Nobody, it seems, is happy with the U.S. health care system. It’s primed to become a driving issue in the 2020 elections. Problems with costs, outcomes and complexity drag it to the bottom of global rankings for developed nations. That’s why it is so important to develop new approaches that can make the health system work better for everyone.
Three persistent health care challenges rise to the top for employers and employees today:
- An overly complex consumer model can make it difficult for employees and their families to navigate. Research shows that 76% of employees say they don’t understand their health plan,1 while 91% don’t know basic health plan terms.2
- High costs that continue to grow for employers. Research shows that 77% of employers say that managing cost is their biggest priority,3 and 76% of employers worry about affordability for employees.4 As a result, 93% of employers say cost drives benefit strategy.5 6
- Wide variation in both cost and quality that is difficult for employers and employees to accept or understand. Health care inefficiency wastes an estimated $765 billion a year,7 while 75% of Americans say they don’t get value for what is spent on health care.8
The industry needs to develop new approaches and workable solutions to these challenges. That’s why innovation is a fundamental priority for UnitedHealth Group®, which invests more than $3 billion annually in data, technology and innovation to reduce health care costs, improve patient outcomes and improve member experience.
By taking a de-centralized, enterprise-wide approach, innovation can surface from many areas within the organization. UnitedHealth Group collaborates with employers, provider systems, non-profits, industry leaders, academic institutions and policy and government institutions to fuel innovation in health care. UnitedHealth Group also invests in promising new opportunities through joint-ventures and acquisitions.
“We are continuously focused on developing new ways to deliver value and better health care outcomes,” said Suzie O’Gorman, Senior Strategic Business Architect, Innovation with UnitedHealthcare National Markets. “We do the road-testing and evaluation of many new point solutions so employers don’t have to. If they show promise we integrate them into our broader network of services for the benefit of all our employers and members.”
Innovation in action: Priorities come to life
Investment and collaboration are yielding some big wins in fighting confusion about health care and benefits among members: inconsistent health outcomes, high medical costs and operational inefficiencies.
New engagement models that deliver on cost and quality
Personal Health Support 3.0 is a new, proactive care management solution that adopts a total-population approach to enhance employee engagement, improve health anddrive down costs.
What sets Personal Health Support 3.0 apart is its deep grounding in over a decade of data and patient experience with thousands of health conditions. This informed innovation enables UnitedHealthcare to identify where employers have the greatest chance to reduce their health care costs among their employee population through targeted and focused interventions to help generate the best possible outcomes.
Personal Health Support 3.0 screens 100% of an employer’s population for episodic/acute and chronic conditions to match individual health needs with the most clinically appropriate resources.This is critical because employers with thousands of employees cannot predict what condition may surface prominently within its employee population. The total-population approach hedges against that unpredictability. Using smart technology and its extensive data resources and clinical insights, UnitedHealthcare identifies gaps in care, determines the cost savings that could be realized by closing those gaps, and the likelihood of the member engaging to develop a Value Opportunity Score, which helps employers prioritize their investment to focus on those conditions having the greatest ability to impact health care costs.
Members have access to a new digital solution that includes messaging, education, care plans and goal tracking. Based on a member’s needs, Personal Health Support 3.0 provides decision support, disease and case management for more than 100 conditions —including a broad range of clinical programs, such as maternity, transplant resource and congenital heart disease resource services.
Personal Health Support 3.0 can deliver up to $9.05 in medical cost savings per member per month — 20–35% more than Personal Health Support 2.0 when comparing base configurations, or up to $10.05 per member per month with the recommended configuration.9
Plan innovation focuses on costs, access
The Colorado Doctors PlanTM (CDP) is a collaboration between UnitedHealthcare and Centura Health. It is built as a simpler health plan designed to deliver lower costs, greater access and healthier employees. Doctors work together to coordinate care, and UnitedHealthcare works behind the scenes using its resources, data and insights to deliver a better experience. This model is a first for UnitedHealthcare and will be expanded to other markets.
Featuring same-day appointments, 24-hour online doctor visits, 24-hour phone access to a nurse and $0 copays for all but emergency room visits, CDP fosters deeper engagement between care providers and members through more proactive and extensive prevention, easier navigation and coordination across the health system, and robust data and analytics to help care teams focus on improving outcomes.
