NEW YORK CITY — Health insurance giant UnitedHealthcare plans to make virtual visits available to more than 4 million Medicare Advantage members next year, enabling them to remotely connect with a care provider for minor health issues or behavioral health support.
In 2020, the payer also plans to roll out home-based monitoring technology for some MA members with serious conditions like congestive heart failure or chronic obstructive pulmonary disease (COPD). This technology can then be combined with machine learning algorithms to help predict potential problems and enable earlier intervention.
"We can use algorithms to reach out and prevent, at scale, hospitalizations or readmissions," Darshak Sanghavi, M.D., chief medical officer for UnitedHealthcare Medicare & Retirement told FierceHealthcare in a recent interview.
"We have an enormous investment in technology," Sanghavi said during a recent UnitedHealthcare event in Manhattan marking the beginning of the 2020 Medicare annual enrollment period.
UnitedHealthcare recently acquired health technology startup PatientsLikeMe, an online network for people living with chronic conditions. Terms of that deal were not disclosed. The insurance giant also is ramping up its investment in data analytics capabilities to gain better insights into its members and their needs.
"We have a lot of information about the quality of care and physicians. We’re now using artificial intelligence to match members, based on their particular medical condition, with a specialist with the highest performance in that specific area," Sanghavi said.
As insurance companies try to lower healthcare costs and improve outcomes, they are increasingly expanding into healthcare services. Humana's chief strategy and corporate development officer Vishal Agrawal said recently the company was shifting to be more of a healthcare company with "elements of insurance."
In order for UnitedHealthcare to manage healthcare spend and members' health at scale the company has to look beyond the "traditional borders," Sanghavi said. "To do that we have to be a health company," he said.
The insurance giant also is investing in programs tailored to seniors' needs, such as HouseCalls, a program that offers members an annual health and wellness visit from home, and Navigate4Me, a personalized, concierge support program. The company expects to complete 1.7 million house calls for its members in 2019.
UnitedHealthcare has the nation's largest Medicare Advantage program with nearly 6 million people enrolled in its MA plans and over $75 billion in annual revenue.
The Centers for Medicare and Medicaid Services (CMS) projects that 24.4 million Medicare beneficiaries out of approximately 60 million will sign up for MA next year. That is an increase from the 22.2 million currently enrolled in the program.
As baby boomers enter their retirement years, they are changing the face of Medicare just as they reinvented the notion of retirement and redefined aging, UnitedHealthcare executives said. These consumers expect more choices, more convenience and more personalized care on demand.
"When we talk about technology, we focus on what’s the problem we’re trying to solve first, rather than 'what’s the technology and how are we going to put it out there'," Sanghavi said.
Many seniors have challenges accessing healthcare in the right place at the right time. "The solution to that is virtual visits. One of the biggest projects we’ve had is to make that available to several million MA members," he said.
Putting digital innovation to work
A pediatric cardiologist by training, Sanghavi moved over to healthcare policy and research work in 2013 as managing director and fellow at Washington, D.C.-based think tank The Brookings Institution. He was then tapped to be the first permanent director of prevention and population health at the Centers for Medicare and Medicaid Innovation (CMMI) under the Obama Administration. There, he oversaw the development of several initiatives including the Accountable Health Communities model and the Million Hearts Cardiovascular Risk Reduction model.
He next moved over to OptumLabs as chief medical officer, leading innovation-directed projects focused on the opioid crisis and chronic medical conditions as well as other health issues. He took his current position at UnitedHealthcare only two months ago and is focused on, among other things, collaborating across UnitedHealthcare and Optum to advance key clinical initiatives.
While his previous work focused on research and policy, Sanghavi said he was interested in putting that research to work.
"What I’m most excited about is looking at those high-level policies and saying 'yes, we want to make healthcare better, but how exactly are we going to get there?' The devil is in the details," he said.
As an example, Sanghavi sees an opportunity to enroll more UnitedHealthcare plan members identified as pre-diabetic into diabetes prevention services. "That can be a win in terms of avoiding a terrible disease and it also saves money. We can look at what changes we can make, whether through technology or insurance benefit design and then measure every step of the way and show the impact we’re having."
The insurance giant can then leverage its access to clinical and claims data to show how its impacting health outcomes and healthcare costs, he said. "We can look at the impact and say, we prevented this many heart attacks or this many people who have substance abuse disorder issues survived because they got evidenced-based care," Sanghavi said. "And that's how we're going to win in the marketplace."
Building out digital tools and measuring the impact on health outcomes will be a long-term initiative, Sanghavi said.
"We put out these digital tools at scale but every year they’re going to get better and better as we learn from our experience. And that takes time," he said. "For example, we want a tool that’s going to help prevent diabetes or heart attacks. It will take months if not years to actually understand the impact because these are chronic conditions. We try to appropriately balance patience with data gathering and make sure we’re appropriately making the user experience as good as possible."