Rhode Island Business Group on Health Presented By: Stephen J. Farrell, CEO September 20, 2013.

Rhode Island Business Group on Health

Presented By: Stephen J. Farrell, CEO September 20, 2013

2Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

The Challenge: Population Health

• According to the NBGH total average health cost per employee: $14,651

• Unit costs accounted for ~60% of total covered trend

• Utilization is still lower than average but has increased each year since hitting a recent low in 2010

• Outpatient services were the largest contributor to utilization trends

Contributions to Trend:

Inpatient 18%

Outpatient 60%

Professional 22%

The Challenge: High Costs



Solution: Modernized Health Care

Confluence of interests Health plan – Provider – Member - Employer


Strategic Alignment

• Improving the health care system’s quality, accessibility and affordability.

• Working hand in hand with other resources in Rhode Island to keep Rhode Islanders healthy.

• Transforming healthcare in the Ocean State to help everyone live the healthiest life they can.

• To prevent disease and to protect and promote the health and safety of the people of Rhode Island.

• Rhode Island's approach to health reform continues to make us a national leader.

http://www.health.ri.gov/

Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Primary care incentives,Performance-based contracts

Shared savings, Shared risk,Capitation(including ACO, PCMH)

Achieving specificMETRICS

Managing a specific CONDITION

Managing ENTIRE POPULATION HEALTH

Bundle/episode payments

We have value-based engagement with more than 600 hospitals, 1,150 medical groups and 80,000 physicians participating in our Accountable Care Platform.1

• 30,000+ physicians• 800+ medical groups• 550+ hospitals

• 160+ Centers of Excellence• 58,000+ physicians• 500+ medical groups• 65+ hospitals

1 Deployment statistics for executed contracts as of March 2013, net of program overlap.

Performance-based Programs

Centers of Excellence Accountable Care Programs

Alignment: Provider - Accountable Care

OVER $21 BILLION OF NETWORK SPEND IS TIED TO OUR ACCOUNTABLE CARE PLATFORM1

6


Alignment: Provider - Accountable Care

• Making Accountable Care possible

• Transparency with providers

• Optum and Mayo Clinic Partner to Launch Optum Labs

UnitedHealth Group

Health Benefits

39M Lives

Health Services

60M Lives


Alignment: Consumer & ProviderCost and quality transparency support better informed decisions

Intuitive tool supports consumer decisions with consistently reliable cost estimates

– Helps each member make the best personal value choice – based on price, quality and convenience

– Methodology gives consumers consistently reliable estimates based on historic claims data, validated against actual fee schedules

– Links separate health events –appointments, procedures and follow-up – into an understandable care path

– Fully integrated within myuhc.com® – allowing members to shop, get trusted information and make informed decisions with a single tool

Providence , RI - Knee MRIRange of Costs

$373 $1,337+

20% Copayment

$7420% Copayment

$267

http://www.welcometomyuhc.com/hcce-review/index2.html


Alignment: Connecting Member & Provider


Alignment: Consumer & Employer

Health Savings Accounts• High deductible cost share plans • Pre-tax HSA member owned account• Tools to help members be better consumers

Aligning member benefits with system changes for optimal member health ownership.

GATED NETWORK PRODUCTS• Emphasis on primary care: individuals select a PCP to help navigate referrals and other care

needs.• We call it our ‘Navigate’ suite of products ; for some markets, it can include a narrowing of the

network

TIERED BENEFIT PLANS • Preserve an open access network and incentivize members for quality provider

choices through tiered benefit designs and other incentives / communications• We leverage our UnitedHealth Premium® quality ratings and COE designations


National Business Group HealthResults on High Performers

• High performers experience 15% lower costs

• High performers experience 3.5% lower trend costs


UHC Modernized Health Plan Result on Modernized Health Plans

$8,342

Low Initiation• No clinical programs; low Rx

integration

• Richness >90%; no CDHP

• Network: INN vs OON tiered benefits; some COEs

• No rewards strategy.

Annual Cost Per Year / Person

$6,361Early Accountability• Clinical suite of programs; Rx

integrated 70% of the time

• Richness average of 77% CDHP average of 68%

• Network: almost all have COEs

• Consequential incentives

24% Lower Costs

*Annual Net Per Employee Per Year Costs – 2010 experience: after cost share and adjusted for demos, geo mix and high cost claimants. 24% cost attributed to 11% for covered decrease and 13% for richness.

Rhode Island Business Group on Health Presented By: Stephen J. Farrell, CEO September 20, 2013.

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Transcript of Rhode Island Business Group on Health Presented By: Stephen J. Farrell, CEO September 20, 2013.