CDP’s easy-to-use online resources help members choose a care provider and schedule appointments. Care providers are supported by clinical resources, programs and analytics to help patients get the care they need under the plan. Within the CDP, members can use the UnitedHealthcare QuickCare FinderTM skill with Amazon® Alexa to say “Alexa, open QuickCare Finder.”
The skill guides them through a series of questions and then directs them to the best care option in the plan, whether a 24/7 nurse line call, an online doctor, a nearby convenience care clinic or an emergency room. QuickCare Finder was developed to reduce overutilization of emergency room visits, 70% of which could have been replaced by lower-cost care alternatives, according to a UnitedHealthcare Emergency Department report.
Leveraging data/machine learning to improve access
Optum Ventures® is the independent venture fund of Optum and invests in promising startups that use technology to transform health care. One example is Buoy Health, which provides a digital health assistant tool to help patients, through artificial intelligence, get advice on the best action to take based on their symptoms and risk factors — helping patients get to the right care at the right time.
Buoy Health serves as a front door to a plan’s advocacy and support through the use of its virtual clinical navigation. Developed at the Harvard Innovation Lab with the help of Harvard professors in medicine, machine-learning, and epidemiology, Buoy leverages advanced algorithms and machine learning to analyze the patient’s symptoms in detail, using a proprietary database built from thousands of clinical papers and millions of patients who have already used Buoy.
In a few minutes of exchange with the user, Buoy obtains a detailed understanding of the individual’s situation and provides the user with options on what to do next, including where and when to seek treatment. For example, should the person call a primary care doctor’s office in the morning, visit an urgent care center or go straight to ER? Then, Buoy connects the patient to the exact service or provider customized to their location, time-of-day, clinical situation, and benefit design. Plans are underway to test Buoy’s capabilities as proof of concepts in 2019. Incorporating Buoy into new and existing product offerings is being discussed for future years.
Reducing costs and increasing simplicity
While Buoy Health is an example of an improved member experience through the use of self-directed digital tools, PreCheck MyScript® is an example of innovation in the hands of providers. The tool gives prescribers more information about the cost of drugs specific to each member through a real-time benefit check process — reducing costs and simplifying an important process. PreCheck MyScript provides prescription clarity up front by giving physicians patient-specific pharmacy information within their existing electronic medical record (EMR) system and workflow. The doctor can see how much the prescription would cost (through a trial claim that happens behind the scenes), see lower-cost alternatives, and be alerted right away if the medication requires prior authorization. If so, the doctor can initiate the authorization process right directly from the tool. PreCheck MyScript enables doctors to make informed prescription recommendations without extra steps in their workflow, and helps improve member understanding of prescription cost options.
UnitedHealthcare developed the tool in partnership with OptumRx®, one of the largest providers of pharmacy care services in the United States and UnitedHealth Group’s free-standing pharmacy care services business. Since its launch in 2017, 147K+ providers are utilizing PreCheck MyScript. On average, 20% of all transactions result in a medication change to a lower-cost alternative and approximately 30% of prior authorizations are initiated electronically or avoided.11
“Our customers and our extensive clinical insights and data are our best resources for identifying potential new innovation projects,” O’Gorman said. “Our data points us to where we should focus, and so do our employer customers to help ensure we continue to deliver value and better health outcomes.”
1 Aflac Workforces Report – Employer Overview, August 2017.
2 UnitedHealthcare Consumer Sentiment Survey, 2016.
3 2017 Aon Heath Survey webinar presentation 4/28/17.
4 Employers Hold Steady in Time of Uncertainty, Fifth Annual Transamerica Center for Health Studies Survey, Nov 2017.
5 National Account Marketing Trends Report, Summary 2018
6 2017 Aon Health Survey Webinar Presentation 4/28/17
7 Roundtable on Value & Science-Driven Health Care, Institute of Medicine of the National Academies, September 2012.
8 UnitedHealthcare Internal Research Report, Consumerism Attitudes, Perceptions and Behaviors, July 2018.
9 2019 UnitedHealthcare data; PHS 3.0 Medical Cost Savings – compares base configuration of PHS 2.0 to base configuration of Personal Health Support 3.0. Average savings across UnitedHealthcare book of business. Actual results will vary.
10 UnitedHealth Group news release, Sept. 27, 2018: “PreCheck MyScript Puts Drug Costs at Physicians’ Fingertips – in Real Time”
11 OptumRx internal data, Feb 2019.
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