Steve Nelson is the CEO of UnitedHealthcare, a healthcare and insurance company that’s No. 5 on the Fortune 500 list. Nelson has served as CEO of UnitedHealthcare since 2017 and previously held leadership positions in the company’s Medicare, Medicaid, and Commercial businesses.
At a time of unprecedented change in the healthcare industry, we sat down with Nelson to discuss evolving expectations of customer experience, how new technology can build closer relationships with customers, and how his organization is navigating the turbulence engendered by the Fourth Industrial Revolution.
Consumer expectations are changing as the technology-driven devices and services they use in their everyday lives become simpler, more personal, and more customizable. Take Spotify for example. It knows my music-listening history and automatically recommends new songs for me. Healthcare should be able to do the same. Every doctor I see should know my cholesterol level, or last blood pressure reading, or other relevant health information — and make personalized recommendations based on this data. As an industry, we have fallen behind. But the rise of consumerism in healthcare is challenging us to ask, “Why can’t we do this too?” And we can.
I see the future of healthcare as a model where health professionals and consumers act as full partners in health and well-being. Health and well-being professionals — whether a physician or even an organization like UnitedHealthcare — provide the knowledge, tools, and data that enable and empower consumers to take ownership of their health and wellness. We designed our Health4Me app with this future experience in mind, making it simpler for people to geolocate in-network physicians or medical facilities nearby, use an “easy connect” feature that lets them skip phone menus and avoid hold times, and get basic plan information. To date, it’s been downloaded more than two million times.
More sophisticated uses of data is the future and will play a huge role in how we continue to innovate and engage in more personalized ways with our members.
As an example, look at a partnership we recently began with Dexcom, a company that makes mobile glucose monitors for people with diabetes. We are helping seniors enrolled in our Medicare Advantage plans with Type 2 diabetes track their blood glucose levels 24/7 and continuously transmit that information wirelessly, so we and their physician can monitor their condition in real-time. More importantly, if a reading indicates a problem, we can proactively take action rather than waiting for that individual to call us or their doctor. We can have one of our nurses call that individual to check in or even make a home visit. It’s creating a healthcare system that works for the consumer, rather than requiring the consumer to navigate the healthcare system.
Another way we are engaging members is right at the point of care — that moment they’re in the doctor’s office or clinic. We developed an innovative new app called PreCheck MyScript where we put prescription information and choices right at a doctor’s fingertips the moment they’re seeing a UnitedHealthcare member. PreCheck MyScript gives the doctor precise cost information about the drug he’s prescribing based on the patient’s benefit plan as well as at which pharmacy she will pick up her medication., It even identifies if lower cost alternatives are available. It also automates prior authorizations when they are needed, resulting in far fewer trips to the pharmacy that result in long waits while the pharmacist calls your doctor to confirm coverage for a medication. We’ve already had more than two million transactions processed through PreCheck since it launched last fall, helping to lower costs and creating a better patient experience for millions of people.
It’s no secret that the healthcare system needs work — in fact, it’s not really a system. It’s confusing, difficult to navigate, and costly. Through continuous innovation, strategic partnerships, and consumer-centered programs, we are always trying to deliver on healthcare’s “Triple Aim” of a better experience, better care, and lower costs.
This is a restless company, dissatisfied with the status quo in healthcare. However, by working with others, developing deep relationships, and applying our significant knowledge and capabilities to make healthcare work better, we can turn this environment of considerable change into an opportunity.
One opportunity lies in our work with care providers. Currently, Americans only receive what’s considered the “recommended care” 55% of the time; 30% of health spending is wasted on unnecessary services and excessive administrative costs. The healthcare system is simply not operating to the best of its abilities.
For too long, we have paid for healthcare based on how many things are done rather than if patients are getting better. But that’s changing. We’ve been partnering closely with providers over the last several years to put more focus on quality care, the patient experience, and cost. We are now basing more payments to care providers on value — the same expectations consumers have with nearly every other service they purchase. We estimate that by the end of 2020, $75 billion worth of our payments to hospitals and physicians will be tied to value-based relationships with care providers. Given the broad reach of our company, I like to think of it as applying innovation at scale and how data, when combined with the right financial incentives, can change behavior.
Since the company’s founding decades ago, UnitedHealthcare has been driven by its mission to help people live healthier lives and to help make the healthcare system work better for everyone. To me, that means we have to modernize the system and make it easier for people to navigate, which requires a more connected, personalized, and collaborative experience. We are doing this today through a variety of innovative products and programs.
For example, we’re building an Individual Health Record that will give millions of people their own digitally accessible and detailed health data, curated for both the individual and care provider. This secure and responsive medical record uses a proprietary design that connects clinical information to put patients at the center of their care, allowing them to collaborate with their doctors in new ways — and that will be seamlessly integrated into their daily lives.
We are also creating more personalized healthcare journeys for people by leveraging our virtual data hub, which is a single data repository where we aggregate and analyze multiple sources of information about a UnitedHealthcare member’s health as well as the care they have received. We are able to see the millions of interactions our members have across the entire health system — such as routine checkups, ER visits, a person’s medication history, and MRI results —but this data standing by itself is not useful until it is connected and translated into simple, actionable information and then combined with evidence-based medicine. Our experts and clinical teams translate the information coming into our data hub, turning numbers and readings into personalized recommendations.