Intelli-series is making health insurance more competitive in Western Pennsylvania

I think many people know that Pennsylvania, and in particular western Pennsylvania, is one of the most uncompetitive health insurance markets in the country. It’s a problem that the Pennsylvania Insurance Commission has recognized and is trying to address under Commissioner Joel Ario.

Competition always leads to lower costs and higher quality. Having more meaningful choices for health insurance gives individuals, employers and providers more negotiating power. This forces insurers to compete for customers by adding services, enhancing choices and reducing costs.

Pittsburgh’s healthcare insurance market became more competitive about 18 months ago when UnitedHealthcare and West Penn Allegheny Health System began offering Intelli-series health insurance plans.

Intelli-Series offers a wide variety of health care plans that encompass every recent innovation in health insurance, including health savings accounts (HSA), health reimbursement accounts (HRA), out-of-network options, disease management, preventive care and wellness programs.

Intelli-series enables employers and their employees to select traditional or more innovative plans that combine high deductible, open access insurance with either an HSA or HRA. A high deductible plan is typically the least expensive healthcare insurance option for a business, while the HSA or HRA enables employees to pay for their share of health care with pretax dollars.

Participants in any of the Intelli-series health insurance plans have access to a core network of providers that includes West Penn Allegheny Health System facilities such as Western Pennsylvania Hospital, Allegheny General Hospital and Forbes Regional, and other hospitals including those in the Excela Health System and Heritage Valley Health System. They can also access healthcare services at other regional hospitals and facilities for higher deductibles and copays.

In addition to this extensive local network, participants in any Intelli-series plan can also use UnitedHealthcare’s national network of more than 560,000 healthcare professionals and 4,800 hospitals.

The Intelli-Series is available to employers in nine western Pennsylvania counties: Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Lawrence, Washington and Westmoreland.

I keep getting asked about wellness programs and I keep saying the same thing: we have them and they’re effective… when people use them

Sometimes I think we at UnitedHealthcare take it for granted that everyone knows about wellness programs. But maybe not so much, judging from some of the questions I get from clients, prospects and news reporters.

Wellness programs have become a really important part of health care. The theory behind wellness programs is that they lead to a healthier workforce and a healthier workforce leads to lower overall health care costs for employees and employers. In addition, healthier employees are more productive because they miss work less.

Like many large national health insurance companies, UnitedHealthcare offers a full range of wellness programs, including many online and some conducted by third-party vendors who are experts in their field. Our most popular programs are those that reflect the most pressing health challenges we face as a nation:

• Weight reduction and nutrition
• Diabetes management
• Smoking cessation
• Heart disease management
• Women’s health issues

Wellness programs are part of many of the health care plans we offer both large and small employers. We have had wellness programs for decades, but over the last 10 years our wellness offerings have expanded significantly due to research that’s proven that preventive care and active involvement in one’s health care decisions are key drivers of better health outcomes and lower overall health care costs.

We can cure it, so why can’t we prevent it?

One thing struck me as I perused through the 2009 America’s Health Rankings survey, which ranks the states on how healthy their citizens are: As a nation, we have become adept at treating many illnesses and diseases, but Americans are not modifying risk factors that contribute to chronic diseases.

Two risk factors, tobacco use and obesity, have emerged as the two leading preventable causes of chronic illnesses that threaten the health of the nation.

While tobacco use dropped from 19.8% of the population last year to 18.3% this year, approximately 440,000 deaths annually are still attributable to this preventable behavior. Over the past year, more than 3 million people have quit smoking, suggesting that smoke-free laws, smoking bans, increased cigarette taxes, access to smoking cessation programs and other interventions can make an impact.

Obesity is growing faster than any previous chronic health issue our nation has ever faced. Today, more than one in four Americans are considered obese. Obesity has increased nearly 130% since the first edition of America’s Health Rankings was issued 20 years ago. Currently, 27% of the population is obese. If current trends continue, 103 million American adults — or 43% of the population — will be considered obese in 2018, making obesity the nation’s next health battle.

The United States currently spends more per capita than any other nation on health care, including $1.8 trillion in medical costs associated with chronic diseases, such as diabetes, heart disease and cancer, which can be linked to tobacco use and obesity.

Every year, United Health Foundation teams up with the American Public Health Association and Partnership for Prevention to conduct the America’s Health Rankings survey. This year, United Health Foundation commissioned a supplemental report to help understand the financial impact of obesity. This supplemental “Future Costs of Obesity” report, written by Kenneth E. Thorpe, Ph.D., Emory University professor and Partnership to Fight Chronic Disease executive director, is the first to provide projections around future health care costs directly attributable to obesity that have been individually calculated for each state, as well as the nation. Left unchecked, obesity will add nearly $344 billion to the nation’s annual health care costs by 2018 and account for more than 21% of health care spending.

So how does Pennsylvania rank when compared to other states when it comes to our two biggest health challenges since 1990, smoking and obesity?

Here are the results.
2009 Pennsylvania State Ranking: 28th
2009 Smoking and Obesity Rankings: (based on a comparison of the incidence rates among all 50 states)
Prevalence of Smoking: 38th
Prevalence of Obesity: 36th

20-Year Ranking in Smoking and Obesity: (based on a comparison of the incidence rates in 1990 among all 50 states to today’s rates)
Prevalence of Smoking: 8% decrease in smoking from 29.3% in 1990 to 21.3% in 2009
Prevalence of Obesity: 15.8% increase in obesity from 12.5% in 1990 to 28.3% in 2009

It looks as if we in Pennsylvania have a long way to go in reducing the preventable causes of chronic illnesses.

New study shows that Pennsylvanians need to improve our health

Every year, UnitedHealthcare’s foundation teams up with the American Public Health Association and Partnership for Prevention to conduct the America’s Health Rankings survey. The 20th edition was just released and the news for Pennsylvania is mixed. Pennsylvania ranks 28th among all states in terms of the health of its citizens (the lower the number, the better the ranking in all cases), which is in the lower half of all states.

One thing I noted in the survey is that in the past ten years, the incidence of obesity among Pennsylvanians has increased by an alarming 46%. And there has been a mind-boggling 59.5% increase in obesity among our African-American population. If obesity rates in Pennsylvania continue to rise at their current levels, obesity is projected to soon cost $13.5 billion or $1,455+ per adult, for state health care spending.

Here are some other areas in which Pennsylvania lags behind other states:
· High incidence of infectious disease – 40th/19.6 cases per 100,000 pop.
· High levels of air pollution – 47th/13.9 micrograms per cubic meter
· Low per capita public health funding – 41st/$49 per person

The study shows that Pennsylvania does have some strengths compared to other states when it comes to the health and wellness of our citizens:
· Low rate of uninsured population – 7th/9.7%
· High rate of high school graduation – 7th/83.5%
· Low geographic disparity within state – 8th/7.9 relative standard deviation

America’s Health Ranking” is the longest running report of its kind. For 20 years, the Rankings has provided an analysis of national health on a state-by-state basis by evaluating a historical and comprehensive set of health, environmental and socio-economic data to determine national health benchmarks and state rankings. The Rankings employs a unique methodology, developed and annually reviewed by a Scientific Advisory Committee of leading public health scholars.

Younger Employees Want Health Care on the Job

Not that there is a lot of hiring going on, but I recently read another study, this one about what college seniors want in a first or second job.

Believe it or not, despite that old myth that young people think they’re invincible, more graduating students want health care benefits than want a retirement plan.

In the study, 19,000 graduating students from all 50 states ranked having a good insurance package a strong third behind opportunities for advancement and job security.

And when the same group listed which benefits were most important to them, medical insurance finished in first place, ahead of even annual salary increases and having access to a 401(k) plan. Moreover, only medical insurance, salary increases and 401(k) plans were mentioned by more than 50% of those surveyed. Women tended to think having a good insurance package was more important than men did.

These findings counter the long-time conventional wisdom that younger people prefer benefits that give them either more opportunity to develop their careers, like tuition reimbursement and bonuses, or more lifestyle flexibility, like vacations and flex-time.

The study was conducted by the National Association of Colleges and Employers, a national resource center for information about the employment of college graduates for more than 50 years.

Employers Still Paying Most of Healthcare Premiums

I saw a recent survey that told me what I knew already: that even as employers seek to reduce costs, they still continue to pay most of the premium cost of their employees’ health care insurance.

That’s what the Kaiser Family Foundation and the Health Education and Research Trust (HRET) say in the 2009 version of their annual snapshot of employee health benefits, which just came out.

The study found that premiums on average rose about 5% across the country over the past year, and now stand at $13,375 per year for family coverage. Individual coverage now averages $4,824 per year across the country. Since 1999, the cost for family coverage nationally has soared by 131%.

