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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:
  • Federal government
  • Manufacturers
  • Payers
  • Providers
  • 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:
  • Employers
  • Health systems and hospitals
  • Payers

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:
  • Employers
  • Federal government
  • Payers
  • 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:
  • Payers
  • Providers

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 benefits

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

We offer clear drug pricing and aligned scale and insights that guide decision-making, helping you navigate change with confidence.

Solution suite

Payment integrity

Best for:
  • Payers

Improve payment accuracy across the claim lifecycle.

Software

Network connectivity

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

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

Industry insights

The AI-Driven Health Plan [White Paper]

White paper

The AI-driven health plan

This white paper offers expert perspectives on leveraging AI to optimize health plan operations efficiency, growth and member experiences.

5 Questions About AI Use in Pharmacy Benefits

Article

5 questions executives are asking about AI in pharmacy benefits

Discover the unique challenges and responsibilities of introducing AI into pharmacy benefit solutions.

When An Infusion Nurse Acts Fast with a Long PANDAS Battle

Article

When an infusion nurse acts fast against a long PANDAS battle

How an Optum Infusion Pharmacy nurse stops an emergency as a parent keeps fighting for care.

How Optum Care Transitions Improves Post-Acute Care

Case study

How Optum Care Transitions helps improve post-acute performance for health plans

See how a leading health plan reduced costs, improved outcomes and strengthened provider relationships with a modern post-acute care model.

Ready to create a healthier tomorrow?