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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.

Frost & Sullivan

Optum has been recognized as a best practices leader in Gen AI bringing greater efficiency to payers.

Everest Group

Optum was recently recognized by Everest Group as Leader in Utilization Management Operations PEAK Matrix® Assessment.

Everest Group

Everest Group positions Optum in the highest Leader position for Care Management Platforms for Payer in PEAK Matrix® Assessment.

Everest Group

Optum is the highest-designated Leader in Payment Integrity Solutions in PEAK Matrix® Assessment.

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

We go beyond risk adjustment to help drive better health outcomes for your members.

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

Celebrating the Unique Role of Optum Infusion Pharmacy Nurses

Article

Celebrating the unique role of Optum Infusion Pharmacy nurses

On average, Optum Infusion nurses spend approximately 1,300 hours per year providing care to patients. Hilary, an Optum Infusion nurse, knows this firsthand.

Pharmacogenomics in Medication Selection

Article

Pharmacogenomics in medication selection

Enable more effective and targeted treatments that address unique needs for patients with pharmacogenomics.

Unlock the Power of Pharmacogenomics with Optum® Precision Script

Fact sheet

Unlock the power of pharmacogenomics with Optum® Precision Script

Integrate PGx data into pharmacy claims to support safer prescribing, smarter medication management and better patient outcomes.

Payers at the Crossroads of Senior Care [On-Demand Webinar]

On-demand webinar

Innovate or fade: Payers at the crossroads of senior care

Join Dr. Jamira Duffy and Heather Jarrett from Optum Health as they discuss the urgent need for innovation in senior care and the considerations payers should focus on.

Ready to create a healthier tomorrow?