Cost management that meets the moment

Balancing those dynamics with today’s competitive labor market and high labor costs is making it increasingly difficult for employers to balance their costs while still attracting and retaining top talent, reinforcing the need for strategic cost management.⁷ The UnitedHealthcare approach focuses on the following 3 areas, which has proven to deliver a 10% average lower total cost of care according to independent studies conducted by Wakely Consulting Group, Santa Barbara Actuaries and ZS Associates:⁸

• Network and plan design
• Clinical and care management
• Employee engagement

Primary care providers have the ability to impact $0.61 of every health care dollar.⁹ Understanding their role, UnitedHealthcare network strategies focus on providers and systems that deliver proven quality and efficiency.

The approach also aligns with employers seeking innovation in network and plan design as a key strategy to control costs.¹⁰ This includes the promotion of value-based care and networks such as Accountable Care Organizations (ACOs) and Centers of Excellence (COEs) to deliver quality, cost-effective services. For example, in a population with 90% of cases at COEs for transplant procedures, cases saw an average of 24% lower hospital length of stay and 55% average contractual savings.¹¹

The expansion of virtual care as a result of the pandemic has also transformed provider networks, with almost 90% of Americans reporting they wanted to keep using these services long-term.¹² Delivering a continuum of virtual care options to employees — wherever, whenever — may help them stay healthier, while potentially reducing the number of costlier and unnecessary urgent care and ER visits.

Additionally, UnitedHealthcare has moved beyond traditional network strategies to focus on collaborating with providers in new and different ways.¹³ For example, integrating a patient’s UnitedHealthcare health record with the provider’s electronic medical record (EMR) can give the provider real-time insights on that employee’s care needs and specific benefits and coverage, which may help reduce costs for the employees as well as their employers.

An effective network strategy helps guide providers and members to physicians who have demonstrated their ability to deliver quality, cost-efficient care, resulting in lower net paid costs, fewer ER visits and shorter inpatient stays for their patients.¹⁴

Understanding and selecting the right plan design can also help ensure employers and their employees get the most out of their health plan. For example, some plans offer upfront pricing information that allows employees to make more informed decisions for their health and pocketbook. Others rely heavily on the primary care provider (PCP) relationship, encouraging employees to go through their PCP to manage their care or make physician referrals. Both may be effective in better managing costs over the long-term.

The proof is in the numbers:

• Up to 15% savings for employers using networks with ACO configurations¹⁵
• 10% lower total cost of care among designated quality physicians¹⁶
• 73% of members enrolled in Surest spent less than $500 out-of-pocket annually¹⁷

According to UnitedHealthcare research, employees made less-than-optimal health care choices 38% of the time, which directly impacted their health — and increased the cost of health care for everyone.¹⁸ And with more than half of all adults having 1 or more chronic conditions,¹⁹ clinical management strategies play a key role in containing costs.

For instance, UnitedHealthcare leverages advanced analytics to identify employees who might have chronic and high-cost conditions that would benefit from an outreach. A nurse asks if the employee would like to participate in proactive engagement through digital tools including secure text messaging, online live chats or nurse outreach based on digital device readings.

When employees call in or online chat for help, a dashboard may alert the advocate to notify the employees of available clinical programs. In fact, 39% of clinical program enrollees came from advocate referrals.²⁰

While not managing a chronic condition or getting preventive care can raise costs in the long term, employees receiving inappropriate or unnecessary care may also result in poor health outcomes and higher costs.

For inpatient care, Medical Necessity is a process to help ensure employees receive procedures and bed days that are clinically appropriate, clinically effective and cost effective. Through Medical Necessity, employers have seen an average of $6.88 savings PMPM and overall medical savings of 2%.²¹

These integrated clinical strategies are helping to identify gaps in care earlier, empowering providers and engaging employees through personalized care support. The result: better outcomes, a simpler experience and lower overall costs.

Empowering employees with tools to maintain or move toward a healthier lifestyle impacts total cost of care. Research showed higher levels of engagement are linked to improved health outcomes, lower costs and higher productivity.²⁴

Where the need is the highest, UnitedHealthcare analyzes the performance of health choices using its Health Activation Index® (HAI®) tool. Across a population, the HAI tool reviews 53 high value health decisions (financial, clinical, resources) and summarizes them into a unique HAI score, where each +1% change equals 0.56% savings.²⁵

Segmentation by life-stage, demographic and socioeconomic factors allows an employer to effectively identify under-engaged groups. Some employers have saved up to 20% in costs by taking full advantage of this data-driven approach.²⁶ 

Wellness and weight loss programs tied to rewards and incentives for healthier choices are another way to help drive engagement to prevent or manage chronic conditions and ultimately, lower costs. For example, weight loss program Real Appeal® can drive a 12% reduction in medical costs for participants in 3 years.²⁷ Combined with digital tools and devices, they can help support a wellness culture in the workplace.

For example, more than 75% of consumers believed that wearable devices to track health or activity data helps them to change their behavior.²⁸ Wearables can be used for everything from logging miles walked to monitoring blood sugar to tracking sleep patterns.

Offering eligible members access to wellness programs presents insurers like UnitedHealthcare the opportunity to form a relationship as a resource in managing overall health. For instance, UnitedHealthcare Rewards incentivizes members for reaching daily goals and completing one-time activities.