Craig Kurtzweil, leader of UnitedHealthcare's Center for Advanced Analytics, explains what five conditions are the costliest and how preventive care plays a role in improving affordability.
UnitedHealthcare's Center for Advanced Analytics aims to improve well-being by engaging with clinical-intervention programs. These programs work to address social determinants of health for people in employer-sponsored benefit plans.
In this week's episode, Craig Kurtzweil, leader of UnitedHealthcare's Center for Advanced Analytics, discusses:
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Evan Sweeney
Hello, welcome to UnitedHealth Group’s Weekly Dose podcast, where we'll get you up to speed on the latest trends shaping the future of health care.
Employers spend billions of dollars each year on health care. But a large portion of those costs can be traced back to just five conditions. That's according to new research by UnitedHealthcare and the Health Action Council, which analyzed more than 320,000 covered lives. The data show that five conditions, cancer, musculoskeletal, cardiovascular, gastrointestinal and neurological account for 50%, or nearly $2 billion in health care costs to employers.
The cost drivers of those conditions vary considerably. Here to talk about these findings -- and to dig deeper into the research -- is Craig Kurtzweil, who leads UnitedHealthcare's Center for Advanced Analytics.
Craig, welcome to the podcast.
Craig Kurtzweil
Thanks Evan, good to be here.
Evan Sweeney
So maybe you can start by briefly explaining the analysis that you guys did, what data did you examine? And what were you looking for?
Craig Kurtzweil
Sure. So this is done in partnership with the Health Action Council, which is, which comprises of dozens and dozens of different employers across the country, which allows us to do some pretty interesting analysis at a at a larger sort of macro view of what's happening across the healthcare system. So this is the fifth white paper that we've done now for the Health Action console. And our goal in some of the prior white papers was to lay some of the foundation around elements, external elements that are impacting health, the health of a population, so mostly prevalence of disease, decision making compliance, things like that. This white paper, we took a little bit different spin on that and really focused on cost. And obviously, there's a connection between health and cost, but wanting to really more focused on what's driving the most spendy conditions that are the cost these conditions that are out there. And how can we dive a little bit further to start to explain to employers what's really what's really driving those concerns? And you're largely looking at employer claims data, correct? Correct. We're looking at employer claims data, both medical and pharmacy where appropriate to try and get in all together view of what's happening across the system.
Evan Sweeney
Okay. And so what service is these five conditions? So cancer, musculoskeletal, cardiovascular, gastrointestinal, and neurological? Can you explain some of sort of the significant drivers behind those conditions?
Craig Kurtzweil
Sure. And I think it's also significant to understand that everyone spends a lot of time talking about some of these conditions, right. So cancer, musculoskeletal as cardiovascular are always up at the top of most employers list. And so we spent a lot of time and energy diving into those issues. And I'll talk about those today as well. But just note the I think it's unique to bring in gastrointestinal and neurological issues. Because it hasn't, it doesn't get a lot of limelight, it doesn't it doesn't get a lot of attention in a lot of the performance reviews with clients. And so as I as I jump through some of these conditions, as you do a little bit of a double click, and then you'll see this in the white paper. If we look at cancer, for example. And I guess across all these conditions, before I jump into each one of them, there continues to be anomalies, or high variances that we see by the different subpopulations that are important to us, as you've seen in past white papers for Health Action console, looking at things by geography, by demographics, looking at social determinants, bringing in health equity views, age, gender, ethnicity, those types of things, we continue to see that there's a wide variety of experiences in each one of these categories. So keep that in mind. As you kind of think about what's driving cancer, those variables matter a lot. But if you're looking at it from a high level, cancer, really the number one driver that we see within that category is very expensive chemotherapy treatments 18% of all of the cancer spend is now driven by those chemotherapy patients, therapies, a high cost to bear but obviously, a treatment that's been done to help mitigate the exposure and the impact that cancer can make on some of these folks live. So a lot of expense, but also value as far as the ability to treat the condition. Musculoskeletal is all about surgeries. And especially as you look at the return to care that we're under right now with people now getting back to the doctor, getting back to taking care of some of the elements that