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.