Perspectives on health plan trends
Resources to help navigate the challenging world of health care
Together, we are driving toward the same things for our health care system — better quality, lower cost and higher consumer and provider satisfaction.
Latest health plan trends
Outcomes-based contracts for payers
Enable outcomes-based contracts and ease challenges.
Move the affordability lever
Learn how to activate savings through comprehensive payment integrity.
Prepare for market expansion
Develop a strategy roadmap for a government programs entry.
Insights
How are you identifying overpayments?
Identifying overpayments after a claim has been paid is a core component of payment integrity.
Value-based insurance and network design
Optum has access to one of the industry’s largest health care data assets and many of the industry’s top professionals.
Moving toward preemptive kidney transplants
Avoiding dialysis in favor of organ transplant can yield better patient outcomes and lower health care costs. So why is it still uncommon?
Kidney Disease Care: A Comprehensive Approach
Find out how an integrated approach produces better outcomes for renal disease — a common, complex and costly condition.
Flexing seniors’ brains and social muscles
Medicare Advantage plans can differentiate supplementary programs by addressing cognitive health and social interaction.
Increasing at-home dialysis for ESRD patients | Optum
See why home-dialysis patients tend to fare better than in-clinic patients, and how patient-centric kidney care management helps them make informed choices.
How Health Plans Can Improve Encounter Data Quality
How holistic programs improve senior health
Medicare Advantage plans need to rise above the competition by going beyond traditional fitness offerings.
Case study 1: High-dollar claim savings
DRG outlier identified, resulting in $200,578 savings.
Case study 2: High-dollar claim savings
DRG outlier identified, resulting in $600,000 savings.
Viewpoints on the 2024 CMS Advance Notice
In this webinar, health plans will hear Optum viewpoints on the proposed CMS changes and how they may affect your MA plan. Be prepared now.
Achieving Growth Through Technology: Part 2
The HouseCalls difference: Kim's story
Kim, a HouseCalls advanced clinician practitioner, believes a good day is when she’s helped someone. Watch the video to see her story.
The Impact of In-home Health Assessments
Learn about the benefits of HouseCalls assessments with these 5 fast facts.
Maximize Recoveries with Subrogation
Identify, investigate and recover medical and disability payments related to accidents.
Read a report about claims payments opportunities.
Thinking about going paperless for claims payments? We commissioned a study of senior health plan executives to hear what’s on their minds.
Health plan solutions designed to lower the cost of care
Tour our ecosystem of capabilities designed to tackle broad-based health plan challenges.
Pharmacy Insights Podcast
Listen to our resident experts discuss critical industry challenges and the solutions you need to control rising drug costs.
Social Determinants of Type 2 Diabetes
This study analyzes how social determinants of health (SDOH) variables impact the incidence and progression of Type 2 diabetes.
Keeping your data secure is mission critical
See how we help prevent costly, disruptive cyberattacks.
3 new drugs to watch this fall
As the year begins to close, we highlight three essential pipeline drugs with an expected U.S. Food and Drug Administration (FDA) decision this fall.
Is your pharmacy benefit manager delivering value?
4 key questions you should be asking.
3 ways to deal with escalating drug costs
Innovations custom built for today’s specialty challenges.
Moving to lower-cost electronic payments
Partner with Optum Financial to increase ACH payments
Intelligent Automation Benefits for Health Plans | Optum
See how IA increases the throughput of the retro case developer process, reducing processing time and freeing resources for other high-value tasks.
Four myths: Carving out specialty pharmacy
Integrating specialty pharmacy means better care, lower costs.
Smart formulary management
Developing and managing formularies that bring clinical and financial value
Why equity in women’s health demands an integrated approach
Why equity in women’s health demands an integrated approach
Enhance R&Q data acquisition with AI and NLP
Learn how digital clinical data, AI and NLP can help health plans get the data they need, when they need it.
