Seguro de salud para empleadores

Laying the foundation to help members understand their health plan is an essential first step when cost and coverage drive about 60% of a member’s experience.⁴

This also involves proactively bringing forward suggestions and insights to help to help them find quality, cost-effective care—whether a member called in with a benefits question or checked their claim status online.

“The number-one thing that drives unease in health care is the unknown—not knowing what to expect or how much it will cost. It creates a feeling of powerlessness. How can we help consumers take back control? That is core to our focus and effort,” says Samantha Baker, chief consumer officer for UnitedHealthcare Employer & Individual.

Digital serves as the front door to a more connected, personalized experience

Digital resources can help. New UnitedHealthcare members receive information to get started even before their plan’s effective date. When they sign in to the member website myuhc.com, they can view personalized onboarding and claims videos.

This one-stop, self-service resource includes a plan- and geographic-specific provider search tool to find quality network providers and areas of expertise, such as LGBTQ+ supportive care and geriatricians for older adults. The employee dashboard also includes claims and medication information as well as personalized recommendations such as clinical and wellness programs, screenings and more. 

Virtual health continues to evolve

Virtual health helps provide broader access to care and convenience for employees. It’s built to make care more intelligent, personalized and accessible than ever before. Plus, it can help improve care quality and continuity while addressing health equity.

Virtual health solutions have evolved beyond on-demand and primary care to additional areas such as health and well-being needs and specialized areas of focus like diabetes management and physical therapy. Improvements and enhancements are ongoing, with new offerings intended to help solve some of health care’s current challenges.

Bidirectional data flow is being incorporated to help ensure that members’ needs are more precisely addressed. Progress is also being made by connecting virtual solutions with traditional care pathways and integrating solutions to help produce better outcomes and improve the overall member experience.

Advocacy supports physical and emotional well-being

Assisting employees as they navigate the health care system can help them get the most out of their benefits and remove frustration, creating a better member experience. Advocacy is a powerful service that supports employees throughout their health care journey.

UnitedHealthcare Advocacy solutions are built to offer more holistic support, with advocates working from a comprehensive dashboard detailing the employee’s health profile, previous contacts and how they’ve utilized the health system.

This integrated understanding helps advocates move beyond benefit and claims questions to show employees how to utilize more of their benefits, like helping employees enroll in clinical programs to address certain health conditions. In fact, 39% of clinical program enrollments are initiated by advocates.⁶

Advocates are also trained to listen for trigger words so they can assist employees and their families who may be struggling with behavioral health needs. This has been increasingly important coming out of the pandemic, with about 47% of U.S. parents reporting a negative pandemic-related impact on their children’s mental health.⁷

“We have the tools to help employees be more resilient ranging from self-help to inperson treatment,” says Trevor Porath, vice president of Behavioral Health Solutions for UnitedHealthcare Employer & Individual. “We also want to be able to identify those who may need support sooner before it becomes a crisis. Our low severity solutions help employees build coping mechanisms for their stress and anxiety.”

Enhanced Advocacy models are designed to deliver a more personalized end-to-end experience for employees, including client-specific reporting to show health outcomes from advocacy efforts. In addition to the potential savings, the enhanced models may add an additional 2% to 4% in total cost of care medical savings.⁸

Offering digital solutions is an essential step in improving the health care experience for employees and providers. These solutions provide crucial information at key decision-making moments — designed to help employees reduce their costs and avoid surprise medical bills.

Real-time transparency

Ensuring members and their care providers are equipped to make more informed decisions based on real-time cost and coverage information can benefit the employee’s pocketbook and the employer’s bottom line.

One way this happens is by integrating a patient’s health record with their provider’s Electronic Medical Record (EMR) through UnitedHealthcare Point of Care Assist®. This gives providers access to real-time insights on care needs and the employee’s specific benefits, which may help reduce costs for the employee.

When providers make referrals, they can see a listing of designated physicians who have demonstrated their ability to deliver quality, cost-efficient care—identified as part of the UnitedHealth Premium® program. Employees can also identify UnitedHealth Premium Care Physicians in provider searches on myuhc.com.

“By entering into the actual workstream of a provider with Point of Care Assist or the transaction stream of the consumer, we can help them make decisions in a direct way—it’s advantageous for everyone,” says Dr. Gerald Hautman, chief medical officer of National Accounts for UnitedHealthcare Employer & Individual.

Aligning with consumer trends in other industries, delivering improved transparency also helps employees avoid or address cost surprises, either directly or through providing cost information to a provider.  

