Clinical Analytics

Utilize member data to proactively identify opportunities to reduce costs

With new benefit mandates, Medical Loss Ratio (MLR) regulations, and population shifts, it is more critical than ever for health plans to access and analyze member information. Data such as a member’s health status, the value delivered through networks, and the performance of clinical management programs helps everyone deliver the best care possible. Access and evaluation of clinical information helps identify trends in utilization, disease prevalence, and their related costs.

With this information, plans are able to:

  • Manage limitations on rating factors in the individual and small group markets by establishing appropriate rate premiums that draw from a variety of health care data
  • Segment populations into measurable risk pools
  • Assess overall future risk by disease or condition
  • Use robust patient data sets to support proactive, comprehensive care plans

In delivering these solutions, Optum leverages a comprehensive suite of proprietary intelligence tools, market-leading software products, and analytic models, as well as a deep bench of actuaries, economists, and analysts.  

Optum helps health plans:

  • Stratify populations
  • Predict future risk (cost)
  • Identify evidence-based gaps in care
  • Deliver more targeted health services to members and compare performance to industry benchmarks


Population Risk Assessment

The next generation of health risk assessment

Traditional HRAs are great at identifying behaviors that impact health and wellbeing sometime in the future (i.e. weight loss, seat belt usage), but offer little information about an individual’s current health status. By adding the world’s most widely-used health status measure, we can offer an almost real-time assessment of risk to help you manage these patients right now.

Data Analysis Tools

Leverage data to improve health and performance

With the right information, your organization could potentially boost the health of members and the performance of a provider network. The Optum™ Impact suite of solutions supports underwriting and care management, provider network management and engagement, and clinical and financial trend analysis.

Analytics Decision Support

Recognize and reward value through measurement

Measuring value has taken center stage in the health care debates. Measurement tools provide key information to define and monitor the quality of care, measure health outcomes and develop better evidence and guidance on the appropriate use of medical services. Increased transparency into the cost, quality, and service of health care delivery has become a top priority.

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