Spotlight on women’s health: Supporting women’s behavioral health care

[INTRO MUSIC]

[Text On Screen – A panel discussion on women’s health. Part 2: Behavioral Health]

[STEPHANIE FEHR AND A PANEL OF SPEAKERS SITTING ON A STUDIO SOUND STAGE, SPEAKING TO THE CAMERA, WITH A WHITE SCREEN DISPLAYING: WOMEN’S HEALTH]

STEPHANIE FEHR: Welcome. We're so excited to be here with you talking about women's health. This is a topic we are all so excited about and passionate about.

[Text On Screen – Stephanie Fehr, Chief People Officer, UnitedHealthcare]

I am Stephanie Fehr, and I am privileged to lead the people teams at UnitedHealthcare and serve as their chief people officer. I'm also so fortunate to work with an esteemed panel today, people who care deeply about this topic and are really experts. So why are we talking about women's health and, really, what is our objective? We have the good fortune of having a lot of data around women's health, and that informs the trends that we see over the course of a woman's health journey. That also informs the type of products and services that will help women navigate their health journeys. And as we've gone through the last year and a half, I know it's been incredibly rewarding for me, and I think all of you, and we've had some incredible discussions and dialogue, that honestly, have really informed how we want to service our customers and our own employees. That's what we're going to talk to you about today. We're going to move on to discussing behavioral health, such an important topic. And we're going to start again with Craig, who will share some data around behavioral health, and then we'll bounce back to us for a discussion. Take it away, Craig.

[Text On Screen – Craig Kurtzweil, Chief Data & Analytics Officer UnitedHealthcare Employer & Individual]

CRAIG KURTZWEIL: Thank you, Stephanie. I'm going to jump into what we're seeing across our book of business associated with behavioral health. Behavioral health is one of the areas where we see probably the most distinct disparities when you compare adult men versus adult women.

[Text On Screen – (Slide 10) Gender differences in disease prevalence, In addition to conditions such as infertility, menopause and pregnancy, women have a unique set of health care concerns and are at a higher risk of developing certain conditions and disease than men.

Condition Prevalence: Women vs. Men

• Musculoskeletal conditions
  • 38% higher back pain
  • 27% higher osteoarthritis
  • 12x higher osteoporosis
• Autoimmune disorders
  • 1.7x higher multiple sclerosis
  • 1.7x higher rheumatoid arthritis
  • 6.5x higher lupus
• Thyroid and other conditions
  • 4x higher thyroid disorders
  • 1.7x higher. Headache
  • 12x higher fibromyalgia
• Behavioral health
  • 66% higher any BH diagnosis
  • 2x higher anxiety, depression
  • 6.5x higher eating disorders
• Cancer
  • 64% higher any cancer diagnosis
  • 146x higher breast cancer
  • 3.2 higher thyroid cancer

*Source: UnitedHealthcare book of business. Based on claims incurred Oct. 1, 2021 – Sept. 30, 2022, and paid through Nov. 30, 2022. ©2024 United HealthCare Services, Inc. All Rights Reserved.]

You can see in the highlighted box, in this view, that adult females have 66 percent higher diagnosis of behavioral health issues, two times the rate of diagnosis of anxiety issues, and six times the rate of eating disorders within that population. I stress the term diagnosis because we know that there's many more in the population, especially on the male side, that have these issues, but are not seeking treatment. So in the female population, we definitely see a lot less stigma associated with it, which is a good thing. Those are women that are seeking treatment.

[Text On Screen – (Slide 36) Maternal mental health crisis continues in women

US postpartum depression*1 CDC, 2015*2020 (graph)

DATA SPOTLIGHT: 1 in 5 US pregnancy-related deaths are caused by mental health conditions

*Sources: “Public Health Impact: Postpartum Depression” UnitedHealth Foundation, “Four in 5 pregnancy-related deaths in the U.S. are preventable” CDC, Advisory Board, ©2024 Advisory Board, All rights reserved, advisory.com]

If we dive a little bit deeper, we see that within the female space, of course, maternal mental health is an opportunity and is a crisis across the United States. We've seen increasing rates of postpartum depression associated with pregnancies. And at this point, one in five U.S. pregnancy related deaths are connected to a mental health condition.

[Text On Screen – (Slide 37) Behavioral health on adolescents

-       Adolescent girls experience 2.6 times higher levels of anxiety compared to adolescent boys

-       Adolescent girls and young women (ages 13-25) are 9 times more likely to be diagnosed with an eating disorder compared to their male counterparts; diagnosis of eating disorders peaks in adolescent girls ages 13-17

Anxiety Disorders and Eating and Feeding Disorders, Claimants per 1,000 (graphs)

*Source: UnitedHealthcare book of business. Based on claims incurred Oct. 1, 2021 – Sept. 30, 2022, and paid through Nov. 30, 2022. ©2024 United HealthCare Services, Inc. All Rights Reserved.]

