Outpatient Psychotherapy and Community Based Services

As a managed care company, Optum is tasked with supporting covered members by providing clinical risk. Our goal is to ensure quality and efficient treatment for our members by identifying cases where a clinical discussion between Optum and the treating provider may improve the quality of care and reduce clinical risk.

Optum uses clinical and claims data to identify cases where interaction between Optum and the treating provider is likely to improve quality of care, adherence to evidence-based care, and care outcomes.  The data comes from submitted Wellness Assessments, behavioral claims, and pharmacy claims. Interventions by Optum are initiated by letter and/or phone call to the treating provider. Optum personnel reviewing the clinical and claims data are licensed clinicians.