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Prospective Solutions

Prospective Solutions for risk adjustment is a provider-first model of collaboration, data and technology to help achieve better outcomes.

Male doctor and male patient

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.


Native workflow integration

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


Practice Assist platform

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


Integrated EHR applications

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


Partnership integrations

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

The Optum field team provides virtual and in-person support

The team is made up of 1,000 Health Care Advocates who work with 70,000 providers to manage 50 million gaps in care in all 50 states. They deliver wraparound services for providers that are customized to the level and type of support each practice requires.

The Optum field team includes medical directors, pharmacists, the clinical team and personnel who help support providers. This support helps enable better member outcomes. The Optum field team includes medical directors, pharmacists, the clinical team and personnel who help support providers. This support helps enable better member outcomes.
I have a caring relationship with my providers, we have the same goals … I’ve made an impact on the people I work with and they trust me.

Health Care Advocate, Optum

Cara Spahr

The time to be member-centric is now

We use predictive analytics to steer members with chronic conditions to their preferred modality of care and offer services that support whole-person care.

Female patient and provider looking at a tablet in patient's home
Male doctor and female patient in a clinical setting

Activating members through multiple engagement levers

We follow up with members to schedule appointments, administer a social determinants of health (SDOH) survey, identify barriers and connect with resources.

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

Explore our solution

Fact sheet

Prospective Solutions fact sheet

Fact sheet

In-Office Assessment Program fact sheet

Case study

The Toledo Clinic case study

White paper

Help physicians spend more time with members

Help physicians focus on patients and spend less time on admin tasks.


Engage providers to impact member outcomes

See how our field team can engage providers to impact member outcomes.

Executive summary

4 steps to optimizing value-based care

Take 4 steps to optimize value-based care with a holistic workflow.