Even as premiums continue to outpace overall inflation, employers are standing by their traditional commitment to help employees pay for health care insurance. Employers now pay about 73% of the cost of the premium for family coverage, the same percentage as in 1999. Employers currently pay about 83% of the premium for individual coverage, according to Kaiser and HRET.

And it looks as if employers on the whole are committed to holding the line on employee costs as much as possible. When asked for their plans for the coming year, only 21% of employers offering health care insurance said they were very likely to raise their employees’ contribution and only 16% were very likely to raise the deductible.

The survey reports that offering health care insurance remains a challenge to the very smallest businesses. Only 47% of businesses with 3-9 employees offer health care benefits, compared to 72% of firms with 10-24 employees, 87% of firms with 25-49 employees and 95% of firms with more than 50 employees. These numbers demonstrate that a lot of people in the work force remain uninsured. Health care reform similar to what the insurance industry is proposing would do a lot to address that challenge.

Another amazing online tool that helps people manage their healthcare

The computer jockeys at UnitedHealthcare just came up with another online tool to help people manage their health care and their health care expenses…and it’s completely amazing!!!

It’s called the treatment cost estimator, and it can estimate the potential cost of many medical treatments.

The treatment cost estimator analyzes the cost data related to hundreds of medical services, including the treatment of 116 diseases and also 3,000 prescriptions. It can tell the user the fees for treatments and procedures specific to individual network physicians and to geographic areas, showing calculations and real-time adjustments for insurance coverage.

The treatment cost estimator can be especially helpful when considering alternative treatments. Patients now can know what it will cost before they see the doctor, which should help them get the best value for the care they need. Sweet!!

Planning to travel this winter? Take along more than a bathing suit and party clothes

Whether it’s a week of relaxation on a quiet beach in the Bahamas or a weekend getaway to the Big Apple for a concert at Lincoln Center and some shopping—or at least window-shopping—, nothing can turn a dream vacation into a nightmare faster than a medical emergency. And with the swine flu epidemic raising concerns about the potential health risks of traveling, it’s important for winter vacationers to be prepared.

Travelers with a medical condition for which they take prescription medication or might need special attention in the event of an emergency should:

• Carry prescription medications in their original containers in a carry-on bag and label them clearly.
• Have their physician write a letter explaining the condition, its limitations, and prescriptions to carry with them in case of an emergency.
• Obtain a copy of their personal health record and carry it with travel documents.
• Always carry their health insurance card and understand the insurance company’s process for seeking medical care when traveling.

Understanding your health care insurance is especially important when traveling abroad on a winter vacation. To be fully prepared for a medical emergency when away from home, travelers should:

• Carry an insurance identification card and a claim form with other important travel documents.
• Understand how their health insurance coverage works outside of the United States. For example, some insurers like UnitedHealthcare offer extended coverage for international medical expenses.
• Find out how the health care system and emergency treatment works in the country they plan to visit.

Anyone planning a trip out of the country should consult with his or her physician about additional vaccinations that may be recommended or required prior to traveling. Also check with your health insurer because not all travel-related vaccinations are covered. Physician visits should be scheduled four to six weeks prior to departure because most vaccines take time to become effective, and some must be given in a series, over a period of days or sometimes weeks.

When traveling abroad, keep in mind that in many foreign destinations there will be obstacles to communication that could make finding help in an emergency difficult. To ensure a language barrier doesn’t stand in the way of getting help, travelers should:

• Contact the International Association for Medical Assistance to Travelers at the nearest U.S. embassy to find medical facilities and English-speaking doctors in the area where they plan to travel.
• Learn the words for doctor, emergency, and hospital in the native language.

Now, “Bon Voyage” and don’t think about your job while you’re having fun!

AIDS in African-American Women Reminds Us Why We Need World AIDS Day

As we approach World AIDS Day on Dec. 1, the troubling incidence of AIDS among African-American women serves as a potent reminder about how far we must travel on the long journey to eradicating this disease.

Health care professionals like to highlight the tremendous progress we’ve made in treating people with HIV and AIDS. The prescription drugs, long-term care plans and innovative treatments we’re providing to patients are all getting better. In general, Americans with HIV and AIDS are living longer and stronger lives. We’ve come a long way in the 25 years since the AIDS epidemic began. The World AIDS Day website, worldAIDSday.org has a lot of information about the history of our battle against this dreaded disease.

But we’ve so much more work to do to battle the spread of HIV among African-Americans, and particularly among women. The Centers for Disease Control and Prevention (CDC) reports that nearly half of the more than 1 million Americans living with HIV/AIDS are African-American and that 40 percent of the nearly 563,000 Americans with AIDS who died in 2007 were black.

Among all women in the U.S. living with HIV/AIDS, 64 percent are African-American. In fact, the rate of AIDS diagnosis for African-American women nationwide is 22 times the rate for white women.

The situation in Pennsylvania reflects the national trend: 67 percent of all women with AIDS or HIV in the Keystone State are African-Americans. This problem is even more pronounced in places like Washington, D.C., where the prevalence of HIV and AIDS among African-American women rivals that of Nigeria.

What’s most frustrating to health care professionals is that AIDS is generally preventable through simple changes in behavior, including increased use of safer-sex practices and testing.

Sadly, too many people – especially African-American women and young people – are not getting the message. According to the CDC, the U.S. has the highest rate of teenage infection in the developed world. Every hour, two Americans between the ages of 13 and 24 contract HIV.

We know that regularly testing those most at risk for HIV – and then providing antiretroviral drugs for HIV/AIDS patients – dramatically reduces the number of people who become infected. Without treatment or education, people will continue to transmit the virus to their partners.

Preventing HIV is not complicated. It takes the individual decision by every person who is sexually active to use safe sex techniques and to get tested. It takes people avoiding IV drugs and drug users vowing never to share needles. Treating AIDS is equally simple: it takes going to health care providers and following their instructions on how to manage the disease and slow its spread.

Many people avoid discussions of diseases that can be spread through sexual contact. But it’s better to talk about sensitive subjects than to let a lack of information threaten lives. Let’s hope that people everywhere, especially African-American women, hear the message of World AIDS day and find out how to protect themselves from HIV and AIDS.

A Checklist of Vaccinations to Keep You Healthy

Earlier this week, I was talking about the fact that many adults forget to get booster shots for the immunizations that they had years ago. I came across a complete list of recommended vaccinations that I thought I would share with you. It’s at www.cdc.gov/vaccines.

Here’s some of the vaccines every adult should have, with a schedule of when they should get them and how often:

• Tetanus, diphtheria, pertussis - Booster of Td every 10 years from age 19-65+
• Human papillomavirus (HPV) for women - 3 doses between ages 19-26
• Varicella (chicken pox) - 2 doses between ages19-65+
• Zoster (shingles) - 1 dose for ages 60+
• Measles - 1 or 2 doses between ages 19-50 yr, 1 dose after age 50
• Influenza - 1 dose annually
• Pneumococcal - 1 dose ages 65+
• Hepatitis A, Hepatitis B, Meningococcal - based on medical and occupational risk factors

Don’t forget to follow the advice of your physician when it comes to both vaccinations and boosters.

Don’t Forget Your Other Vaccinations

There has been lots of media attention on flu vaccines this year, and especially the vaccine for the N1H1 (or swine) flu, which has reached pandemic proportions throughout the world. People most susceptible to the swine flu should get the H1N1 vaccine, and that includes children, adults under 65 years of age, healthcare workers, pregnant women and people with asthma, other lung disease or heart, liver, kidney, blood or immune system problems.

But, even as people are clamoring for their flu shots, many adults are forgetting another important part of preventive medicine, booster shots for those immunizations most of us got as children years ago. Childhood immunizations can fade over time, and some vaccinations require boosters in order to stay effective. Depending on age and medical history, it may be time to update your own vaccination record.

According to 2008 data from The Center for Disease Control and Prevention’s National Health Interview Survey, only 63% of adults under age 50 have received a tetanus shot (Td) in the last 10 years, while only 52% have had a recent vaccination for tetanus, diphtheria and pertussis (Tdap). Only 25% of adults under age 65 with a high-risk status report having ever received a pneumococcal vaccination and just 17% of those between 19-49 received an influenza vaccine this past flu season, according to the NHIS (http://www.cdc.gov/nchs/nhis.htm).

A new kind of tetanus booster now offers added protection against pertussis, also known as whooping cough, and can help prevent the spread of pertussis among children who are too young to be fully vaccinated. Other recommendations include vaccines that protect against shingles, meningitis, hepatitis and human papillomavirus (HPV), which causes cervical cancer in women.

