UnitedHealthcare CEO Brian Thompson and Optum Everycare CEO Kristi Henderson join the podcast to discuss policy solutions to achieve universal coverage and expand access to care.
UnitedHealth Group is committed to a future where every person has access to high-quality, affordable health care and a modern, high-performing health system that reduces disparities, improves outcomes and lessens the burden of disease.
This is the first episode in a three-part deep dive into A Path Forward, UnitedHealth Group's policy solutions that offer a refreshed perspective for how to modernize the health system to:
The first episode in our three-part series features Brian Thompson, CEO of UnitedHealthcare, and Kristi Henderson, CEO of Optum Everycare, who discuss how to expand access to coverage and care in the U.S., including through innovative coverage and virtual capabilities.
Click here for more information on A Path Forward.
Evan Sweeney
Hello, and welcome to UnitedHealth Group’s three-part series on health care policy, where we're taking a deep dive into A Path Forward. It's a set of policy solutions released by UnitedHealth Group that offer a refreshed perspective for how to modernize the health system:
You can download the full document at www.uhg.com/apathforward.
Today, we're going to be discussing expanding access to achieve universal coverage.
Access to health care as a fundamental part of a modern high performing health system. A recent report from the U.S. Department of Health and Human Services shows that the uninsured rate in the United States has fallen to a record low of 8%. But that still leaves 29 million people without health care coverage.
However, by building on the existing health system, universal coverage can be achieved to ensure everyone has access to affordable quality care.
Joining us today is Brian Thompson, CEO of United Healthcare, and Kristi Henderson, CEO of Optum Everycare to discuss how to achieve universal coverage in the United States.
Brian… Kristi.. welcome to the podcast.
Kristi Henderson
Yeah, thanks for having me.
Brian Thompson
Thanks, Evan. Glad to be here.
Evan Sweeney
As you both know, access to care has been really a central policy focus within the US health system for decades, though the challenges have certainly evolved over that time. How is access different today than it was before the Affordable Care Act was signed into law 10 plus years ago?
Brian Thompson
Yeah, thanks for the question. I would say this has been a focus for UnitedHealth Group for many, many years. How it's evolved, I would say the conversation used to be solely around coverage, essentially, do you have insurance. That conversation is certainly still happening, as you pointed out 29 million Americans without coverage. But I do think that the conversation is a little more nuanced today. Exchanges, as an example, have really been established as a great source of coverage for many Americans via the Affordable Care Act. And it's really grown into a viable marketplace for affordable coverage. And in addition to that state Medicaid programs have always been a crucial source of coverage. And that's certainly rung true here. During the pandemic, what we've seen is a big growth in the number of people covered under Medicaid since the public health emergency in early 2020. So ultimately, our focus is still on working towards universal coverage by building on these existing platforms, like the exchanges and like Medicaid that we already have in the marketplace today.
Kristi Henderson
Yeah, I'd love to jump in there and build off of what BT said, you know, we certainly have seen the ways people access the healthcare system evolving with just this increased adoption of virtual care tools. Virtual care really was bred out of the need for us to improve access to care first in the underserved areas and rural areas. But what we've seen over the last few years with the pandemic, has really taken it to a whole other level. We saw that necessity drive the acceleration of that innovation. And just really in a matter of weeks, we saw the front door of healthcare change. The entry point was now a digital front door that started with a virtual visit and then would move on to in person as needed. And so that was a good thing – that necessity drove a lot of innovation, and an immersion into the virtual world and highlighted, really, the art of the possible. So today we're seeing that carryover into a blended healthcare model that uses virtual and in person where people are really getting to choose how they access care. So, it's not just about availability, it's about options and flexibility.
Evan Sweeney
Brian, you mentioned Medicaid, which certainly from a coverage standpoint has been a critical program over the last several years, and particularly during the pandemic, in just ensuring that, you know, millions of Americans have that health coverage. How has that program provided access to care for low-income Americans over that last two-to-three-year time period?
