Your guide to UnitedHealthcare

Transcription

1 Your guide to UnitedHealthcare

2 Face the future with confidence The benefits environment remains challenging. Uncertainty reigns as a wave of new regulation sweeps across the industry. Costs continue to rise while employers and the nation s health care system creak under an increasing burden of chronic diseases like obesity and diabetes. Now more than ever, you need a benefits company with deep expertise and innovative solutions for successful long-range health benefits planning. Now more than ever the right choice is UnitedHealthcare. Changing the system, one person at a time People who are actively engaged in managing their own health are more likely to make good health decisions and achieve better health outcomes. 1 UnitedHealthcare can help your employees get actively involved: providing the tools and resources to help them live healthier lives. That may mean reduced absenteeism, better productivity and lower costs for your firm. Individually, we can each change our behaviors to help improve our own health. Collectively, we can help modernize the health care system and make quality care affordable and sustainable for all Americans. UnitedHealthcare is ready to play a key role in driving this essential transformation. 1 How Engaged Are Consumers in Their Health and Health Care, and Why Does It Matter Research Brief No. 8, October 2008, Center for Studying Health System Change;

3 A legacy of innovation We re a different kind of health care company. We consistently apply creative, innovative solutions focused on helping people live healthier lives and creating superior value for you. Our record of innovation stretches back over two decades. We ve worked to develop new approaches designed to improve health and well-being. In many ways we ve helped transform the health care system through technology and research investments that generate creative, next generation solutions. But always we ve maintained our commitment to simplify the health care experience First company to produce a report card on health care access, quality, and cost measures. The first release of Clinical Profiles SM takes place. Clinical Profiles provides network physicians with data comparing their clinical practices to nationally accepted benchmarks for care. Care Coordination provides integrated case management for chronic or complex conditions by channeling resources to close gaps in care for those who can benefit most. First evidence-based 3-tier pharmacy plan that assigns medications to a tier based on its overall impact on total health care costs, not just by generic versus brand name. The company is the first to adopt National Comprehensive Cancer Network standards for determining chemotherapy drug coverage as part of its commitment to best science. First national telehealth network; remote video technology systems that give patients access to physicians and specialists. Groundbreaking Diabetes Prevention and Control Alliance collaborating with the YMCA and Walgreens to help prevent and control diabetes, pre-diabetes and obesity. Fortune magazine ranked UnitedHealth Group #1 for innovation in the health insurance and managed care sector. 2 2 Fortune magazine; March 22, 2010 Your Guide to UnitedHealthcare 1

4 Putting innovation to work There is a consistent thread running through our history of innovation. In almost every instance it is meant to empower employers, doctors and individuals with better information to make more informed health decisions that may lead to better health. Information Decisions Health We support doctors, consumers and employers with one of the largest collections of clinical data in the world. Our analysis aims to transform raw data into meaningful information people can actually use to experience better care and live healthier lives. Our core values rest on a belief in the power of informed decisions. So we re continually designing information tools and technology that make it easier for consumers to take a more proactive role in their day-to-day health decisions. Our extensive clinical data and advanced analytics are designed to: Promote the use of health professionals and facilities who deliver care supported by the latest clinical research. Identify individuals at risk for health conditions like high blood pressure or diabetes and alert their doctors. Share insights from our claims data with doctors and hospitals. Bringing change to life Innovation means nothing without the power to execute. Our creative solutions come alive through: Thoughtfully designed products Large national network Commitment to excellent member service and employer administration 2 Your Guide to UnitedHealthcare

