Money is available for children’s uncovered medical expenses… and no one is using it!

Money is available to help pay for kids medical expenses not covered by health insurance, but few families are using it! In fact in the entire state of Pennsylvania, not one family took advantage of this opportunity to get help paying for expensive medical equipment and therapy.

The UnitedHealthcare Children’s Foundation (UHCCF) program seems too good to be true! Families in need can receive up to $5,000 to help cover an entire range of medical needs from speech therapy to wheelchairs that are not covered by their health insurance plan.

Last year, UHCCF awarded grants to more than 450 families across the country for treatments associated with medical conditions such as speech and developmental delays, hearing loss, autism, diabetes, cystic fibrosis, Down syndrome and cerebral palsy, yet no one in Pennsylvania took advantage of this program!

We recognize some families experience gaps in coverage for certain medical treatments and equipment, and we are committed to helping fill this void. Since expanding our grant program nationwide in 2007, we have provided more than 1,500 grants to families in need of financial assistance.” UHCCF is dedicated to facilitating greater access to medical-related services that can help improve children’s health and quality of life.

So if you know of anyone who might be eligible, give them the website address, www.uhccf.org, where parents and legal guardians can apply for grants online. And tell your physician friends about the UHCCF grants, because it’s likely one or more of their patients may qualify. To be eligible for grants, children must be 16 years of age or younger. Families must meet economic guidelines, reside in the United States and have a commercial health insurance plan.

ESync shows that better information can help people make better decisions which result in better health care.

In my last blog entry, I talked about the UnitedHealthcare position that by providing better information we can help people make better decisions which result in better health care.

One example of what I mean is a new UnitedHealthcare program called eSync.

ESync is a new technology platform that helps us build a detailed health portrait of each person we serve and then deliver customized health care management solutions directly to them. eSync allows us to combine a wide range of health data, like medical claims, health and lifestyle choices, and demographic factors, and turn it into a practical blueprint that helps people improve their daily lives. eSync lets us offer people effective, personalized care plans – based on their actual needs.

It’s really a simple concept that connects well to what UnitedHealthcare believes: eSync makes it easier for the people we serve to take action and live healthier lives. ESync helps them find the right care, see the right provider, take the right medication, and live the right lifestyle. Based on the data that eSync crunches and manages, we may send the patient:
• Background information about an upcoming medical procedure

• A reminder to schedule an annual exam

• Tips on starting an exercise plan

In each case the outreach is based on the actual needs of individuals.

ESync also gives us the capability to offer proactive outreach for high-risk members. We know they are high risk because the platform pulls together information like claims data, health assessments and referrals from other programs. One of our personal care consultants can then reach out and offer these members a chance to participate in programs specifically designed to reduce their health risk.

ESync helps our members get engaged in healthier lifestyles for a better quality of life, something we all strive for.

By providing better information we can help people make better decisions which result in better health care.

What is it going to take to cut the cost of health care while increasing the quality of care? I believe that the answer is conceptually quite simple. By providing better information we can help people make better decisions which result in better health care.

That seems like a bold statement. Don’t people get good information now? Aren’t people making good decisions about their health already?

Let’s look at the facts, which are based on a number of studies by UnitedHealthcare and others. As it turns out, for many conditions there is a great variance in how different physicians treat their patients. Evidence-based medicine uses real-world experience to determine which treatment works best for a patient or a group of patients with similar medical situations.

But according to studies:
• 45% of all physicians make decisions that are not based on evidence-based medicine,
• 43% of employees, families make less than optimal decisions related to doctors, treatments, prescription drugs and other aspects of health care.

You want to really improve quality? Reduce costs? Then improve decision making – based on the proven data sets.

I sincerely believe that if health insurance companies and medical caregivers work together, we can identify from real-world experience the best practices for a wide variety of medical conditions. And with this information will come better decision-making.

The future costs of addressing obesity could account for 21% of all health care costs before the end of the decade.

More than 40% of all adults in Pennsylvania will be considered obese in 2018 if trends do not change.

That’s the result of a report that the United Health Foundation, the American Public Health Association and the Partnership for Prevention put together as part of their November 2009 American Health Rankings study.

The report, based on research by Kenneth Thorpe of Emory University and the Partnership to Fight Chronic Disease, looks at what the rate and cost of obesity will be nationwide and in each of the 50 states in 2018 if trends stay the same.

