Optum (Change Healthcare)
Overview
Optum, a subsidiary of UnitedHealth Group, is a diversified healthcare company that provides technology services, pharmacy care services, and various direct healthcare services. Optum acquired Change Healthcare, a healthcare technology company, in October 2022. The combined entity aims to connect and simplify core clinical, administrative, and payment processes for patients, payers, and care providers, ultimately leading to lower costs and improved experiences within the healthcare system.
Optum leverages advanced data, technology, and clinical expertise to improve health outcomes, lower costs, and simplify healthcare. The company focuses on improving efficiency for those who pay for and provide care, making healthcare easier by connecting services like doctor visits, mental health, and specialty care. Optum also emphasizes prevention and providing high-quality, evidence-based care.
Reviewed by Pouyan Golshani, MD — Interventional Radiologist
Key Features
- AI-enabled workflow for study prioritization and workload distribution (specifically in radiology)
- EHR integration
- API solutions for eligibility, claims, and attachments
- Data analytics and insights
- Revenue cycle management offerings
- Patient portals for medical records, appointments, and billing
- Mobile app for health management and provider search
- Secure exchange of clinical and financial data
- AI-assisted agents for patient support and contact centers
- Customized reporting and analytics (specifically for cardiology)
Use Cases
- Streamlining radiologist workflows with AI-driven worklist management
- Improving efficiency in claims, billing, and payment cycles
- Real-time verification of patient eligibility and benefits
- Electronic submission and status checking of medical claims
- Enhancing patient engagement through self-service tools and chatbots
- Providing access to patient medical records and appointment scheduling
What Physicians Need to Know
Key Capabilities
Optum (Change Healthcare) offers a wide range of AI-powered solutions for healthcare professionals. These include AI-enabled study prioritization, balanced workload distribution, and consolidated enterprise worklists for radiology, aiming to improve team productivity and diagnostic confidence. They also provide tools for real-time physician collaboration, integrated reference case management, and point-of-care access to EHR data. For revenue cycle management, Optum offers AI to automate tasks from point of care through final coding, enhance clinical documentation and coding accuracy, and streamline claims processing. Their AI solutions also extend to utilization review, helping to reduce denial rates, improve appropriate reimbursement, and minimize audit risk. Additionally, Optum has developed AI tools for speeding up medical claims and reimbursement processes, allowing providers to receive real-time information about patient health benefits. Other capabilities include AI-powered workflows for value-based care, generating population health alerts, identifying risks, and facilitating interventions. They also offer AI for prior authorization, aiming to reduce delays and automate parts of the process. Optum's AI Marketplace provides solutions for eligibility, claims, engagement, care management, data access, and analytics.
Clinical Utility
The AI tools enhance diagnostic confidence through real-time physician collaboration and integrated reference case management in radiology. They improve care outcomes by proactively collecting data at the point of care, generating predictive insights into care and operating room efficiency, and automating workflows to reduce the total cost of care. For value-based care, the Value Connect platform helps identify patients needing intervention and routes next steps into care team workflows, leading to reported reductions in emergency department visits and avoidable hospital admissions. AI-powered utilization review solutions help focus clinician attention on cases that need it most, allowing redeployment of clinicians to other patient-focused responsibilities. Optum's AI also aims to simplify prior authorization, making it faster for patients to receive appropriate care.
Integration Options
Optum's solutions are designed to integrate with existing workflows and EHR systems. For example, their Digital Auth Complete tool integrates into the electronic health record for prior authorization. The Optum AI Marketplace is built to simplify AI integration across clinical and administrative systems, leveraging standardized APIs and development tools. They also offer cloud-based platforms for medical image sharing that allow providers to view and exchange images with payers, patients, and EHRs.
Compliance Status
Optum emphasizes responsible and ethical use of AI practices. Their prior authorization tools are designed to help insurers meet compliance requirements from the Centers for Medicare & Medicaid Services. Optum is committed to data safety and responsible AI use, and their AI Marketplace is built with this in mind. They also highlight the importance of robust governance to maintain safety, privacy, and transparency in AI implementation. Optum's utilization review process complies with applicable legal requirements, and AI is not used to make clinical denials; every clinical denial is reviewed by a qualified medical professional.
Pricing Model
While specific pricing details are not readily available, the Optum AI Marketplace offers various AI solutions, including APIs for patient eligibility, benefits, prior authorization, and responsibility data. Users can build packages for access to real-time data.
User Experience
Optum aims to enhance user experiences and speed up AI adoption through its AI Marketplace. Their revenue cycle management platform, Optum Integrity One, consolidates several functions into a single, easy-to-use interface to improve efficiency for hospital staff. AI-powered tools are designed to streamline communication and care continuity across teams and systems, resolving bottlenecks and reducing paperwork. Optum also focuses on making healthcare easier to navigate with personalized AI companions and self-service tools for patients.