5 Information: lighting the path to better health Information that matters We deliver information that matters. So doctors can see the impact of their clinical practices; so employers can know the best way to structure their benefits plans; and so we can identify potential member health issues sooner. That s how information can help improve health care quality, minimize the risk of complications and reduce health care costs. Informed clinical performance We provide network physicians with their own performance data down to the individual patient level. Their performance is then measured against nationally accepted practice guidelines, and against their local and national peers. Our experience shows that sharing data with physicians whose practice patterns differ significantly from their peers has led to a 24 percent increased adherence to evidence-based medicine guidelines. 3 Identifying at-risk individuals sooner Our latest innovation, the esync Platform SM, is a proprietary technology that synchronizes health care data from many different sources. The esync technology uses different kinds of health data to build a detailed health portrait of each person we serve. Those profiles help prioritize nurse outreach to people with health risks or those who are facing complex health care decisions. This individualized education and counseling helps promote better health for individuals and better results for employers. 3 UnitedHealthcare data analysis of physician practice patterns - 12 months post data sharing. 4 Treatment Decision Support Book of Business; OptumHealth, Jan-Aug, 2009 The Treatment Decision Support program identifies people facing complex health care decisions for conditions having wide variations in treatment costs and outcomes. Then our nurses reach out to them to provide information on evidence-based medicine and any risks associated with their various treatment options. As a result 4 : The power of information 15 percent of members discuss with their doctors alternate procedures; and 22 percent choose UnitedHealth Premium designated specialists doctors who have met national guidelines for quality care. Your Guide to UnitedHealthcare 3

6 Supporting informed health decisions People who are actively engaged in managing their health are more likely to make good health decisions. 5 Every UnitedHealthcare medical plan is designed to promote and support exactly this kind of positive member engagement. People who are actively engaged are more likely to seek preventive care, watch their diet, exercise, monitor their health conditions and adhere to treatment protocols. They even ask more questions, which means they can have greater success in navigating a highly complex and often confusing health care system. 5 We put the power of information to work to help people get actively engaged, make more informed health decisions and take responsibility for their own health. We offer three distinct kinds of health and wellness support: Staying healthy Getting healthy Living with illness Wellness programs Online health assessment helps members understand their lifestyle and health risks while recommending preventive steps and lifestyle changes. Online health coaching programs motivate and guide individuals to make lifestyle choices that may result in improved health and well-being. Reminder mailings recommend preventive care and screenings. Healthy pregnancy program supports expectant mothers through all stages of pregnancy. Care management and decision support The NurseLine SM or Care24 program offers toll-free 24-hour access to registered nurses who can assist with health-related concerns. UnitedHealth Premium designation program gives members information about doctors and specialty centers that meet or exceed national guidelines for quality. Care management services mobilize appropriate care resources for members by identifying gaps in care, like missing medications or misunderstanding care instructions. Chronic and complex condition management Case management nurses reach out to members with asthma, coronary artery disease and diabetes (among other diseases). Complex condition management provides access to leading health care facilities and services to support safe, cost-effective care for transplants, congenital heart disease, kidney and neonatal services. 5 How Engaged Are Consumers in Their Health and Health Care, and Why Does It Matter Research Brief No. 8, October 2008, Center for Studying Health System Change; 4 Your Guide to UnitedHealthcare

7 Supporting improved health outcomes Not all health care is created equal. So our approach to better health includes two essential steps: First, we share the clinical insights from our claims data with doctors and hospitals to support clinically accepted practice patterns. Second, we share our experience with members so that they can make informed decisions when it comes to choosing doctors or facilities that meet quality and costefficiency guidelines. Sharing clinical insights with doctors and hospitals: UnitedHealth Practice Rewards We provide physicians with feedback on their personal practice patterns, including detailed patient reports. Doctors can use this information to monitor their clinical performance and administrative efficiency. Sharing our experience with members: the UnitedHealth Premium designation program The UnitedHealth Premium designation program recognizes physicians for meeting quality and cost efficiency criteria across 20 distinct medical specialties. The program guides members to health care professionals who demonstrate that they adhere to evidencebased medical guidelines for increased quality and efficiency. 6 Building awareness Getting members engaged with Premium designated physicians is the first step toward ensuring that they can find quality care when they need it. That s why we provide employee education campaigns using online tools, s and printed materials that describe the UnitedHealth Premium designation program and its benefits. Proactive connections Our sophisticated information systems build detailed health profiles of each person we serve. Based on those profiles, our outreach nurses can deliver customized information about appropriate Premium designated physicians directly to people who are facing complex health care decisions. In cardiovascular surgery we ve found 6 : 59 percent lower complication rates for UnitedHealth Premium surgeons as compared with other surgeons who did not receive the quality designation 64 percent fewer redo procedures for UnitedHealth Premium surgeons compared with other surgeons who did not receive the quality designation UnitedHealth Premium results 6 : Employers can expect an average savings from one to three percent of annual medical spending. Doctors who meet quality and cost efficiency criteria have costs that are 15 percent below market average. 6 UnitedHealthcare claims analysis, 2007 Your Guide to UnitedHealthcare 5