Brian Thompson
Yeah, as you as you pointed out, Medicaid has been an important part and a fabric of American health care for many years. But since the start of the pandemic, let's go back to around March 2020. Since then, we've seen about 17 million more people covered under Medicaid and I believe Medicaid enrollment now is nearing 90 million across America. It's up about 25% Just since the beginning of the pandemic and one of the reasons for that is as part of the federal response to COVID-19 and the pandemic Congress provided states with extra Medicaid funding if they stopped disenrolling Medicaid enrollees during the public health emergency, and as you fast forward, then these last two years, those temporary requirements are still in place. And the concern, however, is that once this public health emergency ends, states will reinitiate coverage redeterminations. And our fear is that as many as maybe 14 to 15 million people are expected to lose coverage that are currently enrolled because of those extensions that were granted throughout the pandemic. So, the real question then becomes what happens to those people. We believe that there's a really big opportunity to help these people maintain or get new coverages and other forms either through the exchange or through employer-sponsored coverage. So, we're actively working with policymakers to find solutions to prevent the stop that potential for so many people to lose their coverage as this public health emergency expires.
Evan Sweeney
One issue I sort of wanted to touch on it, and maybe somewhat related to that Medicaid program is the issue of health disparities and health equity. And I'm curious, you know, how does access play a role in the disparities we see across the health system today? And Kristi, in particular, how does that converge with access to virtual services specifically?
Kristi Henderson
Yeah, well, in today's world access is really more than just getting access to care, but it's also having convenient access when and where you are. And so that means being able to conveniently access medical, behavioral, specialty, and even pharmacy care in person as well as virtually, that really gives people the ability to access care, wherever they are, and so then it's not limited to location. So that's really been our focus when we launched Optum Everycare now in April – to provide more connection points between virtual and in person with convenient 24/7 access in one place. optometric care now actually, is now serving 16 million UnitedHealthcare commercial members for virtual urgent care, and just under 13 million members for virtual primary care. And so, when you think about your question around health disparities, I would just give you two examples. If you think about transportation as being one disparity around access to care, virtual allows us to have access from wherever anybody is we have clinicians available virtually across all 50 states 24 hours a day, seven days a week, so people can get that access without ever leaving their home. Or if you think about access to primary care, Americans are currently waiting upwards of 30 days on average to see your primary care physician. And with our Optum Everycare now program with virtual primary care, we have access 24/7 to clinicians within a matter of 15 minutes. So those are really breaking down just two examples of disparities that virtual care can address
Brian Thompson
Kristi, I might just pile on there. Those are great examples. And what it really does is it points out this relationship between access and health equity. Current reality is just far too many people experience barriers to health like poverty and, as you mentioned, Kristi, transportation, food insecurity, education, safe housing, that's just a few of the barriers. And our efforts are really focused on providing actionable insights to better understand these unmet social needs, and the gaps in care that arise from them. And I think how we're helping to connect older adults that are Medicare Advantage programs, to help them stay healthy is one good example. And I'll point to a county in the southeast us where we saw a significant racial disparity in medication adherence, folks not taking the drugs that they've been prescribed. And what we found is that those numbers were engaging in preventative care, such as cancer screenings and the like, but it wasn't that they weren't interacting with the health system, it was tied much more to the social barriers that population faced to stay adherent once they had actually seen their doctor.
And what we did is we stood up a program that combined medication adherence support with outreach to address these social needs. And in a really short period of time, about six months, we saw adherence rates jumped considerably up 50% In this geography or community. And it's just one way that if we look a little more broadly, we can see what's impacting people's health it really takes efforts to impact a community at home. And we saw the same impact on an even larger scale through our HouseCalls program, which also provides members within home visits to address unmet pharmacy, behavioral and social needs, in addition to obviously, a full review medical review – very similar to an annual wellness visit. And last year, we made more than 320,000 social determinants of health referrals through that program for things like low-income support, transportation and food insecurity. So even beyond just our Medicare Advantage members, we're looking at this issue as an opportunity to collaborate with local community partners.