Creating connections through partnerships
Hear from an Optum Rx client on how we're partnering together for everyone we serve.
Value Transformation at Keck Medicine of USC
Value Transformation at Keck Medicine of USC
Case Study: UMass utilizes analytics to improve adult immunizations
Population health analytics drive UMass participation in the AMGA AI Collaborative
Increasing Value Through Higher Volume
Improve revenue integrity by expanding admission reviews.
Delivering Value-Based Care for Veterans Affairs & DOD | Optum
Best practices to help transition to value-based care.
Improve access to care with HouseCalls
White Paper: Improve Access to Care With HouseCalls | Optum
Evidence-based Clinical Practice Guidelines for DoD and VA
Improve continuity of care by reducing variation in practice for service members transitioning to Veteran status.
Executive Perspectives: Tech Innovation in Health Care
How AI and other technologies can help heal the health care system
The Doctor Will See You…Anywhere
A profound shift toward coordinated, responsive care is underway in American medicine.
Technology Helps Reduce Barriers to Tobacco Cessation
Learn about the growing change in tobacco cessation.
Veterans Benefits Administration
They honored their commitment. It's time to honor ours.
Avasant Healthcare Payor Digital Services
Avasant's annual RadarView report helps healthcare payors craft a robust strategy for digital transformation based on industry outlook and best practices.
SNFs Improve Care & Business Outcomes for Facilities
The Optum Care Model Helps SNFs Meet Strategic Goals
Solutions to the maternal care crisis are coming into focus
Solutions to the maternal care crisis are coming into focus
Health Care's Guide to Machine Learning
What you need to know about AI's latest buzzword.
Center for Health Equity - The Lewin Group, Part of Optum Serve
See how we help public and private health care leaders, policy makers and researchers support equitable individual and community health.
Navigating Forward: C-suite check-in — Research findings state of health care
Find out what 161 C-suite health care leaders think about how COVID-19 has changed the industry — and where we still must make progress.
Impact member care with in-home assessments
Download the infographic to learn more about how in-home assessments can uniquely impact SDOH.
Star ratings are important to Medicare Plans
Learn how health plans can improve Star ratings through high-touch strategies.
Insights on improved care through technology and scale
John Muir Health shares how the organization uses technology to reach those in need of health care services.
Preparing a strategy roadmap for government programs entry
Amy Jensen, VP of Optum Advisory Services, outlines requirements for a new market expansion.
Optum Care Model & UnitedHealthcare Assisted Living Plan
Support residents living in a senior living community.
Improved Arkansas Medicaid Outcomes
Helping Arkansas improve Medicaid outcomes, reduce costs.
Accelerate your digital transformation
Capitalize on the momentum around digital health solutions.
Optum Advanced Practice Clinician (APC) video
Advanced practice clinicians give personal care
Population health management best practices
Learn about industry players in the population health management (PHM) market and what to look for in a best-in-class solution.
Assisted living plan comparison scenario
Keep your SNF-qualified residents with you longer.
Taking the Blinders Off Cancer Through Immunotherapy
Webinar: Taking the Blinders Off Cancer Through Immunotherapy
Targeted care and lower cost: How one state achieved both
One state achieved both in delivering home health services.
Managing diabetes gains an 8:1 return on investment
Learn how a third-party administrator’s client improved health outcomes and lowered costs.
Optum Rx customer obsession video
How one Optum Rx employee made the system work better for everyone
How to manage medication overload
Hear from a leader's perspective on how to manage polypharmacy.
Will diabetes drugs help us tackle obesity?
Discover four things to know about new uses of GLP-1 drugs.
Specialty drug prices giving you sticker shock?
See how Specialty Compass defuses exploding drug costs.
5 questions: Optum Rx chief pharmacy officer
Michael Einodshofer addresses the risks, challenges and opportunities facing the industry.
How our medication packaging helps the planet
New packaging saves CO2, water, energy, and plastic waste.
