UnitedHealthcare Engagement & Transparency: An Analytic Approach.
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1 UnitedHealthcare Engagement & Transparency: An Analytic Approach. David Ellis, M.D. Senior Vice President and Senior Medical Director Customer Analysis & Solutions
2 The Engagement Strategy Initiation Awareness Accountability Ownership Core Plan Design CDHP <20% HRA vs. HSA CDHP 20-50% More HSA CDHP 50%+ Mostly HSA CDHP 75%+ Mostly HSA Cost Share Support >85% Gold or lower 80-85% or lower Eye on Silver <80% / split Silver or lower <75% / split Silver or lower Network Design Broad + OON cost Share Limited OON benefits, TeleDoc Narrow and/or gatekeeper, Onsite or other nwk augmentation (e.g. clinics) Premium / COEs Basic myuhc and network directory Awareness in plan collateral COEs and coverage mandates Tiered cost sharing Targeted Comm s Clinical and Wellness Resources No requirement PHS or CPHS DM if illness burden warrants Incented Wellness coaching suite Future: Total Popul Mngt models Value-Based / Health- Based Incentives Limited to none (e.g. Health Assessment reward) Activity Based rewards ~$100 - $300 Outcomes based Compliance Carrot/sticks Autonomy and mobility More consequential rewards Communication and Technology Tools: benefits tracking, decision support, myhcce/transparency, social media, scorecard, etc. Change management, targeted communications, culture consulting 2 Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
3 The Engagement Tool HealthPlan Manager 3 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
4 Engaging a Diabetic Population EBM Compliance Prior Current UHC National 94% 96% 95% 96% 74% 80% 77% 75% 71% 69% 69% 55% 35% 34% 36% Diabetes-LDL/1 yr Diabetes-Creatinine/1 yr Diabetes-Eye Exam/1 yr Diabetes-Kidney Screen/1 yr Diabetes-2 HbA1c Tests/1 yr Diabetes Health Plan 4 Variance from Public Sector Norm Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
5 Engaging both Providers & Members 5 Variance from Public Sector Norm Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
6 Premium/Centers of Excellence Quality First with Cost Transparency Longest running physician quality and cost efficiency designation program (since 2005) National industry, evidence-based and medical specialty society standards are used to evaluate individual physicians on more than 75 conditions and 300 measures Only physicians who meet the quality designation criteria are eligible for cost efficiency designation Access 148 markets and 21 specialties account for more than 50% of all medical costs; includes Primary Care Physicians and Specialists Broad Application Available to all members at no additional cost designations integrated into all customer service, clinical, and online experiences Benefit designs based on UnitedHealth Premium designation 6 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. The UnitedHealth Premium program has received the National Committee for Quality Assurance (NCQA) Physician Quality (PQ) program certification and meets the Consumer Purchaser Disclosure Project s Patient Charter standards
7 Consumerism isn t a trend we follow It s the fabric of who we are myhce Health4Me Diabetes Prevention and Control Alliance Diabetes Health Plan Transparency puts consumers in control of their money, their health and their sense of security 7 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
8 The importance of accurately estimating costs Using Current Fee Schedules Means More Accurate Information that Consumers Can Trust 3.1 million cost estimates covering over 574,000 physicians, and more than 4,100 hospitals 92% of estimates calculated based on current provider contracts, supplemented with historic claims data as needed When claims averages are used due to lack of a fee schedule such as a percent of charge arrangement estimates are based on 2 years of claims covering over 20 million members Overall accuracy of 98.5%: estimates are validated against a source of truth contracts and paid claims 8 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
9 myhealthcare Cost Estimator ~160 Carepaths Shoppable Services Future Releases Physician: Office Visits (various), Chiropractic (various), Electrocardiogram (various), Echocardiography (various), Ear Infection, Acute Bronchitis, High Blood Pressure, etc. Preventive: Preventive Office Visits (various), Screening Mammogram, Screening Colonoscopy, etc. High Volume Inpatient Services such as Childbirth, Back Surgeries, Knee Replacement, Hip Replacement, CABG, Cervical Spine Fusion, Coronary Artery Catheterization, etc. Radiology: X-Ray, MRI (Knee, Lumbar Spine, Brain), CT Scan (Abdomen, Chest, Pelvis, Head/Brain), Ultrasound (various), etc Laboratory: Glucose, Hemoglobin, Urinalysis, Vitamin D, Lipid Panel, TSH, CBC, etc Outpatient: Diagnostic Colonoscopy, Endoscopy, etc, Gallbladder Removal, Knee Arthroscopy, Tonsil removal, Ear Tubes, etc 9 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
10 myhealthcare Cost Estimator Consumer Usage Feedback People who have used myhealthcare Cost Estimator told us what they thought. 45% used myhce before scheduling a test or starting treatment 84% are likely to use the tool again 35% stated the information in myhce impacted their provider decisions. Value Four-in-ten users did not know provider, facility and treatment costs could vary so much. Educating members on cost differences, will increase the value of using the tool and increase engagement. 10 Confidential property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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WASHINGTON STATE COMMON MEASURE SET FOR HEALTH CARE QUALITY AND COST Performance Results for Health Insurance Plans DECEMBER 2015 Table of Contents Introduction... 3 About the Results... 4 How to Read
1199SEIU National Benefit Fund for NYC Employees Summary of Benefits and Coverage: What This Plan Covers and What It Costs
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Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.etf.wi.gov or by calling 1-877-533-5020. Important Questions