Personalize Health Benefit Designs: A modern, high-performing health care system may depend on a flexible, consumer-oriented approach to benefit design that better reflects people’s needs, encourages positive health decisions and accommodates ever-evolving medical science. To that end, public and private programs should integrate low-income social support resources into health benefits, such as job training, housing, transportation, and financial instruction. The health system must look at the whole person — not just individual medical conditions — and integrate their medical, behavioral health, and social service access to get a full picture of how to best address their unique needs. We should design flexible benefit packages customized for specific geographic areas within a state to account for local variation and to target “hot spots” of specific health challenges, such as obesity, heart disease, or diabetes.
As part of my series on the Future of Healthcare, I’ve had the pleasure of interviewing Rebecca P. Madsen, Chief Consumer Officer, UnitedHealthcare. Rebecca Madsen is the Chief Consumer Officer of UnitedHealthcare. She is responsible for analyzing, designing, and implementing enhancements to the consumer experience, creating a consumer-centric approach across the organization, and for working to make care more accessible and affordable. During her nearly 20 years at UnitedHealthcare, Ms. Madsen has held a variety of leadership positions spanning strategy, data and analytics, product development, marketing and operations, including Chief Operating Officer for the Northeast Region and National Chief of Staff for the Employer & Individual business. Prior to joining UnitedHealthcare, she worked in the health care and pharmaceutical practices at Accenture. In all of these roles, she has had a passionate commitment to serving people throughout their health care journeys and making sure every consumer has a voice. Ms. Madsen holds an MBA in Health Care Management from The Wharton School, University of Pennsylvania, where she was also a Teaching Assistant, and a Bachelor of Arts degree in History of Science with Mathematics from Princeton University.
Thank you so much for joining us! Can you tell us a story about what brought you to this specific career path? A: My passion for making a difference in health care started more than 25 years ago. For my graduate school application, I wrote about my desire to change the healthcare system one person at a time and to help improve people’s healthcare experiences. I have been working on that goal ever since.
As someone who was diagnosed with cancer at age 39, and with three small children, I know the devastating feeling of a serious health event, and I am passionate about helping people who are in similar situations. I listen to people every day who are working to take care of themselves and their families, stay healthy, obtain access to care, manage acute and chronic disease, and navigate the health care system.
While progress has been made to modernize the health system to make care more personalized and consumer-centric, we have more work to do to help expand access to quality, cost-effective care for everyone.
Can you share the most interesting story that happened to you since you began leading your company? A: There is no one story — the stories I hear every day from our members on the personal journeys they are navigating, where they are stuck, what has helped them, and what matters to them motivates me to be an advocate for change. I’m inspired by stories of joy in the recovery from a health event and, on the other end, the heartbreak when someone has lost their battle. I am grateful for the opportunity to each day listen to people because every person’s story matters.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
A: After I graduated from business school, I worked at a consulting firm. It was a great job, but I decided to move from consulting about health care to working in the business directly at Oxford Health Plans. After six weeks, there were concerns about the company’s future. Some of my friends thought it was funny how off my timing was, but I put my effort into one of the greatest experiences of my career and helped lead our company’s turnaround. I stayed on the journey until our strong performance culminated with joining forces with UnitedHealthcare. Facing those initial struggles reinforced the importance of perseverance and staying positive despite challenges, and those are lessons I carry forward today.
What do you think makes your company stand out? Can you share a story? A: As the nation’s largest health care company, UnitedHealthcare is in a unique position to deliver on our mission of helping people live healthier lives and making the health system work better for everyone. Globally, our enterprise has the privilege to serve more than 140 million people, including nearly 50 million in the United States. This creates a lot of data, yet all that data is important only if we are able to extract meaning from it and translate it to help improve health outcomes at more affordable costs. To help accomplish that, our enterprise each year invests more than $3 billion in data, technology, and innovation.
Those efforts have produced dozens of successful innovations, one of which is Advocate4Me. Advocate4Me is our data-driven customer service platform that uses intelligent routing to help connect UnitedHealthcare members with the Advocate best qualified to help, including clinical professionals such as nurses. The program’s predictive personalization technology is designed to help callers get their questions answered more quickly and completely the first time, help avoid bottlenecks and improve satisfaction. The result: a 93% customer satisfaction rating.
What advice would you give to other healthcare leaders to help their team to thrive? A: Health care leaders must focus on creating a culture among team members that embrace new thinking and a commitment to restless innovation. Our senior leadership team is committed to open innovation and developing programs that enable employees to submit new ideas and receive funding to pursue them.
