Our Approach

Large cities or small towns. Urban metropolises or rural enclaves. Regardless of location or description, each community is unique. At Optum, the health care solutions that we provide are designed to reflect the individuality and diversity of the communities we serve. Our aim in every case is to support the well-being of the person, the family and the community—improving outcomes, achieving whole-person wellness and effectively managing costs.

Every community deserves a system of care that supports consumer and family well-being, while enhancing the success of all stakeholders. Optum brings a structured approach to enhancing established community health/behavioral health  care systems and the outcomes critical to our members and customers. With careful management of costs, our goals are to improve clinical outcomes, expand access to appropriate care, and strengthen individual capabilities to pursue wellness and recovery.

Empowering individuals and families

We continuously develop new ways to help inform and empower individuals in pursuit of their own well-being, health and independence:

  • Expanding peer support and peer- and family-run services across the care spectrum, from health education to crisis respite
  • Building consumer and family advocacy positions into the core structures and leadership of our local operations
  • Addressing all the core elements of wellness, including housing, employment, transportation, and a full life within the community
  • Providing tools and resources to empower members to make healthy choices in treatment and preventive care that are motivated by their own life goals, including:
    • In-person outreach from clinicians, social workers, allied community agencies and peer educators
    • Specialized information and preventive care reminders via telephone and mail
    • NurseLineSM clinical advice and treatment decision support
    • Custom online portals that deliver detailed health and wellness information and resources
    • Mobile apps to enhance movement from engagement to activation of the person-centered treatment plan

Collaborating with providers to improve care practices

Optum partners with local primary care physicians, community health/behavioral health centers and other health care professionals to build upon their wealth of community knowledge and resources, and enhance them with innovative clinical and service approaches. We encourage their participation in Optum-hosted clinical and program advisory boards and community conversations to address local care system gaps. We also provide comprehensive resources to enhance their practices by supporting the delivery of evidence-based medicine:

  • Alerts about member treatment gaps, with specific recommendations for intervention
  • Combined analytic and provider education programs around proper psychotropic medication treatment
  • Clinical guidance and best practices information, including psychiatric consultation to primary-care physicians to address comorbid conditions

Reducing administrative burdens and health care costs

Optum’s health care delivery services are driven by insight from market-leading information technologies. Our systems can:

  • Manage, report and pay claims from multiple funding streams (i.e., braided funding), providing transparency, administrative simplification for providers and near real-time reporting on fund balances
  • Support care planning by integrating data about behavioral health, physical health and allied services
  • Combine data across agencies and programs, providing a whole-person view of individuals and populations
  • Identify high-risk beneficiaries, allowing care managers and providers to focus attention on their needs
  • Identify providers experiencing administrative or clinical issues, providing rapid assistance and support
  • Report on Medicaid-specific claims and encounters, even in the most complex reimbursement environments

A partnership that serves the community

When you work with Optum you’ll find a team focused on collaboration at every level — with you, with the individuals and families you serve, and with allied agencies, community providers and other stakeholders. Our objective is to leverage our capabilities to help you strengthen the capabilities of community-based delivery systems that are already in place and build an enhanced system of care together.

Today, across the country, Optum is:

  • Facilitating community processes to identify and fill core gaps in services
  • Helping existing service providers acquire the necessary tools and skills to offer new treatment modalities
  • Offering technical and financial support to consumer- and family-run organizations as they develop new peer-run services, with an emphasis on achieving certifications and licensure necessary to generate ongoing revenue
  • Recognizing and encouraging naturally supportive organizations within the community
  • Reinvesting in community-based ventures that strengthen and enrich the system of care

Learn more about how Optum can help you achieve your goals.