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Designing a better consumer experience

OptumRx directly touches over 250,000 members every day. Serving this many people is a huge responsibility – and a huge challenge. That’s why OptumRx has designed its entire organization around a member experience that creates better outcomes, lower costs, and improves the overall healthcare system.

In this video, OptumRx CEO John Prince explains how we are innovating to best serve member needs.

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Designing a better experience

We serve 250,000 people each day, so that's 250,000 times we have a member on the other line, we're interacting with them personally. We're not just thinking about somebody who has a pharmacy medication. They also have a medical condition. We think about that whole person. Pharmacy is the biggest touch point to health care. And so we're obsessed around how do we make medications as affordable as possible for consumers so they can get healthy. Pharmacy is really retail. It's a personal experience that you can touch and feel on a retail basis often with lots of interactions. And so you've got to have a really different perspective of how you make that experience simple, seamless, and smart. And that's what we're focused on. And so it's both the design around all the touch points in health care, whether you're talking to somebody on the phone, interacting with digitally. We bring all the data together. The pharmacy data, the medical data, the behavioral data, in real time and give that to our care provider who is actually interacting with them, so that we can actually create the best outcomes from a personal perspective, from a health perspective, and from a cost standpoint. We have the right culture and the people and the capabilities. Each element of that is the diversity that takes to bring all those resources together to serve the health care system. 

This is not something that we're going to do, to the health care system, we're going to partner with the various constituencies across health care to make it bet





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Taking the pain out of Prior Authorization

Prior authorization (PA) can help consumers achieve better health results and lower costs, but outdated PA procedures can be disruptive and cause delays. So OptumRx created a new tool called PreCheck MyScript® that puts complete patient information at the doctor’s fingertips: insurance coverage, potential drug-drug interactions – even lower-cost alternatives. The result: patients get their medicines faster, start their therapies sooner, and ultimately achieve superior health results.



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Next Best Action: Compassionate employees with serious high-tech

When OptumRx members call us for any reason, they talk to multi-disciplinary teams equipped with a custom recommendation engine: Next Best Action. Next Best Action is a precision intervention model designed to ensure that each member touch point can deliver higher levels of patient engagement and lower medical costs.

By leveraging the latest in predictive analytics technology, Next Best Action generates personalized insights based on each member’s comprehensive health profile. That allows call center agents to suggest clinical and cost savings opportunities that members listen to, and take action on.


Sophisticated analytics let us focus on the individual needs of each member

Watch how we use predictive modeling and machine learning powered by OptumIQ to provide simple, affordable, and personal care – improving experiences and outcomes for everyone we serve, while reducing the total cost of care.

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Predicting better outcomes video

For many people, getting the right care and medications they need to stay healthy can be frustrating and confusing. What if there was a better way to provide accurate information with clear choices? And what if we could also determine the best health and savings opportunities, at the best time, for each member?
Guess what? We can.
Just imagine 2-patients with similar conditions. Through intelligence and analytics we can now predict which patient is more likely to join a care management program, changing the course of their health. Or switch to a lower-cost medication to increase savings. How do we do it? When we engage with a member, we integrate all available data points; giving us a holistic view, so we can focus on individual needs. Then, using leading edge predictive modeling and machine learning; made possible through OptumIQ, we’re able to predict the best health and savings options for each individual.
Regardless of how and when the member is engaged, they’re presented with the best opportunities, ranked by the probability they will accept the option. By personalizing the choices, we’re increasing engagement and acceptance.
In fact, OptumRx members accept health and savings offers more than 60% of the time, which is far higher than traditional outreach methods. Because of OptumIQ and machine learning, recommendations have increased member acceptance rates by 3 times more than average. Predictive modeling and machine learning is a win for plan sponsors too, because providing better choices can drive down the total cost of care. The more complex health care becomes, the more we are simplifying the experience with easy to use tools, and personalized health and savings opportunities when and where needed. To learn more about how we’re improving care and lowering costs, visit




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Targeted interventions for members with diabetes

Diabetes is a highly complex, broad-based challenge. It affects over 30 million Americans, a number that is forecasted to rise to nearly 55 million over the next decide, and represents over 20% of all health care spending in the U.S.

The OptumRx Diabetes Management program provides targeted guidance and services designed to prevent costly and clinically dangerous complications. The program uses machine learning and artificial intelligence to stratify specific diabetes risk levels. We then combine data, insight and clinical skills to create customized management strategies focused on controlling diabetes for each member.

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Learn more about OptumRx Pharmacy Care Services

Find out how we're improving health care experiences and outcomes for everyone we serve while reducing the total cost of care.

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Discover how OptumRx goes beyond traditional pharmacy benefit management.

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