Frank Diamond

Health insurers can play a crucial role in fostering patient engagement, according to a study that looks at how UnitedHealthcare encouraged some of its beneficiaries, including about 133,000 of its employees, to become more involved with their care.

“Many proponents of delivery system transformation have framed patient engagement in terms of what providers can do with their patients, without considering the role of payers,” says the study “UnitedHealthcare Experience Illustrates How Payers Can Enable Patient Engagement,” in the August issue of Health Affairs (

United’s HealtheNote program, in place since 2009, sends a message to both the patient and provider when someone is overdue for a diabetic eye screening, for example.

The study states that “consumers and their physicians who receive these messages closed 64% more gaps related to medical management and 30% more gaps related to missed therapy over a three-month period” than those who do not receive the messages.

The study also talks about treatment decision support, which it defines as being able to discuss with patients their options for care and then helping them stay on course.

United began a program through Optum, a division of United that medical practices hire so they can operate as ACOs. “About 25% of patients who engaged with the program ultimately selected a more conservative, evidence-based treatment than was originally proposed, with savings per treatment of more than $11,000, on average.”

Perhaps the best evidence for the fruits of patient engagement involves a program the insurer used on its 133,000 employees. The Rewards for Health program allows employees to earn points when they get screened or lose weight.

Using 2009 as a baseline, employees showed improvements on seven quality metrics in 2010 and 2011, generating $107 million in savings in the process compared to industry averages. Employees saved $1,200 per family per year in premium reduction.

Improvement in quality metrics of enrollees in the UnitedHealth Group rewards for health program, 2009–11

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.