For years, integration has been an elusive goal of the health care system — everyone wants it, but few know what it looks like or what it should do. In the simplest of terms, integration is about improving member experience and outcomes.
It’s about creating the most seamless, unified, connected experience possible for employees and their families. And it’s about achieving the best possible health outcome for that member while controlling costs. Integration starts with the member experience at the core and works outward to build a system that benefits everyone.
“Integration is really about putting the member at the center of everything,” said Jean-François Beaulé, Executive Vice President of Design and Innovation at UnitedHealth Group. “That’s where it all happens.”
Integration can lead to better choices, which are the key to better outcomes, i.e., lowering the total cost of care. Employers are learning how crucial it is to proactively provide members with health and savings opportunities at every interaction. For example, an employer’s health insurance carrier can help connect the dots related to the health of their members and deliver a more effective care approach through tapping caregivers, advocates, pharmacists, virtual assistants and predictive analytics.
Companies have seen that empowering better choices for employees and their families with synchronized, simplified and personalized insights can yield savings of up to $25 per member per month (PMPM) — or $300 per member per year—across a covered population.1
Defining integration—and its impact
One way to understand integration is to look at the problem it is trying to solve: the frustrations and poor outcomes members might have with a fragmented health care system. With member experience at the core, an integrated health system can simplify the employee experience by sharing information across medical, vision, dental, pharmacy and behavioral specialties with the goal of improving the health, wellness and productivity of members and reducing costs for employers.
“An integrated system offers members and their care providers with relevant and complete information at the moment of the health event — and with improved analytics, even before they have the health event,” Beaulé said. “The complexity is adjudicated behind the scenes, monitoring signals and identifying patterns, and when the health moment arises, the member is presented with a simple personalized experience promoting high quality value choices. Simple.”
Integration enables carriers to provide member support both directly through advocacy programs and personalized services and indirectly through a wide range of behind-the-scenes support to help physicians better serve members. For example, indirect support would include providing them with:
- Member and practice-based data sharing.
- Reports on care delivered and optimizations physicians could make next time.
- Tools in their hands, like the ability to precheck a drug prescription by running a trial claim.
- Peer reviews from an extensive network of clinicians.
- Rewards through value-based contracts.
“Unification and personalization of the member experience provides the opportunity for better health choices by creating a reinforcing ‘effect’ through the synchronization of all resource needs for a given health event, e.g., maternity, cancer, pain management. When this experience is integrated within health benefits coverage, this reinforcement can extend to a unified rewards cost-share system with perceptive settings that anticipate typical needs of the individual, whether based on their life stage or health condition,” Beaulé said.
“This is where lies the promise of big data and an intelligent platform having a meaningful impact on waste and persisting variability in our fragmented system,” Beaulé said. “We have the opportunity to evolve the health plan proposition where key health moments can be managed to an optimal level with active individual and provider participation, and the health plan reciprocates with high-value rewards or reimbursements in return, to both member and provider.”
Building blocks of an integrated strategy
Integrated capabilities can help members, providers and plan sponsors make better choices. That integrated approach also allows for care to be delivered remotely as people are dealing with a health event or a chronic condition. There are 4 essential building blocks to this integrated strategy that provide both direct and indirect support to the member, wherever they’re seeking care:
- Combining medical, pharmacy and other clinical data to create a holistic view of each member and support personalized and targeted member outreach efforts. What’s worse for members than realizing their doctor, pharmacist and specialists aren’t on the same page? Combining the data is a good first step to ensure members don’t feel the disconnection of a fragmented system.
- More personalized member engagement by consolidating all data tied to a member to provide personalized health-improvement options. Any recommendation on how to help a member lose weight should take into account their overall health condition and lifestyle — for example, jogging or other high impact exercise may not be an option for a member with arthritic knees or hips.
- More effective clinical care by enabling member support teams to leverage the integrated data systems and holistic view to facilitate provider’s clinical assistance and guidance for members. A pulmonologist who knows a member with severe asthma also had glaucoma would likely try to find an alternative to corticosteroid treatments, which can help relieve asthma but could lead to vision loss for a glaucoma patient.
- Empowering physicians with timely information and decision support, enabling better care decisions and increased patient safety. Before prescribing a drug for even common conditions as high blood pressure or diabetes, a provider needs to know if the member is taking any medicines with which the new drug may dangerously interact.
By promoting increased member engagement across all of the available benefits, this strategy has led to improved quality of care and total cost of care savings. Consider one UnitedHealth Group client, a health care service company with about 40,000 employees, where more than half of the members had 2 or more costly conditions: Deploying advocacy, pharmacy and specialty programs led to higher adherence and engagement among members and resulted in $18 PMPM in savings.2
1 2017 Optum analysis of total cost of care data of fully synchronized clients.
2 This 2016 Optum study measured the medical savings impact of synchronized medical and pharmacy benefits and capabilities for 351 Administrative Services Only (ASO) commercial clients with UnitedHealthcare medical benefits, OptumHealth care management support, and OptumRx pharmacy care services compared to that of 121 ASO commercial clients with UnitedHealthcare medical benefits, OptumHealth care management support, and an external Pharmacy Benefit Manager. The study was based on 2017 medical claims data and included 3.3M members.
Inverse probability weighting was used to control for over 100 key demographic, geographic, health risk, and plan specific factors in alignment to prior study practices. Savings were calculated at the member level and aggregated up to the cohort to allow for better balancing of client membership to the control cohort.
The study features data from nearly 500 clients covering over 3 million members and has rigorous statistical controls.