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Insights for health plans

Our curated selection of resources address emerging trends impacting health plans.

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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.

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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.

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Insights

Achieving growth through technology

HouseCalls Program

Helping support the continuity of care.

How are you identifying overpayments?

Identifying overpayments after a claim has been paid is a core component of payment integrity.

Managing cell and gene therapies

A diverse pipeline of CGT is coming to the market.

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.

Regulatory developments in pharmacy 2022, 2023

We discuss the Inflation Reduction Act, the drug pricing executive order and other federal and state regulations passed in 2022. We also look ahead to 2023.

Flexing seniors’ brains and social muscles

Medicare Advantage plans can differentiate supplementary programs by addressing cognitive health and social interaction.

Enhancing fraud investigations with AI

Simplify the complexities of fraud case review

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.

Beyond barbells: What seniors need in fitness

Medicare Advantage plans need to offer an array of choices to meet the overall health needs of members.

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.

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.

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.

4 new drugs to watch this year

Breakthrough treatments for menopause, Alzheimer's and hemophilia are coming.

Maximize Recoveries with Subrogation

Identify, investigate and recover medical and disability payments related to accidents.

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.

A better path to managing specialty

Learn the actions you can take today to better manage spend and trend while finding the right care for those who need it most

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.

Reality check: New drugs will cost more

The trend toward complex biologic drugs continues.

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.

Make your pharmacy benefit plan work better

4 key questions you should be asking.

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.

Fighting Fraud in Pharmacy

Explore emerging trends and strategies to combat schemes.

Celebrating American Pharmacists Month

Hear from 5 pharmacists on how they’re advancing patient care.

New rules to watch: Summer 2022

How the work of national and local lawmakers will impact you.

Breaking through vaccine fatigue: Top 4 reasons to get yours

New flu and Covid bugs are coming. Time to boost your immunity.

5 approaches to address prescription affordability

Watch our On-Demand webinar to learn about 5 key solutions designed to attack the affordability challenges your members face head on.

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.

Support for substance use disorders

Expand access to evidence-based support to help individuals achieve stabilization and sustain recovery.

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.

8 ways to make drugs more affordable

Discover what plan sponsors need to know.

Is your pharmacy benefit manager delivering value?

4 key questions you should be asking.

Fighting fraud

How one plan sponsor recovered $315,000 in six months.

3 ways to deal with escalating drug costs

Innovations custom built for today’s specialty challenges.

Fighting the tide of opioid overdose

The rate of drug overdose death involving opioids has spiked. See how Optum is the first in the industry to demonstrate expertise in opioid management.

4 key forces shaping the future of pharmacy

These emerging trends will help define the road ahead.

Moving to lower-cost electronic payments

Partner with Optum Financial to increase ACH payments

Building new possibilities for infusion care

How we are exceeding the evolving needs of the home parenteral nutrition market

Biosimilars explained: 5 questions you’ve been asking

Get prepared for more biosimilars to come to market.

A seamless pharmacy benefit change?

We guarantee it. And it's easier than you think.

Will these 4 new drugs re-shape the market?

Get the latest in this quarter’s Drug Pipeline Insights Report.

Social determinants of health

Completing the health data picture

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.

Drug pricing spotlight: Wound care

Combat against brand name products costing 125 times more.

Smart formulary management

Developing and managing formularies that bring clinical and financial value

Specialty Drugs & Prior Authorizations

Having a prior authorization process in place is not enough to ensure specialty drug utilization meets your policy criteria.

Gaining maximum benefit from your revenue cycle strategy

Learn how innovation can help you achieve financial resiliency and stay competitive in today’s market.

Case study: 5/5 satisfaction on implementation

OptumRx earns 100% implementation score from City of Toledo

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: Advanced Pharmacy Audit Services

How a health plan saved more than $1 million

Case Study: UMass utilizes analytics to improve adult immunizations

Population health analytics drive UMass participation in the AMGA AI Collaborative

How value-based care became vital for survival

Article for C-suite leaders to learn how value-based care became vital for survival and whether accelerating their move to value will help their organization thrive in today’s environment.

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

Clinicians in 2030

Optum CNO Kristy Duffey talks with NEJM Catalyst about health care workforce trends and the changes coming to care delivery.

3 ways CRISPR will change the drug world

Pharmaceutical industry finding novel uses for gene editing tools

Symmetry Episode Risk Groups White Paper

Predict future health care utilization

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.

Trends hospital revenue cycles

Key trends in hospital revenue cycle performance

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.

Sustainable Future Cancer Care

Creating a sustainable future for cancer care

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.

Leveraging Virtual Care Management During Coronavirus (COVID-19)

Learn strategies to manage the rapid influx of patients.

Newest regulations impacting pharmacy

View the recent activity at both the state and federal level.

SNFs Improve Care & Business Outcomes for Facilities

The Optum Care Model Helps SNFs Meet Strategic Goals

Opioids: Managing Costs By Managing Risk

Costs associated with abuse have increased dramatically.