And the winner is…

In my last blog, I bragged about UnitedHealthcare’s “All Star of the Game” program that honored Penn State football fans who have done something to improve their own health or someone else’s…but I didn’t mention the winner! Ooops!!

And the winner is…

Susan Day of Gardners, Pa., for leading her team in tackles against a devastating disease. And for her tireless work, UnitedHealthcare and Penn State Sports Properties awarded her the Penn State football “All Star of the Game” grand prize.

Day received the grand prize for working with family and friends to start the Angels for Alyssa foundation to raise research funding for Methylmalonic Acidemia (MMA), a rare genetic disease that causes developmental delays, seizure, hypoglycemia, stroke, coma and even death. Day had lost her nephew Blake to MMA and later became a champion for a cure when her niece Alyssa was diagnosed with the disease.

In addition to naming her All Star of the Game, UnitedHealthcare donated $2,000 to the Angels for Alyssa foundation to help it continue its commitment to finding a cure for Methylmalonic Acidemia.

All of us at UnitedHealthcare are inspired by Susan’s work with Angels for Alyssa. Her dedication gives other children and families suffering from this debilitating disease hope that someday there will be a cure. She is a true All Star in the fight against MMA.

The real all-stars who help other people

UnitedHealthcare of Pennsylvania just completed what’s called a promotional program that allowed me to get to know a little bit about some very special people, this season’s nine Nittany Lion Fan “All Stars of the Game.”

UnitedHealthcare partnered with Penn State Sports Properties at the beginning of the 2009 college football season to honor Nittany Lions fans who are working to improve their own health or the health of others in their family, community or workplace.

Each “All Star of the Game” received a $100 gift certificate for Penn State merchandise and a chance to win the grand prize, a $200 gift certificate plus tickets and tailgate passes to the Nov. 14 game against Indiana University.

We recognized a total of nine All Stars this Penn State football season: Susan Day of Gardners, Pa, John Page of Downers Grove, Ill., Katrina Domkowski of Dallas, Pa., L. Ramon Beiler of New Berlin, Pa., Greg Underkoffler of Myerstown, Pa., Dan Mosel of Harrisburg, Pa., Peter Augulis of Wayne, N.J., Cynthia Wolf of State College, Pa., and Yvonne Dunn of Lewistown, Pa.

All nine of these All-Stars did something great in their community. John Tull of Penn State Sports said “it was one of the most meaningful community promotions I have ever been involved with in my 20-year sports marketing career.”

More Neat Stuff: Medical Swipe Cards

There is a simple way to reduce health care costs and improve coordination of care and patient satisfaction: widespread adoption among doctors, hospitals and health insurance companies of magnetic stripe health care ID cards.

Everyone with health insurance has a card that they give to the receptionist at the doctor’s office. The receptionist usually makes a photocopy of the card and then fills out all the forms by hand or through repetitive data entry to file a claim with the insurance company.

With a health care ID card that uses magnetic stripe technology, the patient simply swipes the card through a device similar to a credit card terminal, and the physician’s office has access to all appropriate patient-eligibility information and personal health records. Some of the information will even automatically populate into the claim form for the physician’s office staff with the swipe of the card, enabling them to submit claims online and receive approvals from the insurance company in a matter of seconds.

The new cards have a number of built-in protections for consumers – information is never stored directly on the card, and access through the card can only be made with the patient’s permission.

Unlike many other industries facing revolutionary new technologies, the medical industry has been slow to adapt swipe card technology. In fact, according to a recent survey published in the New England Journal of Medicine, just 17 percent of all physicians’ offices use any kind of advanced card technology.

Imagine the savings in administrative costs to both health care providers and insurance companies if most or all health care facilities used swipe cards. Millions of administrative transactions per day would become faster and easier. In fact, the Medical Group Management Association (MGMA) estimates that machine-readable patient ID cards could save physician offices and hospitals as much as $1 billion a year by eliminating unnecessary administrative efforts and denied claims. MGMA recently launched a campaign to promote machine-readable cards.

The cost to install card readers is relatively minor, and once installed, the swipe card soon pays for itself in lower administrative costs.

I encourage all health care providers and insurance carriers to adopt swipe card technology using the new universal standards. Other industries have seen rapid adoption of information technologies that lead to cost savings and quality improvements. The health care industry has an opportunity to follow suit, and thereby make a tremendous impact in reducing costs, enhancing quality and playing a critical role in positive health care reform.

More Neat Stuff: Tracking Medical Expenses

Employers have long asked insurance companies to make it easier for employees to keep track of medical expenses.

With the growing trend toward employees taking more ownership over health care decisions, employers have been concerned about getting their employees the information they need to navigate the complexities of health care. For example, research that Intuit Inc. conducted found that many people are overwhelmed by the paperwork associated with receiving medical care.

A number of health insurance companies have begun offering software that helps employees track their health care expenses online. This software works in real time to pull information from an employee’s health care claim making it easier to track doctor visits, prescriptions filled and account balances. The software complies with privacy laws and keeps the information confidential. At UnitedHealthcare, we use Intuit’s Quicken Expense Tracker.

Expense Tracker helps employees better navigate the health care system in several ways by:

• Showing the calculations behind the amount billed and what is owed for each medical bill.
• Giving the current status of the user’s deductibles and out-of-pocket spending and tracking medical expenses for tax reporting.
• Sending email alerts if a claim has an outstanding balance after insurance payments.
• Defining health care terms and codes in easy-to-understand language, which increases the user’s knowledge of health care.

Use of expense tracking software is voluntary on the part of employees. While larger employers have been the early adopters, more and more small business owners are making it available to their employees, too.

Women Have Arrived…

We’re all the rage. Just pick up any business journal or life style publication and you’ll see why; as managers, executives and entrepreneurs, women are taking over as leaders in the corporate world. But what these articles don’t say is that it isn’t any different at home. In many households today, women are acting as the Chief Health Officer (CHO) and taking on the difficult job of managing their family’s health care.

I was recently appointed CEO of UnitedHealthcare’s Pennsylvania region, and nothing could have better prepared me for this role than my experience as the CHO of my own family’s health care. One of my three children was born with a serious health problem that has required seven delicate surgeries, so I have spent more than twenty years managing difficult decisions on both sides of the health care system.

As both a CEO and CHO, I know that keeping up with a family’s health care is a challenging job for any woman. Thankfully, UnitedHealthcare has launched an innovative new online community called Source4Women that has the tools a busy woman needs to simplify and personalize health care decisions.

The website has comprehensive information on health, wellness and disease management along with tips, checklists and support groups tailored for women at different stages of their lives. Interactive resources make everyday tasks like finding a doctor, keeping track of expenses and making healthier lifestyle choices easier with everything from physician ratings to recipes to open forums with health care experts.

Most importantly, Source4Women is a place where we, as CHOs and CEOs, can go to share our stories and show support. It’s an incredible challenge to make the right health care decisions for yourself and your family and we can learn a lot from each other’s experiences. That’s why I want to hear how other women are tackling the issues of health care today while also managing to move ahead in the business world. Feel free to share your thoughts and comments as fellow family health care gurus, and join the community at www.source4women.com.

Stop Elective C-sections, Reduce Infant Mortality

A report I read about yesterday in the New York Times and heard on NPR reminded me of an earlier topic I blogged about a few weeks back: the alarming number of babies delivered through premature elective Caesarian sections (C-sections). According to the report by the National Center for Health Statistics, the United States has a disturbingly high infant mortality rate – a strain on the entire health care system – and it’s mainly because of premature births.

The report nails down the increasing number of C-sections used to deliver babies before the full 39 week term recommended by the American College of Obstetricians and Gynecologists as one of the major factors leading to such shocking mortality statistics. Newborn babies delivered before full term are at risk for serious health complications and in too many cases, don’t survive.

So why such a high number of premature C-section births? Research shows there is a sharp increase in C-sections and the reasons vary, ranging from avoiding holiday hospital stays to scheduling around vacation plans. But whatever the reason mothers and physicians schedule elective C-sections before a pregnancy reaches full term 39 weeks, it’s downright dangerous. A growing body of research reveals that newborns delivered prior to 39 weeks are two-times more likely to end up in the NICU than babies born at 39 to 42 weeks.

That’s why UnitedHealthcare is working with physicians, hospitals and the March of Dimes to reduce the number of elective C-sections. We’ve shared the startling data with all OB/GYN doctors and 4,800 hospitals in our national network and now inform all expectant parents of the risks in our pregnancy pamphlets and online resources. And it’s working. Since we began to spread the word, there has been a 46% decline of NICU admissions!

As anyone can see in the New York Times report, premature births are dangerous, costly, and far too common. If we keep working to eliminate elective C-sections and allow newborn babies to grow to full term, we can not only reduce the cost of health care, but also significantly lower the number of infant mortalities in the United States – a saving grace for the health care system, and a relief to all parents.