If you’re frightened by the thought of more than 40% of all Pennsylvanians needing to lose a lot of weight to get healthier, think about Oklahoma, Mississippi, Maryland, Kentucky and South Dakota. The study predicts that all of these states will have adult obesity levels of more than 50%!

The report says that obesity is currently growing faster than any other health issue our nation has ever faced and that its rapid increase cuts across all socio-economic groups.

Here are some of the major findings of the report:
• If current trends continue, 103 million adults will be considered obese in 2018.

• If the current trend of rising obesity rates continues, the U.S. is expected to spend $344 billion a year in health care costs attributable to obesity in 2018, or more than 21% of all health care spending.

• If we could hold obesity levels to the current rates, we will have saved $820 per adult per year by 2018.

Here are the obesity numbers for the Keystone State, which use 2008 at the starting point. The study gives high, low and mid-point estimates, but I’ll just give the mid-way point: The prevalence of obesity in 2008 was 32.6% with an annual health care cost attributable to obesity per adult of $393.00. If current trends continue, the prevalnce of obesity in 2018 with be 41.8% with an annual cost of $1,455.00 per adult. If able to keep current rate of obesity, Pennsylvania will save $796 per adult annually.

It’s not going to be easy to keep obesity rates at their current levels, let alone lower them. The Center for Disease Control and Prevention describes our current society as “obesogenic,” which is a fancy way of saying that our society promotes the causes for most obesity: increased food intake, nonhealthful foods and physical inactivity. We see our “obesogenic” society every time we drive through a suburban business district and see rows and rows of fast food joints. We see it whenever we click on the TV and see all those ads for less than healthy foods. We see it when we read surveys of how much time children spend daily in front of the TV, game console or computer and how little time families spend on physical activity.

I’m therefore delighted that our first lady has decided to make fighting childhood obesity one of her major goals. At UnitedHealthcare, we also keep an eye on adult obesity. That’s why we are pushing a wide range of nutrition, fitness and other wellness programs and it’s why so many employers are including these programs as part of the coverage they offer employees.

Pittsburgh human resource executives brave snow to hear panel talk about health care and health insurance.

“It was snowing and it was going to snow.” That’s how the American poet Wallace Stevens once described a scene, and it certainly applied to Pittsburgh when I was there on February 16th to be part of the panel at the Pittsburgh Business Group on Health (PBGH)’s 8th annual Health Care Executive Leadership Forum.

All that snow on the ground and more falling, and yet the house was packed with human resource, benefits and finance executives from a wide range of western Pennsylvania employers. They had come to hear the views of 8 speakers, including representatives of 6 regional health insurance companies.

Christine Whipple, PBGH’s smart and savvy executive director, moderated the panel, which included:

• John F. Delaney, Jr., MD, DrPH, Chair, Department of Psychiatry, West Penn Hospital and President, Allegheny County Medical Society
• Diane Holder, President and CEO, UPMC Health Plan
• Patrick McGinn, Regional Head, MidAtlantic & Southeast National Accounts
• Norman F. Mitry, President & CEO, Heritage Valley Health System
• Dan O'Malley, Market President, Pennsylvania Western Region, Highmark Blue Cross Blue Shield
• Mary Lou Osborne, Regional President, HealthAmerica
• Marcie Popek, New Business Manager, Great Lakes Market, CIGNA Healthcare

And me.

We each had about 7 minutes to make a state of the union message about our organizations, after which there was a lively and long Q&A session. The questions reflected what I’m routinely asked by employers throughout the state: How we can use technology to lower cost in the health care system? What is the future of “accountable care organizations,” which are health care systems that reward doctors for teamwork and patient outcomes? What are the advantages of consumer-directed health plans such as health savings accounts (HSA)? The questions show that like UnitedHealthcare and many other insurers, employers are interested in both cutting costs and improving the quality of care.

A funny thing happened, though, in the informal settings like registration and during the break. I fielded a lot of questions in these less formal settings, and it was mostly the same question, “What is it going to take to create real competition in the Pittsburgh marketplace for health insurance?”