2021 PEAK Matrix Report : HealthCare Top 20
2021 PEAK Matrix Report : HealthCare Top 20 | Optum
Health Equity & Women's Health
Create meaningful change for the women in your workforce.
Clinical and claims data: A powerful combination
Get a snapshot of the pros/cons of clinical and claims data.
Improve Women's Health with Community-Based Solutions
Improve Women's Health with Community-Based Solutions | Optum
Optum HouseCalls: In-home Multi-Dimensional Clinical Evaluation
In-home clinical evaluation of health and ongoing care needs
Redirecting Specialty Infusion Costs by Redirecting Site of Care
See how you can lower your plan costs by up to 52%.
Health equity in kidney disease management
Learn 5 strategies for health plans to address inequities in the kidney care landscape and create more equitable access, treatment and outcomes for all.
Which rules will impact pharmacy in 2023?
2023 is already a busy year for pharmacy regulation. Read about the latest regulations that could impact you and your pharmacy benefit plan.
Digital scheduling at a rural health system
Learn how a rural health system achieved an ideal patient experience and increased bookings with digital scheduling.
Family-building inequities
Read how payers can turn the tide on 5 worrisome statistics.
Unlocking the promise of personal medicine
See how a peek at your genes enables more precise prescribing.
Mitigating maternal care deserts
For some mothers-to-be, health care options are disturbingly limited — or even nonexistent.
How to achieve more inclusive MSK care
Musculoskeletal conditions are costly, common and fraught with health inequities. Here’s how a more holistic approach can help payers better serve all members.
Spend more time with members and less time on paperwork
See how prospective assessment programs can reduce administrative burden and allow physicians to focus on what matters most: member care
Slowing the specialty pharmacy carve-out stampede
Study reveals costs for unrecognized kidney disease
Platform strategy for digital transformation
Read more about the digital transformation journey and how to approach these challenges by working toward a product driven model.
SDOH and Medicare Advantage
This paper examines the critical impact of social determinants of health (SDOH) on patient care and how in-home assessments can help.
Hearts Behind the Work: Meet Our People
Meet the people of Optum who are putting you at the center of everything we do.
Webinar: Trends and challenges in telehealth
Explore new ways of doing business that allow you to meet shifting customer expectations, workforce challenges and emerging business goals.
Third Annual Optum Survey - AI in Health Care
AI on the rise: Health leaders turn to tech in the pandemic.
How to control drug costs without compromising care
Explore three principles driving better pharmacy benefit decisions.
Health Plan Leaders on StepWise Migration to the Cloud
Delivering the Personal Touch
Addressing pharmacy issues that matter to you
From specialty pharmacy to drug affordability, our experts tackle your biggest pharmacy challenges.
3 new first-in-class therapies coming
See how innovation is driving the latest product development.
Supporting providers in the transition to VBC
Learn how value-based care (VBC) partnerships between payers and providers are more important than ever.
Analytics in payer-oncologist partnerships
See 4 ways that payers can help health care providers unlock the power of real-world data to drive quality and innovation in cancer care.
Addressing health equity barriers in cancer care
Discover the 5 pillars of equity-driven member navigation.
DocASAP Digital Scheduling for Health Plans
Request a demo of DocASAP to learn how we help payers drive more appointments and improve member satisfaction.
Specialty and Weight Loss Webinar
Hear how weight loss drugs are shaping traditional and specialty spend.
Emerging technologies in underwriting
Listen to the on-demand webinar from Becker Healthcare in partnership with Bill Dimmock, VP of Advisory Services at Optum.
Payer-provider collaboration in ESRD care
Kidney disease is complex and expensive, and disproportionately impacts people with limited financial resources. Here’s how payers can help transform care.
GLP-1 agonists: A new class of weight loss medications
In this conversation, discover how new weight loss drugs like Wegovy are changing obesity management and their connection to diabetes.
Improving care, outcomes and costs
Achieve better care through understanding the customer, not just the patient.
