Smart and effective engagement starts with the right system

Employee health engagement is a hot topic, and for good reason. Higher levels of engagement have been linked to improved health outcomes, lower costs and even productivity. [1] [2] [3]

The conversation around engagement typically focuses on efforts that help employees become more proactive in their health and health care. However, given the historically low levels of health engagement of many employees, it’s not enough to stop there. [4]  

Once people enter the health care system, they are, by definition, engaged. That is, they are engaged with the system whether or not they take advantage of the advocacy support in their health plan. This raises 2 questions: What kind of system is there to meet them? What can be done to help ensure that everyone — even the disengaged — has access to quality, cost-effective care?

Answering those questions starts with making the experience better for our members by advocating on their behalf directly with the health system. This may make it easier for individuals to make more informed health care choices, get the most out of their benefits and better manage costs.

Here is how a connected, informed and effective system may help achieve health care’s triple aim.

Better outcomes: Identifying high-performing providers  

As part of engaging with their health care, employees and their families face a myriad of decisions. But one rises to the top in terms of importance.

“There are a number of different health care decisions members make, such as place of care,” said Craig Kurtzweil, UnitedHealthcare’s senior vice president of analytic innovations. “But the single biggest positive impact on a member’s health care decision pattern begins with choosing high-quality physicians.”

UnitedHealth Premium® designation program evaluates the quality and cost efficiency of physicians across a variety of specialties using evidence-based, medical society, and national industry standards with transparent methodology and robust data sources, including episode cost measurement, as appropriate. [5]

Cost-effectively managing complex procedures

When employees or their family members need more extensive treatment, they often do not know where to go  — or how to find quality, cost-effective care. That’s why UnitedHealthcare has identified Centers of Excellence (COEs) that use evidence-based, quality-of-care protocols to help provide access to cost-effective care for complex medical procedures at leading treatment centers.

For example, the Bariatric Resource Services COEs have helped reduce the long-term personal, clinical and economic costs of obesity by decreasing complications, readmissions and mortality rates. Dedicated nurse case managers have expertise and insights into bariatric patients and their comorbid conditions, while the clinical team promotes lifelong behavioral and dietary changes. One UnitedHealthcare Bariatric COE, when compared to non-COE providers, reduced mortality by 15 percent, readmissions by 16 percent, and reoperations by 12 percent. [6] Participants had a $4,239 lower average cost per surgical episode. [7]

Support programs can also lead to better care. For instance, a chemotherapy preauthorization program avoids the waiting period of up to 3 weeks that cancer patients face while insurers review their proposed chemotherapy plan. Instead, the program works with cancer providers on a set of best practices so they can determine the appropriate chemotherapy regimen for the stage and type of cancer.

Collaborating with trusted providers can be key to delivering an enhanced, personal experience. By sharing data, clinical insights and technology with thousands of clinicians and physicians, UnitedHealthcare can better support appropriate, quality and cost-effective care. By identifying gaps in patient care, the company also helps providers deliver better care and manage their patients’ care more cost effectively. This collaboration not only helps providers identify superior options for patient care but also to identify lower-cost medications, manage prior authorizations while prescribing and consult with peers.

“Members who have trouble choosing a provider may be defaulted to a quality doctor or center. In several UnitedHealthcare programs, for example, members are required to choose a primary care physician when they enroll  — and if they do not, one is chosen for them based on their medical history, location and other factors,” said Ernie Bourassa, vice president of network solutions for UnitedHealthcare national accounts.

“It’s important that members connect with a primary care provider  — it’s really hard to over-emphasize this relationship,” Bourassa said.

Lower costs through more collaboration and best practices

Ensuring that providers follow best practices may not only improve care, but lower costs.

This is often done through payment models, such as performance-based contracts, value-based contracts and Accountable Care Organizations (ACOs), in which providers are paid based on outcome rather than by simple fee-for-service models. Value-based care focuses on quality and uses incentives to reward better health and lower costs. This approach can drive important improvements in how payers and care providers work together to support patient care.

“The value-based approach brings into alignment incentives for physicians, consumers and employers,” Bourassa said.

One way to help encourage value-based care is through bundled payments. Instead of billing for each service, health care providers and facilities are reimbursed for what’s referred to as a “defined episode of care.” For example, using bundled payments for maternity patients includes a best practice course of maternity management to help address the issue of maternal and infant mortality. [8]  Another example: Bundled payments as part of a value-based care program for knee, hip and spine procedures achieved a 22 percent reduction in hospital readmissions and 17 percent fewer complications. [9]

Another way to help lower costs is to shift patients away from using costly sites of care, such as going to emergency rooms in non-emergency situations, or unnecessary and unproven care. For instance, providers are alerted when their patients use the emergency room, so they can discuss appropriate emergency room use when they see them. “UnitedHealthcare is testing technology that communicates digitally with patients right before or when they enter an emergency room, to inform them of lower cost urgent care center alternatives for non-emergent needs,” Bourassa said.

High-cost medications and prior authorization waits can be avoided through UnitedHealthcare’s PreCheck MyScript® tool, in which doctors check how much the prescription would cost, see lower-cost alternatives and are alerted if the medication requires prior authorization (the doctor initiates the authorization process right from the app).

Conclusion

Higher levels of employee engagement may lead to even healthier outcomes and greater cost-savings. We spotlight strategies to help employees make more informed choices about their health and health care here. However, integrated and accessible networks, incentivized to deliver high-quality, cost-effective care, may be the bedrock upon which any engagement takes place. [9]