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State/Province---- Please Select One -------- United States (US) ----US - Alabama (AL)US - Alaska (AK)US - Arizona (AZ)US - Arkansas (AR)US - California (CA)US - Colorado (CO)US - Connecticut (CT)US - Delaware (DE)US - District of Columbia (DC)US - Florida (FL)US - Georgia (GA)US - Guam (GU)US - Hawaii (HI)US - Idaho (ID)US - Illinois (IL)US - Indiana (IN)US - Iowa (IA)US - Kansas (KS)US - Kentucky (KY)US - Louisiana (LA)US - Maine (ME)US - Maryland (MD)US - Massachusetts (MA)US - Michigan (MI)US - Minnesota (MN)US - Mississippi (MS)US - Missouri (MO)US - Montana (MT)US - Nebraska (NE)US - Nevada (NV)US - New Hampshire (NH)US - New Jersey (NJ)US - New Mexico (NM)US - New York (NY)US - North Carolina (NC)US - North Dakota (ND)US - Northern Mariana Islands (MP)US - Ohio (OH)US - Oklahoma (OK)US - Oregon (OR)US - Pennsylvania (PA)US - Puerto Rico (PR)US - Rhode Island (RI)US - South Carolina (SC)US - South Dakota (SD)US - Tennessee (TN)US - Texas (TX)US - Utah (UT)US - Vermont (VT)US - Virgin Islands (VI)US - Virginia (VA)US - Washington (WA)US - West Virginia (WV)US - Wisconsin (WI)US - Wyoming (WY)---- Armed Forces (AF) ----AF - Americas (AA)IN - Andhra Pradesh (AP)AF - Europe, Middle East, Africa, Canada (AE)---- Canada (CA) ----CA - Alberta (AB)CA - British Columbia (BC)CA - Manitoba (MB)CA - New Brunswick (NB)IN - Nagaland (NL)CA - Northwest Territories (NT)CA - Nova Scotia (NS)CA - Nunavut (NU)CA - Ontario (ON)CA - Prince Edward Island (PE)CA - Quebec (QC)IN - Sikkim (SK)CA - Yukon Territory (YT)---- Australia (AU) ----AU - Australian Capital Territory (ACT)AU - New South Wales (NSW)AU - Queensland (QLD)AU - South Australia (SA)AU - Tasmania (TAS)AU - Victoria (VIC)---- Brazil (BR) ----BR - Acre (AC)BR - Amazonas (AM)BR - Bahia (BA)BR - Ceará (CE)BR - Distrito Federal (DF)BR - Espírito Santo (ES)BR - Goiás (GO)BR - Minas Gerais (MG)IN - Punjab (PB)BR - Piauí (PI)IN - Rajasthan (RJ)BR - Rio Grande do Norte (RN)BR - Rio Grande do Sul (RS)BR - Rondônia (RO)BR - Roraima (RR)BR - São Paulo (SP)BR - Sergipe (SE)BR - Tocantins (TO)---- India (IN) ----IN - Andaman and Nicobar Islands (AN)IN - Assam (AS)IN - Bihar (BR)IN - Chandigarh (CH)IN - Chhattisgarh (CG)IN - Dadra and Nagar Haveli (DN)IN - Daman and Diu (DD)IN - Delhi (DL)IN - Gujarat (GJ)IN - Haryana (HR)IN - Himachal Pradesh (HP)IN - Jammu and Kashmir (JK)IN - Jharkhand (JH)IN - Karnataka (KA)IN - Kerala (KL)IN - Lakshadweep (LD)IN - Madhya Pradesh (MP)IN - Maharashtra (MH)IN - Meghalaya (ML)IN - Mizoram (MZ)IN - Odisha (OD)IN - Puducherry (PY)IN - Telangana (TS)IN - Tripura (TR)IN - Uttar Pradesh (UP)IN - Uttarakhand (UK)IN - West Bengal (WB)---- Other (N/A) ----N/A - Not Listed/Applicable (N/A)
Country---- Please Select One ----AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChina, Hong Kong Special Administrative RegionChina, Macao Special Administrative RegionChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCôte d’IvoireCroatiaCubaCuraçaoCyprusCzechiaDemocratic People's Republic of KoreaDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of KoreaRepublic of MoldovaRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French Part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSarkSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaState of PalestineSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyrian Arab RepublicTajikistanThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited Republic of TanzaniaUnited States Minor Outlying IslandsUnited States of AmericaUnited States Virgin IslandsUruguayUzbekistanVanuatuVenezuela (Bolivarian Republic of)Viet NamWallis and Futuna IslandsWestern SaharaYemenZambiaZimbabweUnited States
Number of physiciansFirstSecondThird
Involvement in risk-based modelsFirstSecondThird
How can we help?Would like a demo of Optum One health analytics platformWould like more information
Other:
Which best describes your organization?Health SystemHospitalCommunity HospitalACOPhysician PracticeGovernment AgencyHealth Plan or InsurerPharmaceuticalConsultantAcademicOther
Do you currently have an analytics platform or predictive analytics capabilities within your system?Please SelectYesNo
If not when does your organization plan to start implementation of analytics platform?1 - 3 months6 monthswithin a year1+ yearsN/A
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