Evan Sweeney
So last month – this is very timely – Congress passed legislation designed to tackle at least one issue around access by extending the subsidies for ACA marketplace plans beyond 2022 and through 2025. And Brian, so I'm curious, from your perspective, what impact will that have?
Brian Thompson
Yeah, that's right. And August, Congress passed and President Biden signed into law what's called the Inflation Reduction Act. Those enhanced payments or subsidies, if you will, were initially put into place here during the pandemic in what we call the American Rescue Plan Act in 2021. And it really increased the amount of financial help that those that are already eligible for subsidies and expanded new financial assistance to middle-income families to help them purchase health insurance through the exchange. Now, the same subsidies, they were set to expire here at the end of the year. And what this law did is it really brought that continuation of coverage into play here for them through 2025. And I believe had this not been extended something like 13, or 14 million Americans would have seen a substantial change in the affordability of these plans, they would have would have went up by as much as maybe 50%, for some. So, getting this bill in place really protects a large number of Americans and provides them that access with the additional subsidies for several more years, we certainly support efforts to permanently extend these subsidies and believe this is really a great step in the right direction to ensure that people continue to have access to affordable coverage.
Evan Sweeney
Well, you know, you've both been around the healthcare industry for some time now. I'm curious, where have you seen sort of the meaningful innovation, the new models that make you proud, hopeful for some of the opportunities ahead, and Kristi would love to start with you on that?
Kristi Henderson
Yeah, great, you know, the health care system responded to and evolved its entire model of care delivery throughout the pandemic, and it was incredible. Our goal is to continue that momentum that really became the silver lining out of the pandemic, to continue to innovate to help improve access to high-quality care for more people. So, we were really proud that last year, we partnered with UnitedHealthcare and launched a virtual health plan called Navigate Now, it's a virtual first health plan that provides members with the personalized virtual care that they need with a personalized virtual care team. The care team coordinates their care not only virtually but in person with local providers and clinics, then that's just one way that that innovation has opened the door to more affordable coverage options for more people
Brian Thompson
Well said, Kristie. Maybe I'll just add on to that. Look, we get it our health system is not perfect. But we do believe that the infrastructure that we have here in America is sound and the core component tree that I believe is needed to expand access and ultimately achieve universal coverage is in place. And if we build on that existing infrastructure, we can help even more especially when there is room to innovate inside these existing coverage platforms. And I look at our Surest health plans is another great example of that innovation that we have. This is a product that was initially introduced about five or six years ago. It was formerly known as bind, we've renamed insurance now, it's got the fastest growth rate among all of our employer sponsored plans, I think it's owned by 60 to 70% each and every year. And what makes it different is that it doesn't have any deductibles, it doesn't have any confusing coinsurance. It's really clear and transparent around the cost and the quality that really helps members understand their costs before they make an appointment. And it truly puts the consumer in that driver's seat of making the choice around their own care plans. And it's also remarkably affordable when you have that accountable consumer in the center out of pocket costs as an example are down by almost half compared to some alternative higher Deductible Health Plans. Today, about nearly half of all Americans have coverage through their employer and responding to the demands of the workplace of the workforce, to the increasing costs. Employers are looking for different ways to do things are looking for innovative coverage solutions that meet the needs of their employees. And I think this product –again Surest – is a good example of meeting those needs at lower price points that really put that consumer in the driver's seat.
Evan Sweeney
Great. Well, listen, thank you both for joining today to discuss this important topic. I know you've both worked in this field for a long time, so it really appreciate your time and thoughts.
Kristi Henderson
But You bet. Thank you for having us.
Brian Thompson
Thanks, Evan. Thanks, Kristi.
Kristi Henderson 14:37
Thank you.
Evan Sweeney
That's it for our first episode on UnitedHealth Group's policy solutions to modernize the health system. To learn more, download a path forward at www.uhg.com/apathforward. And join us next week for a conversation on how to lower the cost of care and improve health care affordability. Thanks for listening thanks have a great rest of your week