More Neat Stuff: Nurses manage chronic diseases over the phone

Once a month like clockwork, thousands of people with UnitedHealthcare insurance get a call from a nurse about their chronic condition, usually heart condition or diabetes. The nurse discusses with them how they’re feeling, answers any questions and reminds the patient of prescription refills and doctor’s visits.

These people are all in UnitedHealthcare’s disease management program designed to help improve the health of members with heart failure, coronary artery disease and diabetes.

People in the program have told us they like the personal attention of the regular phone call because they get to talk to a medical professional about their problems without having to pay a co-pay. Some end up spending more time on the phone with the nurse than they would at a short office visit with a physician. And they have to go to fewer physician appointments, which saves them both time and money.

I know of one patient in our disease management program with heart disease, who developed a frequent cough. When he told the nurse, she thought it could be a side effect from one of his medications and suggested he check with his doctor. He followed her instructions and was prescribed a substitute that worked without the side effect.

UnitedHealthcare’s disease management program attempts to manage the “whole person,” by augmenting the calls from the nurses with referrals to social workers and dieticians. The goal is to assist the patient in integrating their physicians' treatment plans into their lifestyle. Some participants receive phone counseling once a month, others more often.

We're Giving Money Away

Since it’s open enrollment season, I’ve been reviewing all the great new and recent programs we have at UnitedHealthcare that help our members lead healthier lives or cut costs out of delivering health care. I don’t want to break my arm patting UnitedHealthcare on the back, but it really is amazing how much neat stuff we’re doing! I think I’ll spend a couple of blog entries talking about some of it.

One really great program is SimplyEngaged, which offers incentives to people who take an active role in improving their health. Our members who participate in the SimplyEngaged program receive a $75 reward for completing a health assessment online or over the phone. Then, based on personal results they are given recommendations for how to go about improving their health. Those who take advantage of tools like online or telephonic health coaching receive an additional $25 reward.

When Cattron Group International, a Sharpsville, PA-based manufacturer of radio remote controls, began to offer SimplyEngaged as a way to make its new insurance plan more attractive to employees, an older workforce who never saw preventative care as a high priority, the possibility of earning cash in return for better health was a cause for action.

So far, 365 Catron employees have enrolled in SimplyEngaged, 93 have completed the health assessment and received the initial $75 reward and 69 have gone further to participate in health coaching and other programs. Some of the most popular programs among employees at Cattron are the healthy lifestyles and health trackers programs as well as the personal health record.

One of the keys to the program’s popularity is that participation is confidential. Employees initiate the program themselves by completing the assessment and receive the financial rewards directly from UnitedHealthcare. This ensures compliance with HIPPA regulations and creates a boundary between the organization and employees’ personal lives.

Cattron likes Simply Engaged because so far it has helped increase the health literacy of its workers and made them more proactive in managing health concerns like hypertension, high cholesterol, diabetes and arthritis while improving their overall wellness. With the help of Simply Engaged, they’re cashing in on better health.

But Do People Like It?

I’ve spent a lot of blog space recently talking about the benefits and features of a new type of health care insurance, the HSA-high deductible combination. For those who just came on board, an HSA, or health savings account, enables employees to pay for their share of health care with pretax dollars and is offered in conjunction with a low premium, high deductible healthcare insurance policy. Employees can save money in the HSA tax-free and draw out funds anytime they want to pay for the premium, deductibles, co-pays or other medial costs. Employees don’t have to spend what they put into an HSA by the end of the year.

But do people like the HSA?

Survey says….Yes!!!

A 2009 study by OptumHealth shows that once employees open an HSA they are delighted with the coverage. In the study, 82% of the respondents—all HSA owners—said that they are fully satisfied with the plan, while 78% believe that the HSA option should remain a health care option no matter what happens in future health care reform.

America’s Health Insurance Plans (AHIP), the trade association of health care insurers, surveys how many people are covered by HSA-high deductible plans once a year. Recent AHIP figures demonstrate that in the past two years, the number of people enrolled in HSA plans has grown by 90% and now stands at 6.1 million nationally, broken down as follows:

• Small groups: 1.8 million
• Large groups: 2.8 million
• Individuals: 1.5 million

Among these 6.1 million are large numbers of people who did not have health insurance before establishing an HSA and taking a high deductible plan. A 2007 AHIP study found that 27% of people with HSAs in employer-based plans were previously uninsured. A study by Golden Rule Insurance, a UnitedHealth Group company, found that an even larger percentage of individual-based HSA buyers—a whopping 40%—were previously uninsured. Based on these two studies, OptumHealth Financial Services estimates that nearly 2.5 million previously uninsured people have gained coverage through HSA plans through January of 2008. And a 2009 OptumHealth survey estimates that 3 in 10 holders of HSA plans say that if it weren’t for the HSA option, they wouldn’t have health care insurance at all.

The HSA-high deductible combination has been particularly popular with two groups that insurance carriers and brokers have had difficulty serving in the past: small businesses and employees with relatively low incomes. We find that among UnitedHealthcare participants, 74% of all small businesses now select the HSA-high deductible option, as do 64% of all employees earning less than $25,000 per year.

So yes, people like the HSA, and with reason: it saves money and if it’s structured right, also helps to improve the quality of care people receive.

Not Every HSA is Alike, Part 2

In my last blog entry, I reminded you of the advantages of an HSA-high deductible health care plan that does not include preventive care in the deductible. If preventive care is not included in the deductible, then the employee does not have to pay anything additional (other than a co-pay) for annual exams, pap smears and other preventive care.

Here are some other variations in HSA plans that can make all the difference to the people in the plan:

• The plan should allow the employer to make contributions to the HSA. Employers can facilitate employees opening HSAs by either giving them a one-time or regular contribution. The regulations governing HSAs enable anyone to contribute, but when employers make a contribution, a greater percent of employees are likely to open an account.
• The plan should have those features employers want now. While some employers are interested in bare bones plans that may only pay for long-term hospitalization, we have found that among employers of all sizes, the current widespread attitude towards health care benefits is to provide certain core components of basic health care:
  - Emergency care
  - Preventive care
  - Prescription drugs
  - Long-term hospitalization
• There should be online capabilities to manage HSA expenses. Many people are reluctant to try an HSA because of the increase in paperwork that’s required to figure out when the deductible limit has been reached. Being able to access all these records on-line 24/7 makes it much easier for employees to manage their health care costs.
• The plan should include some access to wellness programs. Because HSA plans tend to make consumers more aware of costs, they also tend to influence consumers to take actions to maintain or improve their health. For example, a 2008 survey of its members by the Blue Cross and Blue Shield Association found that people with HSA plans are one-third to one-half more likely to use health screening, exercise and health coaching services, compared to traditional health plans that also offer these preventive and wellness services for free.
• The insurance should include extensive training and support.

Employers and individuals cannot assume that all plans are alike. For the near future at least, carriers will continue to introduce innovative features to the HSA plans they offer.

Not Every HSA is a Alike

I forgot to mention an important fact about health savings accounts. They’re not all alike, and the differences between many the plans that are offered may determine if people will actually benefit from this insurance innovation.

Surely the most significant difference in HSA-high deductible plans is whether or not the health care plan includes preventive health care such as annual checkups, pap smears and mammograms as part of the deductible. These routine exams help to find and prevent serious illness, but if they are part of the deductible, employees in the HSA have to pay for them, up to the high deductible limit. If they are not part of the deductible, they are covered 100% by the health plan, meaning that employees are more likely to go to the doctor for these important exams and thus more likely to remain healthy.

Our studies show that participants in HSA-high deductible plans in which preventive care is not part of the deductible receive preventive treatment at rates that are equivalent to or higher than people in traditional plans. In fact, people in HSA plans are:

• 16% more likely to get cervical or prostate cancer screening
• 20% to 40% more likely to get important tests for their condition if they are heart patients
• 15% more likely to have important diabetes tests, if a diabetic.

Another survey, this one by the Wellpoint Institute of Health Care Knowledge, shows that men, who typically lag in the use of preventive care, are more than twice as likely as women to increase their use of preventive care once in an HSA plan.

One More Change, and It’s a Biggie

Last week, in my list of ways in which health care insurance has improved over the past few years, I didn’t mention one major change, because it’s kind of complex.

The change was a piece of health care reform that Congress passed in 2003 that allowed employers to offer a new way to pay for health care expenses using a health savings account.

A health savings account (HSA) enables employees to pay for their share of health care with pretax dollars and is offered in conjunction with a low premium, high deductible health insurance policy. Employees can save money in the HSA tax-free and draw out funds anytime they want to pay for the premium, deductibles, co-pays or other medial costs. Employees don’t have to spend what they put into an HSA by the end of the year.

