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