Cost Management Update
ON-SCREEN TEXT: [Craig Kurtzweil
Vice President, Center for Advanced Analytics]
Hi, I'm Craig Kurtzweil. I lead our Center for Advanced Analytics here at UnitedHealthcare. I'm the data
guy.
ON-SCREEN TEXT: [Controlling costs — it’s all part of the plan]
We define total cost of care as how much an employer spends to treat their conditions in their population.
When we analyze total cost of care, we go much deeper than just analyzing network discounts.
ON-SCREEN TEXT: [Looking deeper than discounts]
Most discount analysis are looking back at claims from one, three years ago, four years ago and beyond.
ON-SCREEN TEXT: [Past claims don’t reflect future spend]
And that may have worked a decade ago but in today's health care system, when things are advancing
and changing every year, every week, every day there's a new technology that's out there, it's hard to
understand how a three-year old discount analysis applies to a health care system that's ever evolving.
ON-SCREEN TEXT: [Total cost of care strategies]
When we think of total cost of care strategies, we think about plan design, network solutions and
engagement opportunities.
ON-SCREEN TEXT: [Needs of employers determine the right cost levers]
ON-SCREEN TEXT: [1 Plan design; 2 Network and clinical strategies; 3 Engagement strategies]
ON-SCREEN TEXT: [1 Plan design guides employees]
When we think about plan design, it's really a set of different incentive levers that are out there to help
guide members towards the appropriate site of care, the appropriate place of service, the right provider at
the right time.
ON-SCREEN TEXT: [Employer
Employee]
If done right, plan design is less about just shifting costs from the employer to the employee
ON-SCREEN TEXT: [Right care
Right time]
but is more about how do we set up those right pathways towards the right care at the right time?
ON-SCREEN TEXT: [2 Network and clinical solutions]
Another key lever that employers can use to drive total cost of care, are network solutions. It is not about
going to see the cheapest provider.
ON-SCREEN TEXT: [Clinical strategies focused on quality]
We are really focused on making sure that members go to see the highest quality provider. As you're
thinking about centers of excellence, you really need to think about the overall total cost of care for that
episode.
ON-SCREEN TEXT: [UnitedHealth Premium® Care Physicians outperformed their peers*
9% Lower total cost of care
High Premium Care Physician utilization resulted in:*
27% lower risk-adjusted spending per-member-per-month (PMPM)
33% fewer ER visits
47% fewer inpatient hospital admissions
*Savings estimates as of Sept. 25, 2020 UnitedHealthcare Network (Par) Commercial Claims analysis for
172 markets. Figures are based on book-of business results and represent the national average expected
cost differential between Premium Care Physicians and non-Premium Care Physicians for entire episodes
of care. Actual savings achieved will vary by customer depending on geographic availability and
customer-specific service mix. All figures and estimated savings represent historical performance and are
not a guarantee of future savings.]
We think that if you go to the highest quality provider, your overall total costs of care will come down.
ON-SCREEN TEXT: [3 Engagement strategies]
Another lever that employers can utilize to drive down total cost of care are engagement tools, advocacy
is critical.
ON-SCREEN TEXT: [Advocacy can simplify a complicated system]
Members need to feel like they have an advocate that can help them make sense of this complicated
system. We see that as a critical aspect of improving total cost of care, improving decision-making.
ON-SCREEN TEXT: [1 2 3]
If you have the right plan design, if you have the right network solution, that's great. But if your consumers
don't understand the health care system and don't understand how to utilize it, you're not going to have
the impact that you would expect. Employer came to us, trend was higher than they expected, didn't know
what was going on. We were looking for ideas, we were looking for solutions. And honestly, we were just
looking for understanding of what the heck is happening.
ON-SCREEN TEXT: [15–20% of employees had diabetes]
Through our analytic capabilities, we were able to come in, calm the situation, sift through the chaotic
data that they were seeing from a claims perspective and bring them to an understanding of the true root
cause population health issue that they were facing. At the end of the day, all of this was driven by
diabetic issues.
ON-SCREEN TEXT: [40% of medical costs were from these employees]
ON-SCREEN TEXT: [More than cancer, musculoskeletal and circulatory combined]
This wasn't going to be a one-time episodic high-cost issue. This is a long-term population health issue
that we needed to approach from all different angles and make sure that we could stop these kinds of
rollercoaster ride claims issues from happening in the future. For the complex employers that we serve,
it's critical that we offer a very customized solution.
ON-SCREEN TEXT: [Controlling costs — it’s all part of the plan]
And to offer customized solutions, it's critical to have the analytics that allow us to understand what
customization is needed and how impactful those solutions will be.
ON-SCREEN TEXT: [Talk to your broker, consultant or UnitedHealthcare representative to learn more]
DISCLAIMERS: [Insurance coverage provided by or through UnitedHealthcare Insurance Company or its
affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates.
© 2021 United HealthCare Services, Inc. All Rights Reserved. 21-433626
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