The benefits of the HSA-high deductible plan to employers are fairly obvious: By switching to the high-deductible plan, the employer lowers the insurance premium and can shift to a more cost-sharing arrangement with employees. The lower cost of the HSA may make it the only plan that some small employers can afford to offer. And if the prediction of many experts is correct, that the HSA-high deductible combination makes people more careful consumers of medical services, then switching promises to yield overall reductions in healthcare cost inflation in the future.

Most high-deductible plans set the deductible at $1,500 or $2,500 per year. Simply by adding a deductible of $1,500-$2,500 to a health care plan but maintaining every benefit and feature in the plan will cut the premium cost by about 25% on average over the same plan but with a zero deductible.

Over the course of a year, adding a high deductible leads to an average decrease in premium costs to employer and employee of $3,836 after switching from a PPO plan to the HSA/high-deductible combination, according to a recent study by the Kaiser Family Foundation. And a multi-year study my company, UnitedHealthcare, recently completed showed that after adjustment for demographic and health status, the HSA-high deductible plans lowered overall health care costs by 7% in 2006 and 9% in 2007. The employer’s share of health care costs was down 12%.

There are many benefits to employees of the HSA-high deductible combination:

• The HSA account is portable, which means employees keep the money in the HSA account if they move to another employer.
• Anyone else can contribute to an employee’s HSA account.
• The employee has easy access to the funds, and with many plans may be able to pay for medical expenses using a debit card tied to the HSA.

A recent OptumHealth study demonstrates that those in HSAs are aware of overall health care costs, and in a sense become more informed consumers. For example, in the last year:

• 64% of HSA holders asked providers about generic options for prescription medications.
• 47% asked providers about the charges for visits or treatments.
• 30% used websites or other resources to research the range of costs for health care services in their area.

Like all of the recent innovations about which I have been talking, the HSA-high deductible combination does not solve all our health care problems. But it does offer a cost-effective option for both employers and employees.

It’s Getting Better, Part 3

In my last few blog entries, I’ve been writing about how health insurance has improved over the past 5 years. I’ve cited examples of technological innovations and of initiatives that have helped consumers take greater control of their own health and health care.

Perhaps the most significant improvement in health insurance over the past few years has been the greater emphasis on prevention. People who don’t get sick not only are healthier, they also spend less on their health care.

Here are some of the most important recent improvements in health insurance that involve prevention of disease:

• Wellness programs. From smoke cessation to exercise, from weight loss to managing diabetes, consumers now have a wealth of wellness programs available through their health insurance plan and/or their employer.
• Health care advice over the phone. A number of insurance plans now offer health care advice over the phone. In the typical service such as NurseLine or one of UnitedHealthcare’s disease management programs, a nurse with experience can help the consumer find a doctor or hospital, understand treatment options and get medical questions answered.
• Health care coupons. Some health care plans have begun offering discount programs that enable covered employees to get discounts of up to 50 percent on health care products and services, including lasik surgery, smoking-cessation programs, gym memberships and even fitness apparel.

I’ve mentioned 9 improvements, all of which share some common themes. For one thing, they all tend to save money while improving care. But beyond that holy grail of raising quality while lowering costs, we can see these other trends I’ve mentioned:

• Many innovations such as real-time adjudication and swipe cards reflect the opportunity that new technology presents for streamlining and thereby cutting the cost of administering health care.
• Some innovations such as personal health records and physician rankings tend to educate consumers and get them more involved in making health care decisions.
• Running through many of these innovations, such as wellness programs and health care coupons, is a strong element of preventive medicine.

No matter what shape health care reform takes, I think we can take it for granted that these themes-technology, personal responsibility and prevention-will lead to a completely new list of innovations in just a few years.

It's Getting Better, Part 2

In my last blog entry, I made the controversial statement that health care insurance has improved in many ways over the past 5 years. I started to prove my point by listing a few technology advances that have improved health insurance.

Here are some innovations that tend to educate patients and get them more involved in making health care decisions:

• Physician rankings. Physician ratings can help consumers select the most appropriate doctor, but if and only if qualified medical professionals do the rating based on clinical standards and quality is rated first, with only those doctors who make the quality standard getting rated for efficiency as well.
• Personal health records. A personal health record (PHR) provides a complete and accurate summary of the health and medical history of an individual using data gathered from many sources. The PHR is accessible online to the individual and anyone who has the necessary electronic credentials to view the information.
• Generic drugs in formularies. Health insurance plans now routinely include generic drugs in their drug formularies resulting in a lower copay for consumers who use generics in place of higher-priced brand names that do the same thing. Consumers who get involved can cut their costs by selecting the generic version.

So far I’ve come up with six ways that health insurance is better than it used to be. And I’m not done yet.

It's Getting Better

In my last blog, I pointed out that my industry —health insurers—takes a lot of heat for what’s wrong with our health care system. I admit that health care insurers have to change, like everyone else. That’s why my industry’s proposal for health reform brings everyone into the system, guarantees coverage for all Americans, does away with pre-existing condition limitations and ends ratings based on health status and gender.

But I also want to point out something that most people don’t realize: Quietly over the last 5 or so years, most health insurance plans have added features and programs that improve health, make it easier to deal with our complicated health care system or cut overall health care costs. These new features don’t solve all our health care woes, but they have made inroads into addressing some of our most complex challenges.

Many of the improvements to health insurance over the past few years result from the application of advanced data processing and other technologies. Here are some examples:

• Real-time claims adjudication. Doctor’s offices can now submit their claims online and know within 10 seconds if a procedure is covered by the patient’s health plan, instead of having to wait days or weeks.
• Medical data synchronization. New data processing software such as the eSync platform collects and synchronizes medical data from a variety of sources, analyzes it and converts it into individual health care recommendations for specific patients.
• The medical swipe card. Patients swipe the medical swipe card through a device similar to a credit card swipe to give caregivers access to all appropriate patient eligibility information and to the patient’s health records. With the card, the physician is able to submit claim forms online and receive approvals from the insurance company in a matter of seconds.

All of these innovations have made maneuvering the health care system easier while reducing administrative costs.

But those aren’t the only changes that have improved health insurance. When I get more time, I’ll list a few more.

Everyone is to Blame

One constant theme in the debate over health care reform has been the laying of blame for all of our health care problems at the door of insurance companies. Now that's just wrong and it's also inaccurate.

Everyone is to blame!

By everyone, I mean everyone! Individuals, physicians and hospitals, drug companies, the government and yes, insurance companies, all are partially to blame for the problems in our health care system, and everyone will have to change in some way to fix what’s broken.

All of us have played a role in making our health care system more expensive and less efficient than it should be, and it will take all of us to fix it.

• Consumers have an important part to play. Many preventable diseases are caused by unhealthy lifestyles, poor diets and little or no exercise. Everyone who pays health care premiums is shouldering the burden of paying for the health care of those with preventable diseases.
• Employers have fallen into the trap of shedding and shifting health care costs instead of thinking about helping employees stay healthy. But if more employers joined the growing ranks of those that create incentives for employees to live healthier lifestyles, health care costs would moderate.
• Health insurance companies should develop reimbursement strategies that facilitate cooperation, such as increasing reimbursements to higher-quality and higher-efficiency physicians and hospitals. Insurers must also become more user-friendly. Transparency about reimbursement practices and benefit levels would help manage the expectations of both consumers and medical professionals.
• Doctors and hospitals also play a critical role in improving the efficiency and affordability of our health care system. Market-based reforms such as physician ratings and reward systems for quality and efficiency could, over time, lead to a system that would improve care and increase efficiency making health care more affordable for everyone.
• Pharmaceutical companies could lower health care costs with one simple step: stop giving consumers misinformation about generics. In many instances the generic is identical to the brand name drug and costs 60-80 percent less. Yet heavy advertising by drug companies influences consumers to view brand name drugs as better. Once convinced, employees pressure their employer to cover the higher-priced brand name drug – driving up the cost of the health care plan.
• The federal government, the largest payer of health care benefits in the country, has perhaps the largest role to play in fixing our healthcare problems. In recent years, the government has engaged in cost shifting by capping or reducing physician and hospital reimbursements and reducing subsidies to the states. This cost shifting has ended up hurting smaller hospitals and people without insurance.

We all hold keys to open new doors to a better and more affordable health care delivery system. But it means that we will all have to give a little more of ourselves so that everyone benefits.

Can We Cover the Uninsured and Drive Down Costs?

A few weeks back I participated in a panel discussion about health care reform sponsored by the Greater Philadelphia Association of Health Underwriters. A few of the questions we were asked I thought were important enough to ask myself again and then answer in my blog.