Biosimilars to save billions in this decade
Prices for popular brand-name biologics drop up to 60% with generic-equivalent biosimilars.
Fertility solution overview
Whether for personal or professional reasons, many couples today are delaying starting a family. However, waiting to conceive can lead to fertility issues — for one partner or both.
5 things to know about the new landscape of fertility benefits
More and more, benefits leaders see the value of reproductive health — and it’s changing how they approach offerings.
Delivering on the promise of fertility care
As a highly specialized area of care, fertility treatment is a significant cost driver for health plans and employers.
Health system boosts reach with payer channel scheduling
St. Luke’s Health dramatically increased volumes and decreased costly no shows with Optum digital scheduling. Learn how your system can, too.
Empowering clients with more choice and transparency
Helping make prescription drugs more affordable for plan sponsors and the members we serve is a universal focus.
Engage providers to impact member outcomes
Download our infographic to learn how Optum can take the burden off of payers to impact provider performance.
Unraveling complexity in specialty care
Learn how Optum is streamlining care delivery with insights from patients and providers to improve outcomes and drive down costs.
Collaborative strategies to optimize complex care management
As caring for complex patients gets more complicated, payers and providers must partner to provide better, more accessible, lower-cost care.
Trends and perspectives for health plans
Driving toward the same things for our health care system — better quality, lower cost, and higher consumer and provider satisfaction.
Breakthroughs in kidney care
Explore the most promising innovations in renal care for people with chronic kidney disease.
Future-ready claims review: automation isn’t enough
As claims grow more complex, many automation methods aren't sophisticated enough for the job. See how payers can take claims review to the next level.
White paper: Defragment care with in-home assessments
In-home assessments can help to improve mental health and other social determinants for seniors. Read about the HouseCalls approach.
Four steps to optimizing value-based care
Learn how combining these steps can help power a holistic workflow between payers and care delivery.
Orphan drugs market: Can we afford them?
We examine key questions around orphan drugs such as why they're so expensive, how they're being used and what plan sponsors should do next.
Transforming the six zones of consumer experience
Discover innovations and success factors to drive engagement, loyalty and growth.
Inflammatory conditions: Trends, pipeline, management strategies
Hear leaders discuss trends for inflammatory conditions and gain insights on how the market is changing with a deep dive on pipeline, biosimilars, and care management strategies.
5 ways shift-of-site care is a win for all women
With unique needs, women benefit greatly from a wider array of care options. Payers and employers can reap big rewards by providing them.
Gene therapy: How to prepare for a growing pipeline
The unprecedented cost of gene therapies requires a fundamental rethinking of how treatment costs are managed.
Ensuring responsible use of AI in health care
See how we use artificial intelligence (AI) and machine learning (ML) to help people live healthier lives and make the health system work better for everyone.
The secret to lowering the total cost of care
Rising pharmacy costs concern everyone. Managing the underlying health conditions behind each prescription is key to addressing these high costs.
Struggling to balance paperwork and patients?
You may be missing out on health plan services that can help.
What’s changing the PBM industry?
In this conversation, learn from Optum Rx thought leaders on how access, affordability and transparency have become imperatives for pharmacy benefit management.
Cost breakthroughs in complex care management
Not every complex care management program is built equally. Here's how to optimize them for maximum benefits.
Drugs to Watch in summer 2023: New therapies
New drugs for postpartum depression, dermatitis and blindness are coming.
Innovative approaches to collaborate with PCP's
Understanding the challenges confronting Medicare Advantage plans and their Medical Loss Ratio.
The time for better payment delivery is now
Market dynamics are driving the need for health care payment innovation. Providers expect fast and reliable payments from health plans.
E-book: How payers can evaluate Centers of Excellence
Not all Centers of Excellence are created equal. Here are five questions that payers should keep in mind.
