What does a seamless Medicare Advantage experience look like? A Q&A with UnitedHealthcare

Since Medicare Advantage launched three decades ago, the public-private partnership has provided older adults and other Medicare beneficiaries an alternative way to receive their Medicare benefits through private health plans, many of which also offer dental, vision, hearing and care coordination benefits. Today, more than 50% of the Medicare-eligible population is enrolled in Medicare Advantage.¹

The program is also a testing ground for innovation, as private insurers explore ways to make their Medicare Advantage plans more efficient and easier to navigate, explains Bobby Hunter, president of UnitedHealthcare. “Medicare Advantage can be a profound modernization engine across the healthcare ecosystem,” he says. “We’re figuring out what works, reporting on it transparently and scaling it.”

In a conversation with Forbes, Hunter explains how technology, transparency and administrative simplification can improve the Medicare Advantage experience for patients and providers.

This interview has been lightly edited for clarity and length.

Forbes: What does modernizing Medicare Advantage mean — and why is it a priority now?

Hunter: Modernization is about removing friction in healthcare. How do we engage more effectively so consumers don’t have to guess about where to go for care or what’s going to be covered? How do we use the tools available to us to drive a completely reimagined healthcare experience?

Medicare Advantage has always been a great incubator where innovation was really tested, from value-based care models to digital capabilities and tools. When innovation works here to eliminate confusion and enhance access, you can harness it and push it across healthcare.

As the population ages, the number of people who will be critically dependent on a successful Medicare program is growing at a rapid pace. We need to be responsive to the moment so Medicare Advantage continues to be successful for decades to come.

That also means being open to thoughtful, tested program reform. There is opportunity to make the program better, and we have a responsibility to protect what works, improve what can work better and help ensure Medicare Advantage remains strong, affordable and sustainable for the long term.

Forbes: Where do you see the biggest opportunities to reduce friction in Medicare Advantage?

Hunter: It starts with the member. There’s too much uncertainty around how to access care and understanding what is covered. When you walk in the footsteps of your members, you can intervene in that moment of uncertainty and make it easier by connecting digital tools and customer support. We want members to feel like they have a trusted advocate in their insurance partner. We want to make the care journey as easy as possible for them.

With advancements in technology, there’s an opportunity to help consumers navigate healthcare more seamlessly, but that requires different parts of the healthcare system to communicate more effectively. Ultimately, the goal is fewer surprises, less guesswork and a more personalized experience that gives people greater confidence in the decisions they make.

Forbes: Why is a stronger partnership with providers so critical to this effort?

Hunter: The provider is at the center of the healthcare experience for the member. To deliver the best member experience, we need to improve the provider experience. This next phase of modernization is about showing up differently for providers, with greater transparency, stronger partnership, better tools and less administrative back-and-forth.

Payers and providers do not always see every issue the same way, but improving the experience requires us to find common ground and take tangible action. We are reducing prior authorization requirements, investing in stronger relationship and issue-resolution capabilities, and modernizing the systems providers use to work with us.

That includes using technology to streamline and automate processes such as benefit checks, eligibility verification, coordination of benefits, prior authorization and claims editing. The goal is to give providers better information earlier, ensure the information is accurate, prevent avoidable denials, reduce rework and create greater clarity during the care process.

If we can find common ground, use technology and eliminate unnecessary administrative work, we can lower healthcare costs and improve the experience for both providers and patients. And we will hold ourselves accountable by listening directly to providers, acting on their feedback and reporting transparently on our progress.

Forbes: What should a modern Medicare Advantage experience look like for members?

Hunter: It’s about giving members real-time access, at their fingertips, to information they need to make their best personal healthcare decisions, like cost, coverage and quality. It’s no different than how you experience any other decision-making process in your tech-enabled daily life. You’re able to quickly research and understand the alternatives and trade-offs.

We want to give people that same level of confidence and clarity in the healthcare journey. When someone needs or is seeking healthcare, they are often at their most vulnerable and navigating something that is incredibly complex. We have so much opportunity to provide a solution in these critical moments and bring it to life for people in a way that gives not only peace of mind, but also better cost and coverage outcomes.

Another opportunity is to continue to drive products that are more personalized and customized. Right now, there’s reasonable variety. Think about your HMO and PPO products as well as products designed for people with chronic conditions or who are eligible for both Medicare and Medicaid. The more personalized you can make it, the better, and not only in terms of the benefits and how you design the product, but also how you engage and communicate with the member based on their preferences. I think that level of personalization is going to be a critical element and will eventually become a basic expectation for how consumers want to engage as they’re working through their healthcare experience.

Forbes: What impact will these improvements have on patient costs and the long-term sustainability of Medicare Advantage?

Hunter: Modernization should eliminate much of the administrative waste and suboptimal processes and systems that exist today. There is a significant opportunity to start eliminating costs from the healthcare system that aren’t driving better patient outcomes. That allows you more capacity to invest in the things that do drive better quality. Every dollar spent navigating unnecessary complexity is a dollar that cannot be invested in care, benefits or services. That is why modernization is not separate from affordability. It is one of the most important ways we can protect affordability over time. 

One of the great things we do in Medicare Advantage is engage members earlier. We have a $0 primary care physician (PCP) copay in almost all of our plans because we want members engaging with their PCP and seeing them frequently to get their annual wellness visits and to check up on their medications. We offer comprehensive clinical care in the home through HouseCalls, $0 copays on hundreds of prescriptions and certain lab testing. And we go a step further by rewarding members for taking important steps to stay on top of their health, including completing certain preventive and routine care activities. It’s about giving people more reasons to engage in their health before a condition becomes more serious.

We do this because if you miss out on preventive care, acuity levels can spike, conditions can escalate and the next step could be an ER visit or inpatient stay. Investing in the earlier part of the healthcare journey to keep people healthier, engaged and on top of their own healthcare will help drive down patient costs overall. Today, a lot of this comes to life through our value-based care provider partnerships. That is a model that aligns incentives around quality, outcomes and prevention — not a volume-based reimbursement model that exists prominently in other parts of healthcare.”

Forbes: How will we know whether these modernization efforts are making Medicare Advantage more successful?

Hunter: We need to listen to members and providers. We’re going to hold ourselves accountable for asking the tough questions, getting the direct feedback and reporting on it transparently. The big one we use is the Net Promoter Score (NPS). It measures whether our members would recommend us as a plan for somebody else and whether our providers would say the same thing.

What’s really interesting about Medicare Advantage is that despite some of the criticism it’s faced, it actually has one of the highest, if not the highest, NPS scores of any health insurance program. In some subcategories like our Medicare-Medicaid dual eligibles, NPS is particularly high.

So there is a really good foundation from which to grow, and now the focus is, how do you drive this modernization agenda to get that even higher?

If our actions are hitting the mark, we’ll double down on them. If they’re not working, then we need to pivot and try something different. When we find what works, we’ll scale it so even more people can experience the unparalleled value Medicare Advantage provides.

That same approach should guide the broader reform agenda I mentioned. We need to test changes thoughtfully, measure the results transparently and scale what demonstrably improves affordability, quality and the member and provider experience. That is how we will protect what people value about Medicare Advantage while continuing to strengthen it for the future.