1. Ignoring the political viability of your solution, what do you think is the best solution to simultaneously cover the uninsured and drive down health insurance costs?
First to covering the uninsured: UnitedHealthcare supports the concept of universal coverage and thinks we can best achieve this goal by building on our current system of commercial insurers. We support reform proposals that guarantee coverage for all Americans and would require all individuals to have coverage. We are also in favor of expanding Medicaid to reach low-income adults.

Now to costs: To some degree covering everyone will help drive down costs, that is, if universal coverage leads to more preventive medicine, which as we know leads to healthier people, which in turn drives down future health care costs.

But we also believe that there are a lot of unnecessary costs in the system that can be eliminated by implementing advanced technologies and modernizing procedures and policies. In fact, UnitedHealthcare has contributed two well-researched studies based on real world case studies that clearly demonstrate how the government and private sector could save hundreds of billions of dollars while improving the quality of care. For example, over the next 10 years, an estimated $540 billion in federal savings can come from implementing changes in four main areas:

1. Incentives to patients for use of high-quality physicians
2. Improved Care Management
3. Physician Incentives & Information to help drive quality care
4. Evidence-Based standards applied to reimbursement

2. Are there any negative implications associated with mandating that all U.S. citizens be covered by at least some standardized level of coverage? There is a deep and profound interconnectedness between the various aspects of health care reform and nothing illustrates this interconnectedness more than mandating universal coverage. As long as we remember this interconnectedness and pass a global program that addresses both accessibility and cost, we should be able to address any negative implications. A personal mandate also requires targeted funding for lower income consumers, which in turn requires new revenues and cost containment. If we address these issues in an integrated manner, we will be able to deal with any potential negative implications. But if we address these issues in isolation, we could run into difficulties.

Open Enrollment Season is Here

The next few months will be a busy time for everyone at UnitedHealthcare because it’s “open enrollment season,” which in the health care profession is as exciting as ski season is to my friends who ski.

The open-enrollment period gives employees the opportunity to re-evaluate the health care benefit plans that are available through their employers. For most companies, open enrollment occurs annually, usually at the end of the year for plan benefits effective the following calendar year.

Employers should look at open enrollment as an opportunity for both the company and its employees to make sure available health care plan options meet health and financial needs.

The first step that employers should make in preparation for open enrollment is to review the past record of health insurance claims. A claims review will identify treatments that employees rarely use and clusters of benefits that employees use frequently. This information can help the employer make adjustments to the health care plans they offer so that the plans truly address the needs of its workforce.

Claims review information may also suggest when it makes sense to bring in speakers for wellness seminars. For example, if there are a growing number of diabetes claims, the employer may want to hold classes in diabetes prevention and management. Employers can also help employees in open enrollment by having their benefits consultants make group presentations about the differences among the various plan designs.

Control the Cost of Drugs

Perhaps the fastest growing factor in health care costs is the cost of filling prescriptions. Many health insurance policies have a prescription drug benefit, but both those with and without health insurance can save money if they:

• Select generic over brand-name drugs. Beside many brand name drugs on the shelf are equally effective and equivalent generic versions. Equal in everything but name recognition, these drugs offer the same level of quality, purity and strength as their brand-name counterparts and cost 30- to 60-percent less. Ask the pharmacist for a generic version and we can save substantially on our prescription medications.
• Mail it in and split it. Prescriptions delivered via the postal mail vs. buying them at retail locations may help reduce drug co-pays and even offer a 90-day instead of 30-day supply. Or consider pill splitting. By following the doctor’s instructions and using a special device to split and take only half of a pill prescribed at double the dose each time, we can save hundreds of dollars a year on medications.

Armed with the 10 suggestions I’ve listed over the last week or so, it’s now time to lace up the running shoes, go for an annual check-ups and, most importantly, know the options you have for reducing health care costs.

Work Your Health Care Plan

It’s amazing how much money you can save on health care once you start to think about it. One thing I notice is that many people spend more money on their health care than they should because they don’t take the time to review their health care plan documents. Here are some suggestions:

• Understand our health benefit plan. Read the fine print, or log on to the health insurance company’s Web site. Know what is covered and what is not, and learn about any available wellness programs that can help improve health, reduce overall costs or even provide monetary incentives.
• Use in-network providers. Seeing a doctor outside of the health care plans network costs more than seeing one in-network. Most health plans have thousands of doctors in their networks. A quick visit to the insurance company’s Web site can help avoid a more costly visit to the doctor.
• Review the doctor’s bill. Making sure we have been billed correctly after an office visit or procedure is a simple routine that can save money and reduce stress.
  

Keep it locked…I’ll give still more cost-savings tips next time post a blog entry!

Prevention, Prevention, Prevention

Lately I’ve been thinking of ways that people can save on health care. In my last entry, I mentioned two ways to lead a healthier life, to stop smoking and lose weight. By living healthier, you need the health care system less and therefore spend less on health care.

Other ways to save money by living healthier have to do with keeping tabs on your medical condition:

• Make primary prevention a priority. Primary prevention is a proactive approach that helps cut costs by helping maintain good health in the first place. By keeping up with immunizations and going for regular check-ups you can take preventive measures to stop health problems before they have the chance to start and have a major impact on the price you pay for health care in the long run.
• Take control with secondary prevention. If you can’t keep a health condition from arising, you can still fight the cost of its effects. Secondary prevention aims for early detection and interventions that slow the progression and onset of chronic diseases such as diabetes and heart disease. Keeping up with screenings, never missing doctor visits and taking medications correctly will help minimize the cost of needing additional care.
• Know your conditions. When you make the effort to listen to your doctors, take notes and fully understand your medical conditions, you are working together with your physicians to manage your illnesses more effectively and therefore cut costs.

More in a few days!

Take Control and Save

We hunt through clearance racks to cut the cost of designer goods. We change the oil and put new tires on our cars to avoid a more costly trip to the mechanic. We spend hours online comparing and contrasting travel sites before booking our family vacations. Why can’t we take the same cost-saving approach to our health care?

No matter what happens with health care reform, consumers will have to start taking a more active role to save money on their family’s health care. There are plenty of ways for the savvy consumer to trim the dollar signs and prevent their health care costs from escalating.

Here are a couple of my favorite ways that average people can take matters into their own hands and reduce health care costs. The first two have to do with living healthy lifestyles:

• Lose weight. An apple a day is no longer the trick. Maybe because we dip it in caramel. Maybe because we don’t eat it at all. Whatever the reason, widespread obesity is driving the cost of keeping the doctor away to where it threatens to break the bank. Get to a healthy weight to avoid costly and damaging health complications. By making the effort to exercise and eat right we can save our health care dollars for any future medical conditions that can’t be prevented.
  
• Stop smoking. Many insurance companies now offer discounts for smoking cessation programs that help fight the addiction. Smoking is tied to serious health risks like lung cancer and emphysema that require costly treatments. The simple act of putting out that cigarette can have a significant impact on the cost of health care.

Check the Evidence First

One of the strategies I’ve been talking about to cut health care costs is using evidence-based medicine for care management and reimbursement policies. Evidence-based medicine is the use of real-world evidence to determine what practices and treatments work best for any given medical condition.

I’ve run across a poignant example of how using evidence-based medicine cuts cost while also raising the quality of care. It turns out that 48% of all newborns admitted to NICU were delivered by scheduled caesarian (C-section) births, many taking place before the 39 weeks that physicians and almost everyone else knows is the full term during which a fetus typically grows before birth.

Medical research shows the greatest growth in the use of C-sections has been among women and their physicians opting for elective procedures, many before the 39 weeks’ gestation period ends. Why do people opt for elective caesarians? Sometimes they do it so the mother is not in the hospital on a major holiday; sometimes it’s to accommodate a vacation.

But whatever the reason that women have elective C-sections before full term, it’s bad for the baby. A growing body of recent research reveals that newborns delivered prior to 39 weeks are two-times more likely to end up in the NICU than babies born at 39 to 42 weeks. No wonder that the American College of Obstetricians and Gynecologists (ACOG) discourage C-Sections to deliver babies before full-term.

When UnitedHealthcare shared this startling data about C-sections and health problems in newborns with a pilot group of physicians and hospitals, they significantly reduced the number of elective C-sections. The result: there was a 46% decline of NICU admissions in three months, a decline that has held stable for more than a year. That’s almost half the numbers of newborns with health problems, almost half the number of distraught parents, almost half the number of potential tragedies. The cost savings to these hospitals, the parents and the health care system are enormous.

We have now launched similar communications programs with all the OB/GYN doctors and 4,800 hospitals in our national network of health care providers. And we’re also putting more about the dangers of elective C-Sections in our Healthy Pregnancy Owner’s Manual that we give to expectant parents and also on our healthy pregnancy website.

