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The Optum Care Model

We are helping health care leaders improve quality and maintain census stability by bridging care for senior living residents.


Collaborative care for better outcomes

Optum partners with health plans to bring specialized health care benefits, clinical support and over 25 years of experience to residents in skilled nursing facilities (SNFs), assisted living communities (ALCs) and memory care units.


One of those benefits is our patient-centric model of care, led by clinicians (typically a nurse practitioner or physician assistant, often supported by an registered nurse) to coordinate and enhance the quality of care for Medicare Advantage Special Needs Plan (SNP) members.



1,800+ SNFS and ALCS

where the care model is active1

26 states

served plus the District of Columbia1

70,000+ members


Right care. Right place. Right time.

Our care model helps prevent unnecessary ER visits and hospitalizations.

Financial benefits:

  • Census stability 
  • Reduces hospital readmissions
  • Supports HEDIS and Star metric improvement
  • Ensures appropriate CMS payment
  • Provides education and in-service for staff

Delivery of care

Our clinical team collaborates with the PCP, staff and other providers

Clinical Benefits:

  • Principal point of contact 
  • No 3-day qualifying hospitalization 
  • Reduces hospital and ER visits
  • Support available 24/7
  • Advance care planning focus

Helping find peace of mind

Our team provides personal, one-on-one support to each member, resulting in family satisfaction and peace of mind.

  • Serves as the primary contact for family and care team
  • Develops relationships through face-to-face visits
  • Provides ongoing family education and engagement
  • Creates a personalized care plan and performs assessment
  • Attends to unique needs and concerns
The biggest benefit for having Optum in a nursing facility is that they bridge the gap between the nursing staff and your medical director and the staff.


Gretchen Black

Explore our solutions


PCPs and the Optum ISNP Care Model in SNFs

Close gaps in care and reduce fragmentation by participating in a cross-functional, team-based care experience.

The Optum ISNP Care Model for SNFs

Break the high-cost cycle by increasing care and benefits to Institutional Special Needs Plan (ISNP) members.

Let's talk about a partnership in care.

  1. 2019 Plan Year, reporting as of December 2019