Intelligent automation is improving member outcomes
Optum Advisory's Loren Koerber and Matt Matousek break down intelligent automation and reducing the administrative burden in health care.
A case study on Excel Medical Center
Using digital integration to ease administrative burdens can help you spend more time with patients and deliver positive patient outcomes.
The next biosimilar wave has arrived. Now what?
In this conversation, learn about a new class of biosimilars and what this means for competition, cost and volume in the PBM market.
Managing risk in value-based care delivery
Watch as Erik Johnson explores models for risk in delivering value-based care (VBC).
Lowest net cost and your bottom line
Learn about strategies to achieve the lowest net cost of prescription drugs through formularies, biosimilars and our Vigilant Drug Program.
HouseCalls: Helping to care for members where they are
As demand for home and community care grows, Optum® HouseCalls can reach your Medicare Advantage members and assess members’ health needs.
Optum Rx Drug Pipeline Insights Reports
Read the most recent quarterly reports on new drugs coming down the pipeline.
Optimize member engagement through collaboration with Optum
A health plan increased in-home assessment rates for their Medicare Advantage members by working with Optum to increase member engagement.
Intelligent automation improves underwriting results
Machine learning coupled with software features and cost-tuning delivered significantly improved predictive value and underwriting results.
Navigating government programs
Learn how small and community-based plans can enter Medicaid programs in our navigating government programs video.
Achieving growth through technology
Alternative funding: Real savings or problems?
See how much "free" drugs will actually cost you.
Changes to risk adjustment are coming. Are you prepared?
Learn how your practice may need to evolve to proactively anticipate the upcoming changes announced in April related to MA and Part D.
Making Risk Adjustment Programs Work for You
Learn how three care delivery organizations reduced administrative burden to spend more time with patients and improve outcomes.
Regulations to watch: Fall 2023
Learn what's at stake as the PBM legislation advances on Capitol Hill.
Redefining the prior authorization process
How we are revamping the prescribing process
Personalized care: Focusing on the member
Hear from Optum Rx chief of operations, Jon Mahrt
How to eliminate prescription waste
Achieve savings by targeting expensive, low-value drugs.
Comprehensive payment integrity savings
Inform and improve your entire claims management lifecycle.
Best practices for reducing provider abrasion
Find out what is driving the recent increase in abrasion and learn what health plans can do to alleviate provider pain points.
Alzheimer's treatment: Time for a level-set?
See success rates, risks and costs of the new Alzheimer’s treatments.
Staying current in your core admin platform
Get current, stay current and leverage the newest platform capabilities with ongoing release management.
How to Engage Hard-to-Reach Kidney Disease Patients | Optum
Case Study: Advanced Pharmacy Audit Services
How a health plan saved more than $1 million
HouseCalls travels far and wide to support members’ health
The HouseCalls program provides health plans with annual in-home clinical assessments for Medicare Advantage members available in 50 states.
3 Ways Digital Movement Is Reshaping Member Experiences | Optum
How to implement patient-centered oncology care
HouseCalls: Fewer Emergency Visits, Hospital Stays
HouseCalls: Fewer Emergency Visits, Hospital Stays
Get ahead of 3 pharmacy trends that will affect your plan
Find out what’s changing the pharmacy market and how it could impact you.
Digital Claim Payments Can Save You Money
Discover 4 ways health plans can save money today, and into the future. by engaging with a digital claim payment partner.
Spotlight: Fitness needs across generations
4 new drugs to watch this year
Breakthrough treatments for menopause, Alzheimer's and hemophilia are coming.
Advancing health equity: How Optum Rx Is overcoming challenges
Thought leaders discuss the intentional vigilance needed to overcome obstacles impeding better access to health care for all.
Enabling Success for the Health Plan Ecosystem
Optum has a complete portfolio of assets designed to enable health plans to make meaningful strides toward achieving their goals.
Behavioral Health Provider Digital Access Survey | Optum
Getting ahead of the mental health crisis
See how leaders are advancing data strategies, screenings and exploring ways to connect consumers to mental health support.