8 Hospital Comparison Program Members in many areas of the country also have access to hospital quality and efficiency data online through our Hospital Comparison Program. The Hospital Comparison Program provides cost and quality information on 50 inpatient conditions and procedures. Hospital quality and cost information is compared with national quality norms and local cost norms to help consumers make an informed choice about the care they receive. The quality and cost data include information on hospital performance in areas such as: Patient volume Unfavorable outcomes Mortality rate Length of stay Average charges Safety practices Did you know that patients at top-performing hospitals are 43 percent less likely to experience a medical error? 7 Information that makes a difference UnitedHealthcare believes that offering credible, understandable information empowers members to make more informed decisions, and may help health care professionals to deliver high quality care at the lowest price. The UnitedHealth Premium program also supports physicians and facilities in their efforts to improve the care they deliver by providing them with rigorous feedback reflecting their overall performance and detailed patient reports. UnitedHealthcare makes it easier for people to find a doctor and understand how their choices can influence the quality of the care they receive and your overall costs. 7 HealthGrades Patient Safety Study, April Your Guide to UnitedHealthcare

9 Products for every need Your company has priorities and goals that will drive your specific benefits strategy. You can trust UnitedHealthcare to make your strategy a success with products that can help employers maintain a healthy and productive workforce while delivering significant cost advantages. With our national network and administrative platforms, you can have one consistent plan design for every location or as many plans as you have locations. It s up to you. Whether you need one plan or many, you get one fully integrated system to simplify your administrative functions and deliver seamless service. Ask about our plan designs that provide lower office visit copayments and greater plan coinsurance coverage when employees find care provided by UnitedHealth Premium designated doctors. Choose the plan that meets your needs Traditional Plans Consumer- Driven Plans Value-Based Plans Essential Benefits Retiree Plans International Plans Proven, familiar plans offering broad freedom of choice. Full range of medical benefits and network access. High deductible plans with financial accounts. Engagement tools to increase employee ownership of their health. Financial incentives and engagement tools to encourage member responsibility and behavior change. Lower cost health care coverage based on limitations in: Network access Benefit coverage A variety of coverage options for employees entering retirement. Plans for United States expatriates and foreign nationals. Supplement your plan with additional coverages like pharmacy, dental, vision, life and disability Your Guide to UnitedHealthcare 7

10 Extensive network access A large network can help control costs and maximize employee benefits. Since 98 percent 8 of Americans can access our network, your employees can easily see a participating doctor. That s critical because we estimate that for all services combined (inpatient, outpatient and professional), using the network results in an average reduction off billed charges of 40 to 55 percent. 9 We make it simple to build the benefits plan you need with the largest single, proprietary network of doctors and hospitals in the nation: 645,000 doctors and health professionals 5,105 hospitals 64,000 pharmacies 1,000 convenience care clinics Includes 2 out of 3 available health care professionals across the country 95,000 specialists designated for their quality care Other cost saving measures Physicians and facilities that aren t in our network set their own prices. The result can be higher billed charges for employers and higher out-of-pocket costs for members. While our extensive network will always provide the best quality and value to your employees, if your employees do choose to go to a non-network doctor or facility, we offer two non-network programs to help control costs. Shared Savings Program 10 Our Shared Savings Program contracts with third party vendors to access and negotiate discounts on services received from nonnetwork health care professionals. The average savings is 15 to 35 percent off of the physician s or facility s billed charges. 9 Maximum Non-Network Reimbursement Program 10 This program caps certain eligible expenses from non-network physicians and facilities at a maximum amount based on the payment methodology used by Medicare. This fixed maximum helps control medical trend and reinforces to members the value of seeking services from network health care professionals. Whether your employees choose network or non-network care, we re always looking for ways to save you and your employees money. 8 Full-Year 2008 Nationally Recognized Third Party Benchmarking Data 9 UnitedHealthcare Non-Network Programs At-a-Glance, Sept Note: Maximum Non-Network Reimbursement and Shared Savings Programs may not be available in all areas or for all group sizes. 8 Your Guide to UnitedHealthcare