My answer was and is simple: You don’t have to wait for real competition. It’s here now! UnitedHealthcare is not new to the market. We’ve been here for six years. We’re an established presence and we’re already bringing innovative options to the market. We have a strong network of over 85 hospitals and more than 20,000 health care providers serving Pennsylvania. We’re one of the few health plans that are growing statewide.

The PBGH is a great forum for asking and answering the tough questions about health care and health insurance. As it says on its website, PBGH “strives to improve the delivery, cost and quality of health care through its quality and data initiatives, and by providing forums for the exchange of ideas and viewpoints.” You can find more about PBGH and an audio recording of the speaker remarks at the PBGH website.

There are lots of ways to fight cancer and we’re trying to identify the best ones for each patient.

A few days ago I told you about our new Oncology Care Analysis (OCA) program, which is the very first program to combine clinical and claims data to gauge the quality of cancer patient care based on approved treatment guidelines.

I wanted to write a little bit more about how OCA is going to help improve how physicians treat cancer.

Treatment of cancer varies widely among doctors and hospitals in the United States. The Oncology Care Analysis program’s goal is to help improve quality and coordination of cancer patient care by providing oncologists with information and feedback relevant to the care they are providing to their patients.

The OCA electronic medical record delivers coordinated patient information to the treating physicians that they may not have in their existing medical records, such as patient compliance with medications. For example, physicians may not be aware if their patients are not filling prescriptions for essential cancer medications. The record also contains important information about procedures performed by other specialists, including radiation oncologists and surgeons.

In November 2009, UnitedHealthcare initially shared OCA program patient data with 1,500 participating oncologists to help them better understand the strengths of their patient care along with areas for improvement. Each participating oncologist received aggregate national program results in addition to their individual results, along with relevant guideline data for each eligible patient under their care. UnitedHealthcare also shared aggregate national results with 12,000 additional oncologists within its health care provider network in an effort to introduce the tool and the cancer registry program.

UnitedHealthcare creates a national cancer care registry to help oncologists cure cancer.

One of the leading ways that we as a nation are going to improve the quality of health care while putting a firm brake on cost increases is to collect and analyze clinical data to determine the best treatment options. Health insurers have a large role to play in this process because we have both the numbers-crunching capabilities and enormous data banks of claims information.

Historically it’s hasn’t been easy for insurers to look at the quality of cancer care because cancer is so complicated and claims information tells us so little about the patient. UnitedHealthcare went to work on this challenge three years ago.

And now we have some results!

A few weeks ago, UnitedHealthcare announced that we have launched our Oncology Care Analysis (OCA), which is the very first program to combine clinical and claims data to gauge the quality of cancer patient care based on approved treatment guidelines from the National Comprehensive Cancer Network (NCCN), an alliance of 21 leading cancer centers.

UnitedHealthcare’s cancer registry includes clinical and claims data from more than 2,600 oncologists and 8,600 patients across the country with breast, colon or lung cancer. The powerful combination of cancer stage data and claims information creates a coordinated electronic medical record of a patient’s care and then compares that treatment regimen to existing NCCN guidelines.

We are sharing the results with participating oncologists to help improve the quality of cancer care and lead to better outcomes for patients. And it goes without saying that in doing so we’re complying with every privacy law.

UnitedHealthcare’s OCA program incorporates the NCCN Clinical Practice Guidelines in Oncology™, a widely accepted source of guidelines for cancer care in the United States, and the NCCN Drugs & Biologics Compendium™, which is based on the NCCN guidelines and contains scientifically derived information designed to support decision-making about appropriate use of drugs and biologics for cancer patients.

Developing the OCA data base was a collaborative effort between NCCN, UnitedHealthcare and Ingenix, UnitedHealth Group’s health information, technology and consulting company.

By the way, the NCCN is quite an impressive group of cancer-fighting organizations. It includes City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women's Cancer Center Massachusetts General Hospital Cancer Center, Boston, MA; Duke Comprehensive Cancer Center, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Memorial Sloan-Kettering Cancer Center, New York, NY; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children's Research Hospital/University of Tennessee Cancer Institute, Memphis, TN; Stanford Comprehensive Cancer Center, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; UNMC Eppley Cancer Center at The Nebraska Medical Center, Omaha, NE; The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt-Ingram Cancer Center, Nashville, TN.

Wow, that’s a lot of intellectual fire power!