UnitedHealthcare is calling for hospitals and obstetricians everywhere to end scheduling elective C-sections unless they are positive that the procedure won’t take place until after the baby has reached full term. Note I said “elective,” because sometimes there are pressing medical reasons for a premature C-Section.

As it turns out, for many conditions there is a great variance in how different physicians treat their patients. If health care insurance companies and medical caregivers work together, we can identify from real-world evidence the best practices for a wide variety of medical conditions. As we can see in the case of elective C-Sections, using evidence-based guidelines in medical care will lead to healthier outcomes for patients.

Let’s Move On Beyond Protest

Yesterday was a pretty exciting day in many communities as the grass roots political organizations MoveOn.org, Health Care for America Now and labor unions held a series of rallies on health care reform across the country. Here in Pennsylvania, a march was held in downtown Philadelphia and a rally in downtown Pittsburgh.

These demonstrations featured rhetoric that attacks the health care insurance industry. The attacks tended to mischaracterize our contribution to the health care system. Many of the attacks were against some of the issues that we as an industry identified and have already agreed to take action on, like pre-existing conditions.

Now while I don’t agree with some of what the protesters are saying about my industry and health care reform, I, like everyone else at UnitedHealthcare, recognize that everyone has a right to express their opinion as long as it’s done respectfully. And at many of the protest sites around the country, UnitedHealthcare representatives welcomed the protestors and engaged in a brief dialogue on some of the key health care issues. As our nation continues to debate how to best modernize our health care system, we must be respectful of individuals’ varying perspectives on this important issue.

As I have written a number of times in this blog, UnitedHealthcare strongly supports health care reform and making coverage available to all Americans. The proposal put forth by the health care industry is a good one that extends health care coverage to almost everyone, eliminates some of the inequities in current coverage and starts to address the high cost of health care in the United States. I think if some of the protesters read our proposal carefully they would see that we aren’t that far apart.

Health Care Reform, Part 3

In my last entry I started talking about the two white papers my company recently released "Federal Cost Containment - How In Practice Can It Be Done?" and Health Care Cost Containment - How Technology Can Cut Red Tape and Simplify Health Care Administration", that describe how to save hundreds of billions in health care costs starting now while improving the quality of care.

In my last blog, I detailed costs to federal health care programs such as Medicare and Medicaid. Besides saving billions in federal medical programs, we can cut billions in administrative costs throughout the entire health care system.

These administrative cost savings come from implementing three cost-saving strategies over the next 10 years:
1. Requiring that all health care insurance carriers, including government, use common technology standards and implement technology enhancements such as automated health plan ID cards and electronic fund transfers can save $225 billion.
2. Using advanced data-processing techniques to pay claims quickly and more accurately can save $87 billion.
3. Streamlining and standardizing the process of checking and rating the credentials of physicians, hospitals and other caregivers can save $19 billion.

If the federal government, health care providers and private insurance companies implement these strategies, they can play an important role in freeing up a tremendous amount of money that can be dedicated to expanding coverage to more of the uninsured and to addressing our other health care challenges. Moreover, it would go a long way toward creating a much healthier America.

Check out these two white papers. They will really open your ideas to the possibilities for improving our health care system through health care modernization.


Check the Evidence First

One of the strategies I’ve been talking about to cut health care costs is using evidence-based medicine for care management and reimbursement policies. Evidence-based medicine is the use of real-world evidence to determine what practices and treatments work best for any given medical condition.

I’ve run across a poignant example of how using evidence-based medicine cuts cost while also raising the quality of care. It turns out that 48% of all newborns admitted to NICU were delivered by scheduled caesarian (C-section) births, many taking place before the 39 weeks that physicians and almost everyone else knows is the full term during which a fetus typically grows before birth.

Medical research shows the greatest growth in the use of C-sections has been among women and their physicians opting for elective procedures, many before the 39 weeks’ gestation period ends. Why do people opt for elective caesarians? Sometimes they do it so the mother is not in the hospital on a major holiday; sometimes it’s to accommodate a vacation.

But whatever the reason that women have elective C-sections before full term, it’s bad for the baby. A growing body of recent research reveals that newborns delivered prior to 39 weeks are two-times more likely to end up in the NICU than babies born at 39 to 42 weeks. No wonder that the American College of Obstetricians and Gynecologists (ACOG) discourage C-Sections to deliver babies before full-term.

When UnitedHealthcare shared this startling data about C-sections and health problems in newborns with a pilot group of physicians and hospitals, they significantly reduced the number of elective C-sections. The result: there was a 46% decline of NICU admissions in three months, a decline that has held stable for more than a year. That’s almost half the numbers of newborns with health problems, almost half the number of distraught parents, almost half the number of potential tragedies. The cost savings to these hospitals, the parents and the health care system is enormous.

We have now launched similar communications programs with all the OB/GYN doctors and 4,800 hospitals in our national network of health care providers. And we’re also putting more about the dangers of elective C-Sections in our Healthy Pregnancy Owner’s Manual that we give to expectant parents and also on our healthy pregnancy website.

UnitedHealthcare is calling for hospitals and obstetricians everywhere to end scheduling elective C-sections unless they are positive that the procedure won’t take place until after the baby has reached full term. Note I said “elective,” because sometimes there are pressing medical reasons for a premature C-Section.

As it turns out, for many conditions there is a great variance in how different physicians treat their patients. If health care insurance companies and medical caregivers work together, we can identify from real-world evidence the best practices for a wide variety of medical conditions. As we can see in the case of elective C-Sections, using evidence-based guidelines in medical care will lead to healthier outcomes for patients.


Take Control and Save

We hunt through clearance racks to cut the cost of designer goods. We change the oil and put new tires on our cars to avoid a more costly trip to the mechanic. We spend hours online comparing and contrasting travel sites before booking our family vacations. Why can’t we take the same cost-saving approach to our health care?

No matter what happens with health care reform, consumers will have to start taking a more active role to save money on their family’s health care. There are plenty of ways for the savvy consumer to trim the dollar signs and prevent their health care costs from escalating.

Here are a couple of my favorite ways that average people can take matters into their own hands and reduce health care costs. The first two have to do with living healthy lifestyles:
· Lose weight. An apple a day is no longer the trick. Maybe because we dip it in caramel. Maybe because we don’t eat it at all. Whatever the reason, widespread obesity is driving the cost of keeping the doctor away to where it threatens to break the bank. Get to a healthy weight to avoid costly and damaging health complications. By making the effort to exercise and eat right we can save our health care dollars for any future medical conditions that can’t be prevented.

· Stop smoking. Many insurance companies now offer discounts for smoking cessation programs that help fight the addiction. Smoking is tied to serious health risks like lung cancer and emphysema that require costly treatments. The simple act of putting out that cigarette can have a significant impact on the cost of health care.


Prevention, Prevention, Prevention

Lately I’ve been thinking of ways that people can save on health care. In my last entry, I mentioned two ways to lead a healthier life, to stop smoking and lose weight. By living healthier, you need the health care system less and therefore spend less on health care.

Other ways to save money by living healthier have to do with keeping tabs on your medical condition:
· Make primary prevention a priority. Primary prevention is a proactive approach that helps cut costs by helping maintain good health in the first place. By keeping up with immunizations and going for regular check-ups you can take preventive measures to stop health problems before they have the chance to start and have a major impact on the price you pay for health care in the long run.

· Take control with secondary prevention. If you can’t keep a health condition from arising, you can still fight the cost of its effects. Secondary prevention aims for early detection and interventions that slow the progression and onset of chronic diseases such as diabetes and heart disease. Keeping up with screenings, never missing doctor visits and taking medications correctly will help minimize the cost of needing additional care.

· Know your conditions. When you make the effort to listen to your doctors, take notes and fully understand your medical conditions, you are working together with your physicians to manage your illnesses more effectively and therefore cut costs.

More in a few days!


Work Your Health Care Plan

It’s amazing how much money you can save on health care once you start to think about it. One thing I notice is that many people spend more money on their health care than they should because they don’t take the time to review their health care plan documents. Here are some suggestions:
· Understand our health benefit plan. Read the fine print, or log on to the health insurance company’s Web site. Know what is covered and what is not, and learn about any available wellness programs that can help improve health, reduce overall costs or even provide monetary incentives.

· Use in-network providers. Seeing a doctor outside of the health care plans network costs more than seeing one in-network. Most health plans have thousands of doctors in their networks. A quick visit to the insurance company’s Web site can help avoid a more costly visit to the doctor.

· Review the doctor’s bill. Making sure we have been billed correctly after an office visit or procedure is a simple routine that can save money and reduce stress.