We go a little bit further and look beyond just adult females and let's look into the youth population. Especially in a post-COVID world, we've seen a rapid escalation of behavioral health issues and specifically anxiety related issues in our young female population. You can see in the 13 to 17 year old age group, you see the females in that bracket having more than two times the rate of diagnosed anxiety. And that just becomes even more extreme when you go to the 18 to 25 year old population. On the far right, you can see eating disorders just dramatic, just swings dramatically within to the female population in all age bands. It's definitely focused in those young women.

[Text On Screen – Behavioral health, The Surest plan design encourages members to seek behavior health care

• Surest improves affordability for behavioral health care
  • Females on the Surest plan paid only $20 out of pocket per counseling visit – 50% less than the comparison group
  • Anxiety and depression were the most prevalent behavioral health conditions among females
  • Females on Surest paid less out of pocket in 2023 compared to members on a conventional health plan for treatment of depression and anxiety:
    • Depression – 82% lower cost
    • Anxiety – 88% lower cost
  • 23% of females accessed behavioral health care on the Surest plan vs. 19% for traditional health plans
  • Behavioral health diagnoses per 1,000 female members, (graph)
  • Anxiety: comparison 94.9, Surest 102.8
  • Depression: Comparison 56.1, Surest 70.0
  • Trauma-related disorders: Comparison 45.9, Surest 54.8
  • Neurodevelopmental disorders: Comparison 31.1, Surest 39.6
  • Bipolar and related disorders: Comparison 8.9, Surest 11.0
  • Feeding and eating disorders: Comparison 2.6, Surest 3.4

*Data was taken from Surest claims database and a large market national health insurance company claims database. Claims were incurred January – December 2023 and paid through January 2024. Surest™ ©Bind Benefits, Inc. d/b/a Surest. All rights reserved]

If we go a little bit further and talk about what does this look like within the Surest population? One of the biggest opportunities within behavioral health is just to make sure that people feel the opportunity and don't have any barriers to seek treatment, to see your doctor, to recognize there's an issue and seek treatment. One of the issues associated with seeking treatment is just stigma. Can you overcome some of the cultural and social norms that develop some stigmas in our population? And secondly is, can we overcome some of the financial barriers? And that's where Surest does a great job of eliminating that barrier and making it really simple and easy for females to seek treatment associated with behavioral health. And you can see that in the slide in the bottom right. Much higher percentages of women having these issues, or in my view, seeking treatment for these issues by removing some of those financial barriers. And with that, Stephanie, I'll kick it back to you.

STEPHANIE FEHR: Thank you so much, Craig. Super interesting information. I'm going to jump right to Alison. Let's talk a little bit about stress, Alison, and how stress impacts women's health. What are some strategies that we could use to mitigate some of that?

[Text On Screen – Alison Richards, Chief Executive Officer, Surest]

ALISON RICHARDS: I think stresses affects every aspect and every stage of our life. As we've been talking through all of these different conversations, you have hormonal imbalances, you've got menopause symptoms. All of these kind of increase the mental conditions and mental health conditions. We could go on and on, on the slides that we see about it. What I would say, from a Surest health plan perspective, it really encourages members to seek  behavioral health care. And especially when we take advantage of it, because we removing some of those barriers when it comes to the health care, specifically. Some of the statistics you saw on the slide, 23 percent of females on the Surest plan have accessed behavioral health care versus 19 percent on traditional plans. So when you're removing some of those barriers and creating an avenue, whether it's digital or by advocacy, where people can call in and do those different types of things, you're creating it that they know what the cost is, either if a telehealth visit, that it's a zero, or going to brick and mortar for $20 or wherever they need to go, they know what the cost is. When you know what the cost is, it removes some of that aha out of it, and I'm not scared to make it happen. I think there's just a lot of tools and things that we have to make sure that there's awareness. We're creating affordability, accessibility. Those are all key things, when we look at this space, of how we're offering health plans and benefits to it, to enable people to acknowledge care and really make sure that they have the asset there and availability of it.

STEPHANIE FEHR: As you can see in the data. That's amazing, the 23 percent is an amazing stat. Thank you for that. Lisa, let's go to you. Alison's talked about some really great things that digital has brought to behavioral health, which is one great resource. What other benefits exist that can help women through the challenges with behavioral health? And also, balance all the different demands we have on our lives that are really different than what men face, typically.

[Text On Screen – Dr. Lisa Saul, Chief Medical Officer, Women’s Health UnitedHealthcare]

DR. LISA SAUL: I think that balance is key, key to focus in on because women are the decision makers for health care and oftentimes are the major and primary caregivers, not only of their nuclear family, but as we are living in sandwich generations, we're often tasked with taking care of adult relatives as well. I know we're dealing with that in my family. And as a result, that puts a lot of pressure on a person. And then you're also trying to go to work every day. And so what Optum has done is partnered with Clio, which provides that support for working families who are caregivers, both of children, adults, and those with special needs, to help provide an oxygen mask for the person that is the primary caregiver, who is trying to navigate all of the people that they have to take care of, as well as taking care of themselves, and provide some of those tools and resources to preserve mental health and wellness while functioning in that role.

