UnitedHealth Group wants to close 600M gaps in care by 2025. Here's how

UnitedHealth Group is aiming to address 600 million gaps in care for its members by 2025.

The healthcare and insurance giant released its annual Sustainability Report last week, where it outlined three strategic goals to improve health outcomes and affordability.

Alongside addressing care gaps, the company said it wants to ensure at least 85% of its members receive preventive care each year by 2030 as well as to make sure 55% of outpatient surgeries and radiology services are provided in high-quality, cost-efficient sites of care by 2030.

Margaret-Mary Wilson, M.D., executive vice president and associate chief medical officer at UnitedHealth Group, said these goals were selected because they get at the key broader push toward a more accessible and quality health system.

"We selected these intentionally because if you stop and think about them for a minute, they're actually pretty strategic," Wilson said during a press briefing with reporters last week.

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Wilson said the company has a number of avenues to tackle those three goals. To address care gaps, she said it is planning to lean on data analytics and shared-decision making tools to empower providers to identify these gaps more readily.

For example, UnitedHealthcare offers a tool called Point of Assist that populates members' electronic health records with claims data and other information the insurer can provide, making them available at the point of care.

"The physician now has the universe of data related to a specific person and is able to identify how comprehensive their care has been and therefore proactively address gaps," Wilson said.

In addition, OptumCare providers use a tool that presents them with scientific evidence at the point of care that can arm them to address these care gaps, Wilson said. Taken together, she said the company expects these tools to enable providers to more proactively address gaps in care.

In 2019, UnitedHealth Group closed 104 million gaps in care, Wilson said. 

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Wilson said that as of 2019, about 78% of members received preventive care services. She said leaning on value-based care arrangements and virtual options will be key to boosting that number.

Last year, UnitedHealth launched a virtual primary care plan, which has a reach of 300,000 people. Those tech tools enhance the traditional, in-person primary care options, Wilson said.

"That virtual care overlay is going to be helpful in supporting our providers' face-to-face care in ensuring we can truly meet the need for preventive services," Wilson said.

In addition, encouraging the use of alternative sites of care, when appropriate, for radiology and outpatient surgeries can lead to significant savings; Wilson said moving such services from hospitals to physicians' offices or ambulatory settings decreases costs by nearly 200%.

She said even moving just joint replacement surgeries to ambulatory settings when appropriate could save the healthcare systems $3 billion annually and avoid nearly 500,000 unneeded hospital admissions.

"We're looking … to our members and our providers to hold us accountable to these commitments," Wilson said.