Support Quality
Optum provides support resources and sign-in options for account management and product support. The AI Marketplace offers support and resources, including quick sandbox access for developers to test solutions. Optum deploys expert teams skilled in both healthcare and AI to lead AI transformation and provides continuous support.
Implementation Complexity
Optum's AI Marketplace is designed to simplify AI integration across clinical and administrative systems. They offer ready-to-implement curated solutions and APIs to help organizations streamline operations and reduce integration costs. Optum also provides expert-led AI integration to assess transformation readiness and create tailored solutions.
Evidence Base
Optum leverages decades of healthcare expertise and advanced data infrastructure for its AI solutions. They have thousands of active AI use cases, including over 500 generative AI applications. Optum's AI solutions for utilization review are supported by physician advisor expertise and evidence-based medical research. The Value Connect platform, used by Optum clients, has shown results such as a 29% decrease in emergency department visits and a 28% reduction in avoidable hospital admissions. A pilot program with Optum Integrity One showed a coding productivity increase of over 20%. Optum has been recognized as a Leader in Everest Group's 2025 Revenue Cycle Management Platforms PEAK Matrixu00ae Assessment and Healthcare Data, Analytics and AI Services PEAK Matrixu00ae Assessment.
Physician Tip
Leverage Optum's AI-enabled radiology solutions for improved diagnostic confidence and streamlined workflows, including AI-enabled study prioritization and real-time collaboration tools. Utilize their AI-powered tools for revenue cycle management to enhance coding accuracy and accelerate claims processing, potentially reducing administrative burden. Explore the AI solutions for utilization review to optimize clinician time and improve reimbursement accuracy. For value-based care initiatives, consider the Value Connect platform to identify at-risk patients and facilitate timely interventions. Engage with Optum's AI tools for prior authorization to potentially reduce delays and simplify the approval process. Remember that while AI assists, clinical denials are still reviewed by qualified medical professionals.
Optum's AI solutions are designed for seamless integration with existing EHR systems and clinical/administrative workflows. The Optum AI Marketplace provides a centralized ecosystem of curated solutions and APIs for simplified integration. Cloud-based platforms facilitate image sharing with various stakeholders, including EHRs. Optum also offers tools that connect with numerous payer systems for prior authorization. They emphasize leveraging standardized APIs and development tools for efficient building and accelerated speed to market.
Details
| Category | EMR / EHR Systems, Medical Billing & RCM, Practice Analytics & BI |
| Pricing | Unknown — unknown |
| Deployment | Cloud-based solutions with API integration capabilities. |
| Compliance | |
| BAA Available | Unknown AI-estimated |
| HIPAA Compliant | Unknown AI-estimated |
| FDA Status |
Unknown AI-estimated No information found regarding FDA clearance for Optum's AI tools or physician directory services. |
| Integrations | |
| EHR | Not specified |
| Specialties | Cardiology, Hospital Medicine, Radiology |
What the Web Says
Optum (Change Healthcare) generally receives negative reviews from physicians and healthcare IT professionals, with many expressing concerns about prioritizing profits over patient care and a toxic work environment. While some users on G2 and Reddit report positive experiences with specific providers or ease of use for certain features, the overwhelming sentiment points to significant issues with management, customer support, and the impact of corporate acquisitions on healthcare delivery. The company's data and analytics arm saw a 35% increase in revenue year over year following the acquisition of Change Healthcare.
Overall: NegativeStrengths
- Streamlined insurance payments and online patient payments for some users.
- User-friendly interface and customizable tools in some Optum products.
- Providers are reported to be helpful and consistent in quality of care by some patients.
- Good work ethics and support for performance reported by some physicians.
- Access to the latest tools and technologies and learning options for some employees.
- Integrated payments can reduce processing fees for practices.
Limitations
- Prioritization of revenue and profits over staff and patient well-being.
- Toxic work environment, micromanagement, and high employee turnover.
- Poor medical leadership and lack of autonomy for physicians.
- Inadequate customer support, communication issues, and difficulty reaching the correct departments.
- Understaffing, leading to overwork and duties outside of job descriptions.
- Frequent changes in management and company acquisitions causing instability.
- High cost of services, potentially impractical for smaller practices.
Based on reviews from: Reddit, Indeed.com, G2, Becker's Hospital Review, SoftwareFinder, Optum.com, Capterra
Last updated: 2026-08-25
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Press & Coverage
American Hospital Association
UPDATE: UnitedHealth Group's Change Healthcare's Continued Cyberattack Impacting Health Care Providers | AHA - American Hospital Association
A cyberattack on Change Healthcare in February 2024 disrupted numerous systems and services, impacting healthcare providers nationwide. The American Hospital Association (AHA) has been in communication with HHS and Optum regarding support for timely patient care and temporary financial assistance for providers.