STEPHANIE FEHR: Such a great example. Thank you. That's great. And Will, let’s wrap up with you. Access has always been an issue, and it's even more of an issue post-COVID. How have we and Maven really addressed this issue around access?

[Text On Screen – Will Porteous, Chief Growth Officer, Maven]

WILL PORTEOUS: On Maven, your point actually resonates a lot. Oftentimes, when people realize there isn't a cost barrier, or at least know what the cost barrier is, they're more likely to utilize it. That's the great thing about Maven. For the member, it's free. You can use it unlimited. And I had mentioned earlier, we have 35 different specialties covered on the platform. Behavioral health is the most commonly used, regardless of where the member is in their family journey. So it's clearly a need. And it's an unlimited free use. I think what's a little different about how Maven thinks about this, in terms of access, is there is a need for generalized behavioral support, but oftentimes in your life you have very specific needs. And a lot of times it does come around these family health journeys. You have anxiety about going through IVF treatments. You have anxiety about going through a pregnancy. You have depression during a postpartum period. And menopause, as you mentioned earlier, it's a whole new slew of needs you have. I think that's what's nice about a Maven product, is you can get unlimited access to these types of providers that are hard to find. And because it's virtual, you can find someone who looks, sounds, and believes like you. But then three, you can find someone who knows how to treat that aspect of what you're specifically going through in that moment. So it's a supplement to the broader behavioral health system, specific to your need in that moment.

STEPHANIE FEHR: That's awesome. Very good. Thank you. That's exciting. Everybody's health is so unique, but having the subject matter expertise, it's very important. So good. All right, lightning round time. We're going to go around and do some advice for anyone listening who would like to understand where to go next, from an action perspective. I'll start with you, Lisa, if that's okay.

DR. LISA SAUL: Sure. I think that this is a topic that is so universal. Everyone is dealing with something, and it's not always attached to a diagnosis. And so just that I think it's important to be able to provide support resources before it escalates to be a major issue. I think that in a society that's less and less nuclear, these are the sorts of supports that people need. So I think providing that is really, really essential. That is such a good way to put it. We are not very nuclear anymore. Thank you.

WILL PORTEOUS: I actually think, in getting to know you guys, and know you over the years, I think one thing is, executives watching this, is be open about your own situations. Oftentimes, just hearing someone else's going through it, particularly at the executive level, it opens up so many more.

STEPHANIE FEHR: It's quite validating isn't it?

WILL PORTEOUS: Yeah, to be willing to pursue it, to the degree you're willing, be open with what you're going through yourself.

STEPHANIE FEHR: I love that. Thank you.

ALISON RICHARDS: I love the openness, and I would say, and continue to advocate for your needs in different environments too. Be curious, ask questions. If you're unsure about, if you're sitting in a doctor's office, even, you don't understand what they're saying, right, ask a question. And navigate, help navigate the process. There's so many resources available to you and especially through all the programs you've heard about here today, through UHG. So I would just say, be curious and ask questions.

STEPHANIE FEHR: No, it's such a great point. And we're surrounded by experts. We work for a healthcare company, which is such a benefit. So ask questions. Great one. Again, thank you so much for sharing your expertise.

[OUTRO MUSIC]

You guys are an amazing team. And thanks to all of you for being here, and we look forward to chatting again soon. Thank you.

[LOGO: UNITEDHEALTHCARE]

[Text On Screen – UnitedHealthcare, There for what matters™, Insurance coverage for fully insured plans is provided by All Savers Insurance Company (for FL, GA, OH, UT, and VA), by UnitedHealthcare Insurance Company of IL (for IL), by United Healthcare of Kentucky, Ltd. (for KY), or by UnitedHealthcare Insurance Company (for AL, AR, AZ, CO DC, DE, CA, IA, ID, IN, KS, LA, MI, MN, MO, MS, MT, NC, NE, NH, NV, OK, PA, RI, SC, SD, TN, TX, UT, VA, WV, AND WY). These policies have exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact either your broker or the company. Administrative services for insurance products underwritten by All Savers Insurance Company and UnitedHealthcare Insurance Company, and for self-funded plans, are provided by Bind Benefits, Inc. d/b/a Surest, its affiliate UnitedHealthcare Services, Inc., or by Bind Benefits, Inc. d/b/a Surest Administrators Services, in CA. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Maven and Maven Wallet are products of Maven Clinic Co. Maven is an independent company contracted to provide family-building support including care advocacy, virtual coaching, and education. Maven does not provide medical care and is not intended to replace your in-person health care providers. Use of the services is subject to terms of service and privacy policy. Maven® is a registered trademark of Maven Clinic Co. All rights reserved.]