It is also important for your company’s policies and practices to match your mission and culture. We recently introduced a new employee well-being program that encourages daily movement and making healthier diet choices. To support those goals, we started giving employees at our corporate headquarters flavored water (and removed soda from vending machines and cafeterias), offered discounted pricing for salads and other nutritious foods, and incorporated walking into more employees’ daily work schedules.
Empowering your people to challenge the status quo — and demonstrating alignment between your company’s stated mission and real-world practices — can be key elements to developing high-performing teams.
According to this study cited by Newsweek, the U.S. healthcare system is ranked as the worst among high-income nations. This seems shocking. Can you share with us 3–5 reasons why you think the U.S. is ranked so poorly? A: It’s no secret the health system can be confusing to navigate and expensive. Plus, some overarching trends in our country, including an aging population and higher rates of people with chronic conditions, contribute to relatively poor outcomes.
I think what’s challenging is a lack of connectivity among different parts of the health system, such as electronic medical records. There needs to be more interoperability — all parts of the health system need to be able to communicate, which can help eliminate duplication of services, reduce fraud, and provide a more complete, holistic view of a person’s health.
Another challenge is our system’s fee-for-service structure, which incentivizes health care providers to deliver more care, rather than better, more coordinated care that is focused on prevention. Moving to value-based care models, such as accountable care organizations and bundled payments, could help improve the health system and deliver greater value to society.
If you had the power to make a change, can you share 5 changes that need to be made to help improve the overall US healthcare system? Please share a story or example for each.
A: Despite spending $3.4 trillion on health care in the United States, the value and quality of health care remain uneven, with too many Americans receiving care that provides insufficient health benefits or experiencing preventable medical errors. Here are five specific ways to help achieve the triple aim of better care, improved health outcomes, and lower costs:
Expand Access to Quality, Affordable Health Care Coverage: Despite a significant decline in the uninsured population due to the Affordable Care Act, over 28 million Americans will remain without coverage in 2025. Expanding access to coverage for the uninsured requires forward-thinking solutions to several structural challenges in the coverage marketplace, including a lack of affordable coverage options for many people and difficulties in applying for coverage.
To make eligibility and enrollment less complex, states should be allowed to consolidate Medicaid and exchange options into single, subsidized state-based markets that work in conjunction with a national eligibility framework. We should also grant states more flexibility to design benefit structures and care provider networks that reflect local health care needs, while incorporating into plans consumer incentives and engagement tools.
For example, UnitedHealthcare Motion® gives eligible people access to wearable devices and may enable them to earn more than $1,000 per year by meeting certain daily walking goals. Since launch, current participants walk an average of nearly 12,000 steps daily,* more than double the average American adult. Expanding the use of effective, pro-consumer benefit designs and engagement programs may help improve health and lower the cost of coverage.
Personalize Health Benefit Designs: A modern, high-performing health care system may depend on a flexible, consumer-oriented approach to benefit design that better reflects people’s needs, encourages positive health decisions, and accommodates ever-evolving medical science.
To that end, public and private programs should integrate low-income social support resources into health benefits, such as job training, housing, transportation, and financial instruction. The health system must look at the whole person — not just individual medical conditions — and integrate their medical, behavioral health, and social service access to get a full picture of how to best address their unique needs. We should design flexible benefit packages customized for specific geographic areas within a state to account for local variation and to target “hot spots” of specific health challenges, such as obesity, heart disease, or diabetes.
For instance, we developed an interactive online resource that enables employers to analyze and understand health data, providing an analytics-driven roadmap to help improve health outcomes, mitigate expenses, and empower employees to take charge of their health. The platform recently enabled a self-funded national retailer to analyze its out-of-network claims for back surgeries, isolating the area and factors contributing most to these costs, and then launching an educational campaign that achieved estimated savings of nearly $1 million**.
Integrate Data, Analytics and Technology: A modernized health care system relies on infrastructure that supports insightful, efficient care delivery and a better consumer experience. We are investing significant resources to help improve the interoperability of data across various parts of the health care system. We can see millions of member interactions across the system — routine check-ups, emergency room visits and medication history — in real time and use that information to help enhance care management: Are we finding different sites of service? Are we helping people transition out of the hospital faster and into a secure setting? Are we helping people avoid hospital admissions or, following a treatment, readmission?
We are working to help give our members access to an Individual Health Record™ (IHR), a modern health record that curates information from multiple sources, including electronic health records, pharmacies, and medical claims, to help support physicians in care delivery through data sharing and evidence-based guidelines. Once launched, UnitedHealthcare members will be able to see a more complete view of their health history reflective of clinical and claim information from visits to their care providers, offering a convenient and portable way to access health information. For care providers, they can see what other care clinicians have provided, even if practicing within different health care systems. The IHR may also enable better collaboration between care providers and consumers, enabling them to jointly review the same information to together make more informed health decisions.