How to manage blockbuster anti-obesity drugs
The pricey weight management drugs work well, but users need coaching and support to maintain the benefits.
Rules impacting pharmacy: Summer 2023 legislative sessions
Learn what's at stake as the Senate considers PBM legislation.
3 ways to address vaccine fatigue
Learn about researched vaccine messaging themes and important steps you can take to promote critical vaccinations for members.
Cancer costs are rising — are you ready?
Viewpoints on the 2025 CMS Advance Notice
Don't miss this exclusive webinar and the chance to learn how your Medicare Advantage plan can better prepare for the 2025 changes.
Experts agree: PBMs add value, lower costs
PBMs don’t cause high drug costs — they’re part of the solution. Our drug prices beat the “low cost” vendors.
The impact of corrective actions on Stars ratings
Learn more about the impact and implications of a Corrective Action Plan and how Stars and these corrective actions are interconnected.
Combating the opioid epidemic
Medication interventions save lives — more people need access to them.
Meet the rising demand from seniors to age in place
In-home assessments can improve outcomes, reduce health care costs and align with member preference.
Help Improve Your Members' Health with Optum HouseCalls
Medicare Advantage members receiving in-home assessments saw reductions in emergency department visits and inpatient hospital stays across 4 conditions.
A New Approach: guidance along the fertility journey
Discover how health plans can set aside ad hoc solutions and adopt a comprehensive approach to improve health outcomes and accessibility to fertility care.
Gene therapies: Can we afford the future of medicine?
Learn how to manage financial risk as gene therapies become more commonplace.
The value of DEX Z-Codes in the commercial space
Optum and Palmetto experts partner in discussing how to solve genetic lab challenges in legacy solutions.
How Health Data Can Improve MSK Care for Members | Optum
2024 Stars Preview: A Return to Normal and a Path Forward
Perform key actions to manage your Stars performance with a focus on member engagement. Learn how to take control of your Star ratings now.
Exciting advances for sickle cell, chronic obesity, Alzheimer’s
See potential cures for sickle cell and new help for chronic obesity and Alzheimer’s, along with how they work and how much they cost.
5 trends that defined pharmacy in 2023
See which trends are shaping the present and future of pharmacy care services.
Tackling the youth mental health crisis
A board-certified adult, child and adolescent, and addiction psychiatrist discusses how to connect children and families to needed behavioral health solutions.
Youth mental health research findings
In our new report, you'll learn key findings about the mental health needs of young people and their caregivers, and discover opportunities for intervention.
Helping members achieve their goals
See how the right mental health care makes a difference.
Guided help for mental health support
We’re making it easier for people to access care.
Mental health support for youth and caregivers
Youth are struggling more than ever before with their mental health and well-being. We can help.
Supporting Youth Mental Health: On-Demand Webinar
Dr. Yusra Benhalim shares insights on the challenges we must overcome to reach youth.
Creating better behavioral health care
We help people find care and support that’s easy to understand and access.
Making a better future for mental health care
Guide members to the right behavioral health care when they need it.
Care Pathways study
Mental health specialists serve a critical role in reducing total cost of care for plan sponsors.
Support for long-term recovery
Find substance use disorder treatment that includes evidence-based resources and compassionate care for members and their communities.
Support for substance use disorders
Expand access to evidence-based support to help individuals achieve stabilization and sustain recovery.
Supporting our kids
Mental health needs are increasing in youth. Experts share their insights on how to best support them so they can grow into healthy adults.
Personalized support for members with autism
Optum is breaking barriers in supporting members and families who are diagnosed with autism spectrum disorder (ASD).
Understanding college students' mental health needs
Read about the realities of campus behavioral health care and how we can make it better.
Working together to help end the opioid epidemic
Opioids are powerful drugs with a high risk of misuse and dependence. A comprehensive solution can help address this complex problem.
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