they've kind of set aside during the pandemic. We're seeing even more of those musculoskeletal surgeries come to fruition and so, within musculoskeletal it's all about your pathway to care. Do you choose physical therapy, chiropractic, or do you go straight to having surgeries and so overall, a specifically knee surgeries the biggest portion of the pie with over 8% of the cost of musculoskeletal being driven by knee related surgeries. And then under heart disease or broader cardiovascular disease, the biggest driver, there's one that again, doesn't get as much attention. We talk a lot about stroke and heart attack and those types of things. But heart rhythms, abnormal heart rhythms is the biggest cost driver there about 10% of the circulatory or cardiovascular claims is driven by abnormal heart rhythms, definitely some area of opportunity there. And then gastrointestinal, which is again, a topic that doesn't get as much time and attention. But underneath that category are things like colitis, and Crohn's disease, irritable bowel, those types of things. And the number one driver, there are all the new medications, so immunosuppressant drugs, is over 12%, of our GI spend. And then finally neurological, which is becoming more and more important, as you see more especially of kids suffering from those types of conditions. But under neurologic we're thinking about Parkinson's and MS and epilepsy, those types of claims. And really MS is dominating that category, over 13% of our neurological spend, is driven by MS specifically.
Evan Sweeney
And another one where I imagine you see, or especially incoming higher drug costs, probably on the horizon for that category.
Craig Kurtzweil
Correct. There's no, I mean, there's a lot and to be fair, there's a lot of folks that are really struggling with both, both the GI and neurological there's folks that are really struggling with those conditions. And some of those medications can be lifesaving can allow that, that that employee to work. But you're right, they're very expensive, and there's many more in the pipeline that are coming down. The other piece to kind of think about within both, again, those two categories that don't get as much time that neurologic and gastrointestinal, is that we're talking about the impact to medical cost. But just note that the impact of productivity and presenteeism for these folks in the workforce is extreme. If you're suffering from neurological conditions, at times, you can't work in one of the conditions that is always highly prevalent, but rarely talked about all the gastrointestinal issues that are out there. If you're suffering from irritable bowel syndrome, or colitis or things, Crohn's things like that, that it's makes it very, very hard for you to be a productive and present worker. So keep that in mind that we're looking at a piece of the puzzle, and the medical cost, which is very important, but the productivity cost can be even more than what you're seeing here.
Evan Sweeney
Is there anything that surprised you about this particular analysis?
Craig Kurtzweil
I think there's, there's a couple of things that I think are pretty interesting. One is that when we looked at these five conditions, and we took a step back and look to see for those members, how engaged are they with their health care? So not just in managing these conditions, but more broadly, as we think about our health activation index? And are those folks making good or bad choices when managing their overall heart health? So are they seeing their doctor are they're getting their cancer screenings, those types of things. And at the end of the day, we saw that, for these conditions, if for those members that are making better health care choices broadly, that their the cost of these services was about 17 to 31%. Less, that if those members are making good health care choices, compared to the population that's making below average health care choices, right? When you talk about health choices, can you give me an example? Is it sort of the provider you're choosing? Is it sort of the decisions you're making for your own health and wellness? Yes, it would be. We have about 53 different decisions that are part of our decision-making index, our health activation index. So it includes things like are you going to the right provider at the right time? So talking about musculoskeletal? Do you go right to surgery? Or do you try physical therapy, chiropractic, things like that? If you are of the appropriate age, gender, are you getting your cancer screenings done impacting especially our cancer category here? Or are you just generally going to your doctor every year for a wellness checkup? And a lot of the population chooses not to do that? Or if you have a specific disease, a chronic disease like heart disease, or asthma or diabetes? Are you following evidence based medicine to mitigate that condition? So those are these some examples of some of the decisions that we're evaluating to see if a member is engaged in practically managing their health?
Evan Sweeney
Yeah. So we've talked a bit about the cost and where those costs are, at a broad level, but what's the biggest takeaway for employers who are bearing a lot of these costs?