UnitedHealthcare’s core offerings that address this include:

Surest^TM: A reimagined kind of health plan built around the idea of cost transparency. With clear, upfront copays and no deductibles or coinsurance, employees can check prices and compare options in advance — the way they shop for just about everything. Putting employees in the driver’s seat, Surest is designed to help employees make informed and cost-effective decisions for themselves and their families.

• 46% lower average out-of-pocket costs for members⁹

Naviguard®: A service developed to help address issues surrounding out-of-network (OON) balance medical bills, a significant concern for employers and consumers. Leveraging local market expertise and analytics, Naviguard works to deliver end-to-end issue resolution and reduce OON costs.

• $2.4K average per-bill reduction¹⁰

PreCheck MyScript®: A technology embedded within a physician’s existing EMR system that shows which medications are covered, highlights any lowercost options that are clinically appropriate and calculates exactly how much they will cost based on an employee’s plan to help the provider and employee make a more informed decision.

• $111 average member prescription savings per switch to a lower-cost alternative¹¹

When employers integrate medical benefits with pharmacy, behavioral and specialty benefits, it enables advocates to go beyond benefit and claims questions. For instance, integrated UnitedHealthcare medical and vision benefits helps connect members with chronic conditions to their primary care provider and disease management programs when concerns arise from an eye exam.

“When we have all the systems under one roof, this allows us to connect the dots and potentially get a member into a clinical program sooner for a better outcome and cost savings,” Madsen says.

Analysts can look across very complicated data systems—including medical, pharmacy, advocacy and clinical—and translate data into actionable insights. And they are finding key opportunities to help improve the delivery of quality, cost-efficient care.

This goes beyond data analysis that highlights issues and anomalies such as a high prevalence of a chronic condition in an employee population.

Addressing social determinants of health (SDOH)

These data capabilities also extend to understanding the potential needs of employees outside the workplace, which can impact their job productivity and more importantly, their overall quality of life.

Research on the drivers of positive health outcomes has shown that access and quality of clinical care contributes only about 20% toward overall positive health, while SDOH such as employment, family and social support and community safety are twice as impactful.¹² In fact, 80% of all health outcomes are driven by SDOH.12

“It’s critical to look at the sub-populations of an employee population to pinpoint precise opportunities. It can be market, age, gender or geography, or things we need to know from the employer like division, job type or salary grade,” says Craig Kurtzweil, chief analytics officer for UnitedHealthcare Employer & Individual.

UnitedHealthcare also uses de-identified claims data from its members to identify who is most likely to need support with SDOH like access to nutritious food or affordable housing. Call center advocates then use real-time interactions with a curated database of community resources to help employees dealing with challenging life events or situations. A similar database can also be found online to search for community resources. Nearly 70% of those employees end up accepting SDOH offers of support.¹³

“Addressing SDOH moves us beyond just medical approaches. We know broader understanding is ultimately the key to putting members first and improving well-being,” says Dr. Cyrus Batheja, national vice president of Enterprise Transformation and Strategic Solutions for UnitedHealthcare.

Delivering dedicated support for complex conditions

While personalization can mean suggesting an overdue wellness exam for some employees, for others it can translate to providing a greater level of support and a more holistic approach to care.

For families of children with special needs, the Special Needs Initiative offers a single point of contact through the Family Engagement Center®. A dedicated team of multidisciplinary experts across UnitedHealthcare and Optum also helps families find specialty providers, manage claims and preauthorization issues and connect them to community resources.

The ability of the Special Needs Initiative to help simplify the member experience has been applied to Complex Care Concierge, a specialized and coordinated system of care tailored to adults with complex health needs.

For patients with complex health needs, the top 3% to 5% of this group face challenges navigating the system, reporting 5 times the number of claims. Additionally, the top 1% of patients with complex health needs drive more than 30% of health care costs.¹⁴ The program works to transform their experience by:

• Coordinating care with providers and the health plan on the employee’s behalf
• Supporting the employee and their family with one point of contact and Family Engagement Center resources

For members with Special Needs Initiative support, 95% of issues are resolved.¹⁵

“The advocates in these programs know the smallest details of a member’s care plan, which helps them proactively direct and problem solve on the member’s behalf. This may reduce waste and improve the member experience,” Hautman says.

Simplifying the member experience at every step

Delivering a member experience designed to improve health outcomes requires a cohesive approach that fully addresses a member’s needs—including medical, behavioral, financial and social factors. And advocacy has the ability to bring it all together, putting the member at the center of care.

Employees engage with solutions and tools in different ways depending on their state of health. Healthier employees may rely more strongly on digital tools or virtual care visits. For employees with complex health conditions, they may benefit from dedicated support where they have a single point of contact who can help guide them through their care options.