Provider Profiling Services

Find and keep the best providers

It can be challenging to find and maintain high-quality, cost-effective primary care providers for Medicaid beneficiaries. And without a primary care doctor, patients use more expensive inpatient services more often.

Optum™ Provider Profiling Services can help Medicaid programs better understand and compare the value of services purchased. We'll help you identify providers who are more accessible and who follow evidence-based guidelines for care.

Excellent and efficient health care providers make patients and the entire system healthier. Leveraging advanced analytics and deep experience, experts from Optum™ and The Lewin Group help your agency:

  • Evaluate primary care providers and medical care group quality and efficiency
  • Compare per-member-per-month costs of patients attributed to individual providers
  • Design and model the effects of payment-based incentives
  • Target providers most likely to deliver better value, and work with them to transform their clinical practices

Provider profiling helps Medicaid agencies:

  • Gain understating as to the true quality and efficiency of provider services
  • Improve care and outcomes by identifying and incenting providers who adhere to evidence-based care guidelines
  • Reduce costs by identifying potential reimbursement models that spread risk and reward quality outcomes
  • Rebalance spending by promoting better primary care and reducing unnecessary inpatient services