Over the past year, UnitedHealth Group has conducted a series of independent reviews of its practices as part of a broader turnaround effort at the company.
The healthcare giant released the last of these analyses on Thursday, digging into the processes it uses to establish medical policies. The reviews were conducted by FTI Consulting and Rubrum Advising, a provider-led firm with expertise in medical coverage policies.
While the auditors dove into the processes the insurer uses to develop its medical policies, the report doesn't examine the application of those polices and any impact on coverage denials, an area where UnitedHealthcare has drawn significant public scrutiny.
The report concluded the company's methods "were strong overall and that the medical policy development process reflected numerous best practices."
For instance, UnitedHealthcare's Medical Policy team uses a structured and standardized process to establish medical policies, rooted in evidence-based and stakeholder-informed approaches. Clinical evidence comes from nationally recognized authorities, and epidemiologists play a key role in the review process, per the report.
In addition, the analysts concluded that the team is well-staffed with qualified workers and operates under a strong governance model. Medical policies are built "using systematic evidence review, evidence-based tools and industry best practices," and UnitedHealthcare is transparent about posting these policies and making updates.
All policies are reviewed at least once per year, the report found.
CEO Stephen Hemsley said in a letter to investors that the company will continue to conduct such analyses.
"We will continue to subject key practices across UnitedHealth Group to independent review, share results publicly and make changes where needed," Hemsley wrote. "This work reflects our broader commitment to transparency, accountability and continuous improvement."
While the report concluded that overall processes in place at UnitedHealth were up to snuff, the consultants did offer multiple areas of improvement for the company, too. For instance, the analysts said that the team could improve its documentation practices, including how it details criteria for policy development.
Plus, the report suggests that UnitedHealthcare review how it documents vetting criteria for internal and external subject matter experts. The company could also do more to formally document training and education for members of its governance committee.
Medical policy documents can be lengthy and complex, so the consultants recommended the insurer consider developing a template that standardizes the written format for each policy, which would make it easier to understand. For example, the template could make it easier to connect the evidence summary to the coverage rationale.
"While these gaps do not diminish the overall strength of the program, addressing them would further enhance transparency and consistency and provide opportunities for continued refinement," the analysts wrote.