2024-02
Healthcare Ready
2024 Optum/Change Healthcare Cyberattack
The February 2024 cyberattack on Optum/Change Healthcare exposed vulnerabilities in the healthcare infrastructure, affecting pharmacies and patient care nationwide due to Change Healthcare's role in processing 15 billion healthcare transactions annually. The incident highlights the need for robust cybersecurity measures in the healthcare industry.
2024-02
CMS.gov
Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated Payments to Part A Providers and Advance Payments to Part B Suppliers | CMS
CMS made accelerated and advance payments available to Part A providers and Part B suppliers experiencing claims disruptions due to the Change Healthcare/Optum cyberattack. These payments are designed to help with cash flow issues, with repayment commencing through automatic recoupment from Medicare claims.
2024-03
National Academies of Sciences, Engineering, and Medicine
Business Resilience and Risk Management: The Change Healthcare Cyberattack
A cyberattack on Change Healthcare in February 2024, part of Optum and UnitedHealth Group, is potentially the most extensive healthcare data breach to date, impacting patient information and financial transactions. The Department of Justice had previously challenged the Optum-Change Healthcare merger due to concerns about market control and sensitive data access.
2024-08
Inc. Magazine
UnitedHealth Knew About Cybersecurity Gaps, Investors Allege. Then a Breach Hit 190 Million People - Inc. Magazine
A shareholder lawsuit alleges that UnitedHealth Group leaders misrepresented the effectiveness of their cybersecurity measures, leading to the 2024 Change Healthcare ransomware attack that exposed data of 190 million people and cost over $2 billion. The lawsuit claims the company de-prioritized patient privacy and data security.
2026-08
Health Affairs
UnitedHealthcare Pays Optum Providers More Than Non-Optum Providers - Health Affairs
A study using CMS payer transparency data found that UnitedHealthcare's payments to Optum providers are 17% higher than to non-Optum providers, increasing to 61% in markets where UnitedHealthcare has a 25% or more market share. This suggests that intercompany transactions within health care conglomerates may warrant scrutiny for potential regulatory gaming or attempted foreclosure.
2026-02
Optum
Optum Financial Completes Acquisition of Alegeus Technologies
Optum Financial has acquired Alegeus Technologies, expanding its capabilities to help consumers save, pay for, and manage healthcare expenses, aiming to make healthcare more accessible and affordable.
2026-07
Optum
Optum & Change Healthcare Complete Combination
Optum completed its combination with Change Healthcare in October 2022, aiming to simplify core clinical, administrative, and payment processes in healthcare to achieve a more intelligent and adaptive health system. The merger is expected to increase efficiency, reduce friction, lower costs, and improve the experience for all stakeholders.
2022-10
Videos
Product demos, reviews, and walkthroughs for Optum (Change Healthcare).
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Frequently Asked Questions
Optum EHR is designed to streamline clinical workflows with features like customizable chart summaries, voice recognition, and patient portals, aiming to improve patient management and documentation. It offers practice management functionalities, appointment scheduling, and templates with guidelines to assist physicians across various specialties.
Optum EHR is a HIPAA-compliant and CCHIT-certified electronic health record solution. It also fulfills the requirements of Meaningful Use Stage 1 and 2, ensuring secure management of sensitive patient information and supporting practices in preparing for value-based care.
Optum EHR pricing is not publicly disclosed and depends on the practice's size and needs, requiring a customized quote. While the subscription pricing can be competitive, potential hidden costs might include initial implementation, ongoing support, and the possibility of increased expenses over time compared to some competitors.
Some reported limitations include potential lagging in the system, initial implementation costs that can be a barrier for smaller practices, and a dependence on Optum's ecosystem which might limit flexibility. Additionally, some physicians may find the system complex, requiring ongoing support.
Physicians have several alternatives to Optum EHR, including popular systems like Epic, Oracle Cerner, eClinicalWorks, Athenahealth, NextGen Office EHR, and Practice Fusion. Other options frequently considered for physician group management services include OptumCare, CVS Health, and Plum.
Optum EHR is designed to synchronize medical records, financial data, and claims within a unified interface, improving efficiency and reducing costs. The company emphasizes its role in connecting and simplifying core clinical, administrative, and payment processes for healthcare providers and payers. While specific integrations are not always publicly disclosed, Optum aims to consolidate and enrich EHR data across therapeutic areas and sites of care.
Optum Physician EMR Suite adheres to stringent security standards and is fully HIPAA-compliant, ensuring the secure management of sensitive patient information. In response to past cybersecurity issues, Optum (as part of UnitedHealth Group) has offered resources and guidance, stating they monitor for data compromise and provide support for affected providers.
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| Last Verified: 2026-08-23 | First Added: 2026-08-23