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.

Support for long-term recovery

Find substance use disorder treatment that includes evidence-based resources and compassionate care for members and their communities.

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.

Health plan pitfalls

Read a follow-up to Optum study of health plan executives.

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.

Reimagining Quit Services for the Future webinar

Create a focused approach to tobacco cessation.

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.

The rising cost of cancer care

Understand the trends and how to respond.

A life saved — 2nd.MD member story

A second opinion from 2nd MD saves member’s life.

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

The Path to 4+ Star Performance

Implications for 2023 Star Ratings

Reserve Health Readiness Program

Customized health care solutions for the DoD.

Generating fuel for growth

Generating fuel for growth

Targeted care and lower cost: How one state achieved both

One state achieved both in delivering home health services.

Behavioral Health Solutions

We support the journey to better health.

Case study: Provider performance analytics

Case study: Provider performance analytics

Controlling the unprecedented costs of gene therapies

See how you can leverage cost benefits from gene therapy.

Hemophilia: Extremely rare, extremely expensive

Better management strategies and new treatments emerge

Managing diabetes gains an 8:1 return on investment

Learn how a third-party administrator’s client improved health outcomes and lowered costs.

How to eliminate prescription waste

Achieve savings by targeting expensive, low-value drugs.

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.

Don't Pay 5000% More for Commonly Available Generic Drugs

This widespread practice costs plans millions.

Will Diabetes Drugs Help Us Tackle Obesity?

Discover four things to know about new uses of GLP-1 drugs.

How a client avoided $109M in pharmacy costs

View the Optum Rx Drug Pipeline Insights Report for 2022.

A new approach to rising specialty costs

See how contracting with medical providers can reduce drug costs

High-cost gene therapies

A comprehensive approach to the next generation of cures

The big picture on cancer

How high cost oncology drugs are changing specialty pharmacy.

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.

The dangers of polypharmacy

Millions of workers at risk due to overprescribed drugs

Industry trend to watch: Eczema

New treatment options could mean bigger costs.

How our medication packaging helps the planet

New packaging saves CO2, water, energy, and plastic waste.

4 steps to limit infusion drug costs

Specialty drugs account for over half of all drug spending

Making sense of copay cards

How copay cards can disrupt your benefit strategy

Rush to judgement?

An inside look at the FDA's prescription drug approval process.

A young patient’s hemophilia story

See how OptumRx helped change a patient’s life.

2021 PEAK Matrix Report : HealthCare Top 20

2021 PEAK Matrix Report : HealthCare Top 20 | Optum

Personalized care: Focusing on the member

Hear from Optum Rx chief of operations, Jon Mahrt

Improve outcomes with EHR implementation and optimization

Learn how to define a new way forward by optimizing workflow, automation, and key metrics with your EHR.

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

How the pandemic has changed pharmacy care

Learn how COVID-19 has accelerated the rise of home and virtual care.

Reducing disparities in care and outcomes

Achieving health equity is a community-wide effort.

Redirecting Specialty Infusion Costs by Redirecting Site of Care

See how you can lower your plan costs by up to 52%.

The New Model Of Personalized Care

Predictive analytics improves user experience and outcomes.

Taking the Pain Out of Prior Authorization

How we are revamping the prescribing process

Shipping Sensitive Medications

See how medications are protected in transit.

Rare diseases, large costs

The rise in orphan drugs is offering hope

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.

Personalized support for members with autism

Optum is breaking barriers in supporting members and families who are diagnosed with autism spectrum disorder (ASD).

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

Creating better behavioral health care

We help people find care and support that’s easy to understand and access.

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.

Mental health support for youth and caregivers

Youth are struggling more than ever before with their mental health and well-being. We can help.

Helping members achieve their goals

See how the right mental health care makes a difference.

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.

Gene therapy: Big potential, big prices

New strategies needed as revolutionary but costly therapies emerge.

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.

Behavioral Health Provider Digital Access Survey | Optum

Case study: Strategic formulary changes

How a third-party administrator helped clients save $6.49 PMPM.

5 questions: Premium Value formulary

Hear from OptumRx SVP of clinical & formulary services

Third Annual Optum Survey - AI in Health Care

AI on the rise: Health leaders turn to tech in the pandemic.

4 more psoriasis drugs on the way

Psoriasis costs up 40% in 5 years. Will these drugs help?

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

Advancing the Frontier of Precision Medicine

The future of guided prescribing is here.

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.

Value-Based Care: How payers can help providers

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.

Making a better future for mental health care

Guide members to the right behavioral health care when they need it.

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.

Guided help for mental health support

We’re making it easier for people to access care.

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.

Understanding college students' mental health needs

Read about the realities of campus behavioral health care and how we can make it better.

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.

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.

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.

Strengthening nursing home partnerships during COVID-19

Optum and Saber worked together to ease the COVID-19 burden.

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.