11 Award-winning service You expect your benefits plan to execute the basic administrative services at an extremely high level; things like paying claims, answering member calls, and minimizing paperwork. When you choose UnitedHealthcare you ll appreciate the care and attention to detail we bring to these vital tasks: Seamless set-up of your benefit plan by your case effective date. Easy online administration through Employer eservices, our secure administrative website that allows you to add or delete enrollees, check claims, pay bills and more all online, anytime. Knowledgeable service professionals who resolve issues on the first call 94 percent 13 of the time. Multiple channels to answer employee questions by phone, and through our member website, myuhc.com. Claims paid accurately over 99 percent 13 of the time. We re continually investing in our technology and our personnel so that our customers get the best possible customer experience. For example, we use instant surveys and a behavioral analytics tool that automatically audit customer calls so supervisors can coach call center staff. Tools like these are helping us to take service and call quality to an entirely different level. Our hard work is paying off: UnitedHealth Group received first place in insurance category for the American Customer Satisfaction Index (ACSI). 11 UnitedHealth Group was named Best Health Plan Provider by the readers of Business Insurance in the magazine s annual Readers Choice Awards. 12 Today s business world demands motivated, creative workers to produce top quality results and lasting client relationships. Benefit plans from UnitedHealthcare are designed to match individual health needs with customized care support, which may result in a healthier and more productive workforce. 11 American Customer Satisfaction Index (ACSI) Q1, Business Insurance, Fifth Annual Readers Choice Award, Internal claims analysis, 2009 Contact your broker or UnitedHealthcare representative today to put UnitedHealthcare s innovative capabilities to work for you. Your Guide to UnitedHealthcare 9

12 To learn more about UnitedHealthcare s innovative capabilities, please contact your broker or UnitedHealthcare representative. The Healthy Pregnancy Program follows national practice standards from the Institute for Clinical Systems Improvement. The Healthy Pregnancy Program can not diagnose problems or recommend specific treatment. The information provided is not a substitute for your doctor s care. NurseLine SM nurses cannot diagnose problems or recommend specific treatment and are not a substitute for your doctor s care. NurseLine services are not an insurance program and may be discontinued at any time. The Care24 Program integrates elements of traditional employee assistance and work-life programs with health information lines for a comprehensive set of resources. It is not a substitute for a doctor s or professional s care. Due to the potential for a conflict of interest, legal consultation will not be provided on issues that may involve legal action with UnitedHealthcare, or its affiliates, or any entity through which the caller is receiving UnitedHealthcare, or its affiliates, services directly or indirectly (e.g., employer or health plan). The Care24 Program and its components may not be available in all states or for all group sizes and are subject to change. Coverage exclusions and limitations may apply. The UnitedHealth Premium designation program is an information resource to help our members choose a physician. It may be used as one of many factors members consider when choosing the physicians from whom they receive care. As with any performance assessment program, physician evaluations have a risk of error. For a complete description of the program, including details on the methodology used, geographic availability, program limitations and medical specialties participating, please see myuhc.com. The hospital comparison program uses data from publicly available data sets, UnitedHealthcare claims and hospital data from Leapfrog and CMS, to create a multidimensional view of hospital performance. Not all facilities are eligible for evaluation for the program. The hospital comparison program is intended as a resource for informational purposes only. UnitedHealthcare does not provide health care services or practice medicine. Physicians are solely responsible for medical judgments and treatments. Inclusion in this program does not guarantee the quality of care being rendered. All physicians and facilities that contract with UnitedHealthcare have met credentialing requirements. Regardless of rating, plan enrollees have access to all physicians and facilities in the UnitedHealthcare Network. For a complete description of the hospital comparison program, including details on the methodology used, geographic availability and program limitations, please see myuhc.com. Specialty benefits and programs may not be available in all states or for all group sizes. Components subject to change. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by UnitedHealthcare Insurance Company, United HealthCare Services, Inc. or their affiliates /10 Employer 2010 United HealthCare Services, Inc.