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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 benefit management

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

Viewpoints on the 2027 CMS Advance Notice

Report

Viewpoints on the 2027 CMS Advance Notice

The proposed changes contain a mix of both opportunities and challenges. Read the report to learn how these changes could impact your organization.

AI Helps Build a Better, More Human Health Care Experience

Article

AI is helping build a better, more human health care experience

As rising costs, administrative friction and uneven access continue, the need for smarter and simpler solutions remains urgent.

How Mature Is Your Health Plan's Payment Integrity Program?

Article

How mature is your health plan's payment integrity program?

Discover the five levels of maturity and practical tips to strengthen your plan's performance.

Beyond Payment Integrity: An AI-Driven Approach to Affordability

Article

Beyond payment integrity: An AI-driven approach to affordability

Medical costs are rising, and health plans need solutions. See how an AI-driven, enterprise-wide approach may be the key to affordability.

Ready to create a healthier tomorrow?