Reduce Health Care Costs: Total health care spending in the United States is projected to grow from over $3.4 trillion today to $5.4 trillion by 2024, resulting in higher health care costs for individuals, employers, states, and the federal government.2 To help address that, we must adopt new policies and adjust payment incentives to help reduce the cost burden of unaffordable prescription drugs. That includes adopting drug formularies that use evidence-based standards and medically necessary criteria to assess whether emerging drugs represent measurable clinical advances and deliver value to consumers.
Additional steps are necessary to help modernize payment policies and protections to slow the rate of medical price inflation, which is expected to double by 2024. For example, regulations should prohibit out-of-network care providers treating patients at in-network facilities from billing at more than a reasonable percentage of Medicare-allowed charges. To support health care providers, we should establish medical malpractice legal “safe harbors” for physicians who practice in accordance with evidence-based standards to help reduce the practice of defensive medicine and lower provider malpractice premiums. Meanwhile, all consumers should have access to health care quality and cost information to comparison shop for health care as they would with other products and services.
Promote Quality Care Delivery and Reform Payment Models: We can help improve care quality and health outcomes by using integrated data and technology more effectively to help inform treatment decisions and drive greater intelligence and efficiencies across the health care system. For example, the health system should increasingly leverage common data standards that allow for seamless and secure data exchange, and enforce connectivity as a requirement across stakeholders by implementing stronger rules around required electronic medical record functionality.
We must support the transition away from fee-for-service payment models to value-based performance payment models that promote better health outcomes. Value-based care models can foster increased accountability for quality and cost, such as shared savings programs and performance-based contracts, and reward health care providers for effectively managing people’s health. UnitedHealthcare has developed more than 1,000 accountable care organizations (ACOs). We have seen that the most effective ACOs perform better than non-ACOs on 87% of the most common quality measures, including reducing hospital admissions by up to 17% and costs by up to 12%.
What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities, and d) leaders do to help?
A: There are many specific steps health care stakeholders should consider, including:
Industry: Embrace New Care Models and Collaborations — As an industry, we must not remain stuck in the traditional ways of doing business, and further collaborate with industries that have significant experience implementing a digital-first strategy. In addition, emerging technologies, such as telemedicine, can help remove barriers to care and make treatments more convenient and cost-effective. Meanwhile, direct-to-consumer care models are showing promise and spurring providers to adapt, helping foster innovation that supports greater consumer choice.
Individuals: Prevent Premature Chronic Conditions — As many as 80 percent or more of the incidence of premature chronic conditions are caused by modifiable lifestyle choices as opposed to being caused by genetic factors, according to a study by the Centers for Disease Control and Prevention (CDC). People should consider ways to make healthier choices, including consistently walking and opting for whole foods, while mitigating additional risk factors, such as stopping smoking and limiting drinking.
Communities: Make Whole-Person Health a Priority — The World Health Organization defines health as: “A complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition is instructive, as communities are well served to invest in programs and services to support whole-person health. Examples include investing in social safety net programs, such as Medicaid, and expanding access to affordable housing, public transportation and career counseling.
Leaders: Simplify the enrollment process for publicly subsidized coverage options — Our nation’s leaders are in a unique position to modernize our approach to care by building upon what is working and putting America on a path to a more effective, simpler and higher-quality health care system. Part of that is reducing the number of uninsured adults by making eligibility and enrollment less complex for publicly subsidized coverage options, including public exchanges, Medicare, and Medicaid. Simplifying this process, such as integrating enrollment in health coverage with enrollment in other means-tested programs (e.g. food stamps), may encourage more people to enroll in coverage and access care.
As a mental health professional myself, I am particularly interested in the interplay between the general health care system and the mental health system. Right now we have two parallel tracks — mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
A: Research shows that medical conditions, mental health conditions and substance-use issues are connected and often occur at the same time, so it’s important to address all of these problems concurrently if we’re going to support whole-person health.
Through Optum, a UnitedHealth Group (NYSE: UNH) company, we are supporting medical-behavioral integration and helping close gaps in the health care system by identifying how, when and where to target medical and behavioral interventions. For instance, we give primary care physicians tools to help them recognize the signs of mental health and substance use conditions and what questions to ask so they can help connect their patients to treatment if they need it. Then we help eliminate a lot of the most common gaps between medical and behavioral care providers via a shared technology platform that facilitates care coordination between case managers and clinicians.
Access to care is also a major barrier: people often are unable to access high-quality mental health or substance-use treatment that is coordinated and integrated with their medical care. Optum can leverage technology to help people get the behavioral health care they need by using advanced analytics to identify patients who could most benefit from support, and then reaching out to them before their conditions worsen.
How would you define an “effective” health care provider”?