Craig Kurtzweil
I think you know, I'm data driven. So I think first and foremost, it's the emphasis that it is important to truly understand what's happening in your population. What subpopulations are driving these issues, what type of procedures are driving that, it's not good enough to know that these are the top five conditions, you really need to know which shop which subpopulation really needs, your time and attention. So try to avoid the peanut butter spread approach around solutions, but really focus on the sub population of need. We know that seeing for example, one of our premium designated providers to treat a back related issue can save a substantial over a 30% total cost of care reduction, due to the fact that those providers do those procedures right the first time, there's less complications, less redo rates, things like that across getting treated for some of those more common back related issues. Then there's other things that are a little bit harder. When you look at heart disease, and you look at cancer at top two categories, that's going to be much more of a long term sort of solution, right? There's going to be prevention that's going to be needed for cancer. It's all about screening, how do we make sure that we can find these cancers as early as possible?
Evan Sweeney
Yeah. So two part question here. How did the last two years of the pandemic sort of factor into this analysis? And then sort of looking forward? How might the pandemic impact some of these conditions, especially when you think about things like, you know, a missed cancer screening?
Craig Kurtzweil
Yeah, that's the big fear we had we had significant reductions and care abatement in care another way to say it, especially during 2020. But that continued in 2021. And honestly, it still exists today, where members are still not accessing the healthcare system at the same rate that they were before. So we're still watching and looking to see, especially for cancer, for all the, you know, we had about a 40 to 50% reduction in mammography is that that occurred during the pandemic, does that lead to now finding breast cancer at a later stage, it's going to be much more impactful to the member and obviously, much higher cost. So that would hit all of these categories. We saw reductions in heart disease related conditions being treated, and musculoskeletal surgeries being avoided. And even in within the neurologic, and gastrointestinal areas, again, folks just kind of dealing with those conditions on their own without being compliant with seeing their physician and being treated for those conditions. So now that things are starting to open back up and the system is getting back to quote unquote, normal, we're going to be looking to see, is there added risk in the system for those folks that weren't treating their heart disease weren't screening for cancers. And if you didn't get treated, some of the other issues like the neurologic and gastrointestinal issues, does that lead to increased the severity of some of those conditions?
Evan Sweeney
Right. So stepping back a little bit, this is, as you said, the fifth year, you guys have done this analysis and release these findings. What have you seen over that time period, and what changed and what remains the same?
Craig Kurtzweil
I think we've learned a lot, right, we've looked at and focused on some of the influencers of how, and we've kind of we've built the story over time. And within this white paper, we actually see elements of all the other white papers embedded into here, but really focused on the inequities that are our high variances that we see within a population. So focusing on your zip code matters a lot, Social Determinants the health of the community you live in, tells me a lot of what you're going to receive from a healthcare perspective on outcomes we're going to expect, when you look at some of the common conditions that we explored last year, even within a seemingly common condition, we see high variety of care patterns. Females over age 50 Having a completely different experience with heart disease than their male counterparts, those types of things. So what I would say is that some of the issues that we talked about in the prior white papers, what we're seeing is that they're becoming more and more the headline topics across healthcare. And I'm and I hope that means we're, we're kind of thinking ahead a little bit and hitting some of those topics before they come mainstream. But now with, if you look back at some of our past white papers, they are the hot topics of today. Social determinants, health equity, some of those, those variances that we discovered a few years back, is now making the headlines across most employers. So I wouldn't say they've gotten better, but I would say what we try to do with these white papers is shine a spotlight, right? We can't fix a problem that we don't know. But let's recognize there's an issue with community there's an issue with health equity. And then from there, we start to react and start to implement solutions within UnitedHealthcare and across the healthcare system.
Evan Sweeney
Yep, absolutely. Makes sense. Well, Craig, thank you so much for joining us and talking about these important issues.
Craig Kurtzweil
Thank you.
Evan Sweeney
That's it for this week's episode. Thanks to Craig for joining and thanks to you for listening have a great rest of your week