wig, Chief Clinical Officer for Optum Rx, and hear how we’re addressing cost and clinical trends in pharmacy.

Ready to create a healthier tomorrow?