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A new approach to risk adjustment

Optum® Prospective Solutions offers pre-visit and point-of-care support to help improve member outcomes. Our services support early detection and ongoing evaluation of chronic conditions for Medicare Advantage (MA), Affordable Care Act (ACA) and Medicaid members on behalf of health plans. These services include:

  • Prospective member assessments
  • Digital integration strategy and implementation
  • In-person and virtual support
  • Member engagement campaigns

Meeting providers where they are

Optum works directly with providers to administer these services. We equip providers with actionable clinical insights, personalized member care gap information and administrative support. This helps create a workflow that prioritizes provider and member needs at the point of care and beyond. By reducing administrative burden, providers have more time to focus on clinical activities. In turn, this leads to better outcomes for members.

Collaborative service model for providers and health plans

Meet providers where they are with multiple modalities for prospective member assessment submission.

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Native workflow integration

Providers can use their own internal tools and preferred resources to develop electronic workflows that fit their needs.

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Practice Assist platform

This multi-payer, multi-program platform lets providers manage member care opportunities and program performance.

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Integrated EHR applications

Providers can access risk suspects, quality gaps and supporting program documentation all within their native EHRs.

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Partnership integrations

Optum partners with best-in-class, third-party technology services to offer providers even more options for digital assessment submission.

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See how Optum can drive better risk and quality outcomes for members, health plans and providers.

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Explore our solution

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Prospective Solutions fact sheet

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In-Office Assessment Program fact sheet

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The Toledo Clinic case study