Trends and perspectives for health plans

Together, we are driving change toward the same things for our health care system — better quality, lower cost and higher consumer and provider satisfaction.

Increasing affordability
Cultivating provider relations
Driving growth at scale
Advancing member health and experience

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Making health care more affordable

Reducing the total cost of care is a challenging but key affordability lever. Health plans are investing in intelligence and analytics to better identify cost drivers in complex care, care gaps, medical cost management, specialty Rx, digital technology and SDOH.

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Optimizing your payment integrity program

Payment integrity best practices help you achieve your in-year cost savings goals.

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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.

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Article

Claim review: How to adopt best practices

Learn how a comprehensive claim review strategy can help you stop repeat errors and increase payment accuracy across the claim lifecycle.

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Podcast

Until It’s Fixed

Listen to this can’t-miss podcast for professionals across health care.

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Better payer/provider relations within health plan markets

Improving health care payer/provider communication by removing points of friction in clinical and administration processes is a key driver of success. Strategies to reduce provider burden while increasing transparency enable more time to focus on patients.

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Help physicians spend more time with members

See how prospective assessment programs can reduce administrative burden and allow physicians to focus on what matters most: member care.

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Infographic

Engage providers to impact member outcomes

Download our infographic to learn how Optum can take the burden off of payers to impact provider performance.

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Improve Medicaid risk adjustment accuracy

Discover 3 actions that may improve Medicaid risk adjustment accuracy.

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Executive summary

4 steps to optimizing value-based care

Reduce total cost of care and improve member outcomes.

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Driving plan growth and diversification at scale

Health care payers are focused on growth and entry into new lines of business, including Medicare Advantage, ACA and Medicaid. They’re also looking at developing new plan and network designs. Successful growth requires effective risk management and strong performance on quality outcomes.

Executve summary

2025 CMS Final Notice

What potential impact may the 2025 CMS Final Notice have on Medicare Advantage plans?

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Shooting for the Stars? Make it about members

Improve Star performance through a 3-step approach.

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Executive summary

2024 Star ratings preview

Key actions to managing Stars performance by focusing on member engagement

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Health plan executive insights

Three themes emerged in our latest CEO study: rising customer expectations, government influence and labor shortages.

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Advancing member health and experience

To drive systemic change, social determinants of health (SDOH) initiatives have taken on greater importance. Increased financial pressure, food insecurity and housing challenges are continually on the rise. Virtual care strategies focus on meeting members where they are.