A: We evaluate health care providers in our national network of more than 1.3 million professionals by using evidence-based quality measures.
The UnitedHealth Premium® Program is one of the longest-running physician quality and cost-efficiency designation programs in the industry. It evaluates physicians in various specialties using evidence-based medicine and national standardized measures to help consumers locate physicians who have met benchmarks for quality and cost-efficient care. The program draws on data covering approximately 380,000 physicians across 16 specialties to help people identify where they may be more likely to get quality and cost-efficient care.
Orthopedic Premium Care physicians had 15% lower cost of care than non-Premium Care physicians; Premium designated orthopedic surgeons, for instance, have 42% fewer re-dos on knee replacement surgeries and 32% fewer redos on hip replacement surgeries.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life? A: Stand by your principles, work hard, show compassion and make a difference. These are words that I live by, both in and outside the workplace.
Are you working on any exciting new projects now? How do you think that will help people?
A: Our team is working on various projects with the same underpinning: Help consumers more seamlessly manage their health and navigate the health system. We know that prescription drug coverage ranks among the most commonly used benefits for many people.
We recently introduced PreCheck MyScript®, which can help people save time and money at the pharmacy by enabling physicians to find the most effective medication, and minimize the patient’s out-of-pocket cost — in real time — based on the patient’s actual health benefit plan and preferred local pharmacy. This information is delivered directly to the physician’s e-prescribing platform and can be reviewed before the patient even leaves the exam room.
PreCheck MyScript has completed more than 24 million transactions in the past 12 months. When prescribers select the lower-cost alternatives, the members save an average of $80 per prescription. In addition, clinical research has established that medication adherence is critical to improved chronic disease outcomes and reduced health care costs. We have observed significant improvements in medication adherence rates for three chronic conditions (diabetes, hypercholesterolemia, and hypertension) after PreCheck MyScript was implemented.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them? A: I love books about people’s personal journeys, especially women who overcame adversity and what motivates them. Michelle Obama’s book Becoming inspired me; and I am currently reading Maid: “Work, Low Pay and a Mother’s Will to Survive.” My father recently sent me Melinda Gates’ book The Moment of Lift, which highlights the value to society of lifting up women, including the links between poverty and disease and the lack of female empowerment.
I am inspired by people’s stories, which overlaps with my work at UnitedHealthcare to understand people, their experiences and how to help others. These are the foundational themes of my life and why I love health care and what I do, which is making a difference one person at a time.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? A: I am grateful for the opportunity I have to listen to people from across the country and to advocate for them. Through my work, we are developing ways to help enhance people’s health care experiences and enabling them to more effectively navigate the health system. By working together to help enhance the health system and how people approach their well-being, we can make a difference in the lives — and health — of more people.
How can our readers follow you on social media?
A: People can follow UnitedHealthcare @UHC on Twitter or click here for our Newsroom.
References:
1 UnitedHealth Group Advocate4Me scorecard, 2018
2 Centers for Medicare & Medicaid Services, National Health Expenditure Projections 2014–2024.
3 Congressional Budget Office, March 2016
4 Bassett, David R., Holly R. Wyatt, Helen Thompson, John C. Peters, and James O. Hill. 2010. “Pedometer-Measured Physical Activity and Health Behaviors in U.S. Adults:” Medicine & Science in Sports & Exercise 42 (10): 1819–25
* All UnitedHealthcare Motion results based on 2018 internal analysis of program participants. ** Cost-savings results are averaged for illustrative purposes, and health outcomes are not guaranteed.
5 National Health Expenditure Projections, 2014–24: Spending Growth Faster Than Recent Trends. Health Affairs, 2015.
6 UnitedHealthcare analysis of claims data, 2016
7 2018 UnitedHealthcare Network (Par) Commercial Claims analysis for 16 specialties and 169 markets. Rates are based on historical information and are not a guarantee of future outcomes. Average savings per patient/episode based only on claims for conditions and procedures directly used in the determination of physician designations.
8 Third party analysis of OptumRx claims data. July 2017 — November 2018 based on 2.6 million members, >110,000 providers, and 13.3 million transactions using PreCheck MyScript.
9 Centers for Disease Control and Prevention. CDC Grand Rounds: Improving Medication Adherence for Chronic Disease Management — Innovations and Opportunities. Published Nov. 17, 2017. Accessed on Nov. 3, 2018
10 OptumRx data. Measurement of PreCheck MyScript impacted scripts within the diabetes therapeutic class, the statin therapeutic class, and the hypertension therapeutic class. Savings represents a pre/post methodology. Pre period is Oct 2016 — Sept 2017 and post period Oct 2017 — Sept 2018. Population included in the measurement was continuously enrolled.