Keep it locked…I’ll give still more cost-savings tips next time post a blog entry!

Control the Cost of Drugs

Perhaps the fastest growing factor in health care costs is the cost of filling prescriptions. Many health insurance policies have a prescription drug benefit, but both those with and without health insurance can save money if they:
· Select generic over brand-name drugs. Beside many brand name drugs on the shelf are equally effective and equivalent generic versions. Equal in everything but name recognition, these drugs offer the same level of quality, purity and strength as their brand-name counterparts and cost 30- to 60-percent less. Ask the pharmacist for a generic version and we can save substantially on our prescription medications.

· Mail it in and split it. Prescriptions delivered via the postal mail vs. buying them at retail locations may help reduce drug co-pays and even offer a 90-day instead of 30-day supply. Or consider pill splitting. By following the doctor’s instructions and using a special device to split and take only half of a pill prescribed at double the dose each time, we can save hundreds of dollars a year on medications.
Armed with the 10 suggestions I’ve listed over the last week or so, it’s now time to lace up the running shoes, go for an annual check-ups and, most importantly, know the options you have for reducing health care costs.

Health Care Reform, Part 2

One very good outcome of the President’s speech on health care last week was the focus on cutting waste out of our health care system. I just wish more of the debate over health care reform and modernization focused on what we already know will work to slow cost increases and improve the quality of care. For example, UHC recently issued two white papers, "Federal Cost Containment - How In Practice Can It Be Done?" and "Health Care Cost Containment - How Technology Can Cut Red Tape and Simplify Health Care Administration," that show how over the next 10 years we could cut hundreds of billions from health care costs starting right now, including billions in the cost of federal health care programs and billions more in administrative savings to physicians, hospitals, government, employers and even consumers.

What’s amazing is that none of these cost-cutting ideas lowers the quality of health care and most actually lead to healthier people. All are tried-and-true techniques for cutting costs, backed by rigorous research by such distinguished groups as RAND Corporation or Dartmouth University, or by our own experience managing $115 billion of health care a year for our members.

Let’s first take a look at some things the federal government can do to save hundreds of billions in government-sponsored health care program costs:
1. Give people incentives to use higher-quality health care providers. For example, assessment of the quality and efficiency of health care providers using evidence-based standards and efficiency benchmarks and giving people incentives to use higher-quality physicians can save $37 billion.
2. Use more evidence-based care management. For example, using onsite nurse practitioners at skilled nursing facilities to manage illnesses and prevent avoidable hospitalizations can save $166 billion; utilizing integrated medical management that applies clinical evidence-based care management tools can reduce admission rates and save $102 billion.
3. Give physicians incentives to provide the highest-quality care. For example, establishing a primary physician as the central ongoing coordinator of patient care, reducing unnecessary or duplicative treatments while ensuring needed preventive care can save $20 billion; sharing comparative data on the quality and effectiveness of specific treatments to encourage physicians to adopt evidence-based clinical guidelines can save $15 billion.
4. Apply evidence-based standards to reimbursement policies. For example, application of clinical evidence to determine clinically appropriate diagnostic radiology tests can save $13 billion; analysis of claims before reimbursement to detect improper coding, duplicate billing and billing for non-existent patients can save $57 billion.

More on these white papers next time!

Health Care Reform, Part 1

I’m asked for my take on health care reform several times a day now. For some reason, people assume that a health insurance executive would be against health care reform.

Of course, nothing could be farther from the truth.

I, and my company UnitedHealthcare, believe that health care reform and modernization are essential. The goal of health care reform should be affordable high-quality health care coverage for all citizens. For us, health reform means modernizing our health care delivery system with new technology, tackling the fundamental drivers of health care cost growth, strengthening employer-based coverage and providing well-targeted support for low-income families.

My industry’s proposal for health reform brings everyone into the system, guarantees coverage for all Americans, does away with pre-existing condition limitations and ends rating based on health status and gender.

I also agree with what President Obama said in his speech last Wednesday that it makes sense to build on what works and fix what doesn’t, rather than try to build an entirely new system from scratch. As the president pointed out, one sixth of our economy is health care, and it makes no sense to tear down one sixth of the economy. It makes more sense to fix what’s broken.

It is difficult for anyone to predict how the reform debate in Washington will ultimately play out. However, there is consensus that the current health care system needs to be modernized and that every American must have access to quality affordable care.

Helping young heroes help their peers

Sometimes I’m really proud of my company, UnitedHealthcare:
· It helped Greater St. Mathew Baptist Church in Philadelphia hold healthy cooking classes for a group of preteens who prepared a healthy luncheon for 50 of their peers.
· It helped Klein Elementary School students in Erie plan a wellness-themed science fair with a family night to share their projects and prepare a healthy dinner.
· It helped students in the Lackawanna College early childhood education program bring healthy eating and lifestyle programs to 6 childcare centers in northeastern Pennsylvania.

We helped all these programs fight obesity and unhealthy lifestyles through our HEROES program, which awards grants for youth programs that get friends, classmates and community members moving toward a healthier lifestyle.

UnitedHealth HEROES is a service-learning, health literacy initiative designed to encourage young people, working through educators and youth leaders, to create and implement local hands-on programs to address the issue of childhood obesity. The HEROES program awards grants to schools and youth-focused, community center-based programs that demonstrate a clear understanding of the health risks associated with childhood obesity and propose creative solutions that can be easily implemented, scaled and measured in their schools and communities.

In its second year, UnitedHealth HEROES is now open to new applications from schools and community organizations with creative ideas for spreading the word about childhood obesity in 2010.

Meanwhile back at the ranch

Health care reform remains in the news. But meanwhile, back at the ranch, what can we do right now to lower health care costs? Actually, quite a bit.

For example, businesses can offer employees incentives to shift to the combination of a high-deductible health plan and a health savings account (HSA). A recent study of employers offering UnitedHealthcare plans concluded that an HSA program provides a 10 to 12 percent absolute cost savings over a four-year period.

Larger employers can study their employee population’s aggregate use of health care benefits to identify and provide special wellness programs to address health issues that are most prevalent in the work force – e.g., nutrition and weight-loss programs to combat diabetes.

Wellness programs can help employees lead healthier lives. Many health care insurers like UnitedHealthcare now offer free online and telephone health care assessments and wellness classes.

And all employers can encourage their employees to use generic drugs, which usually are the same chemical compounds as brand-name pharmaceuticals, but cost less.

Why health care costs keep going up, Part 3

More thoughts on what’s driving up health care costs: New technologies improve medical care but also drive up the cost of care giving. For example, in what has become known as a “medical arms race,” many medical practices invest in expensive imaging machines, and once a group owns one, there is a natural tendency to use it more rather than refer patients to lower-cost facilities designed to conduct these tests.

I’ve now identified three trends raising the cost of health care: unhealthy living, the economy and how expensive medical technology is used. The economy should eventually take care of itself. But addressing unhealthy lifestyles and the inappropriate use of medical technology will require large numbers of people and organizations to change engrained habits and usage patterns. It’s important that health care reform provides incentives for that to happen.

Why health care costs keep going up, Part 2

I’ve been thinking about some of the reasons that it will be hard to contain health care costs even if we get meaningful and sustainable reform. One temporary but currently quite painful condition is the state of the economy. Several studies have shown that many people with chronic conditions such as diabetes or heart disease stop taking or take smaller doses of their medication or forego other medical care because they can no longer afford it. This results in greater costs to our overall health care system because they then go to the doctor or the emergency room only when they deteriorate and need more expensive treatments.

One of the advantages of UnitedHealthcare’s clinical partnerships with the physicians and hospitals in our network is that they help people who are not taking their medicines for financial or other reasons. Our computer can compile a list of people who didn’t fill their regular prescriptions every month and get that information to the physicians treating them, who can explain that not taking medicine will make you sicker and cost even more money.

Why health care costs keep going up

I have high hopes for health care reform: that it will result in most if not all Americans having health care insurance; that the quality of care will improve; and that costs will stop going up by so much year after year.

It’s in this third area that I have some concerns. In my 25 years in the health care insurance business, I’ve seen first hand some trends that will make it very hard, although not impossible, to contain future costs. The one that comes to mind first is unhealthy lifestyles. A multiyear study published in the Archives of Internal Medicine found that if people would do 4 simple things, exercise regularly, eat healthy, not smoke and maintain a normal weight, they could cut their risk of diabetes, heart attack, stroke or cancer by 80%.

Across the country, there continues to be an increase in these conditions. A new government study says that on average, we spend $1,400 year a more on medical costs for an obese person than for someone of normal weight. The total bill for delivering health care in our country would decline dramatically if more Americans adopted healthy eating habits and exercised regularly.