Part one of a two-part series on OptumInsight and the growth of technology and analytics in the healthcare industry, with CEO Rick Hardy.
OptumInsight is one of many health care and technology companies using analytics and algorithms to streamline health care. In the first of a two-part interview, OptumInsight CEO Rick Hardy joins the Weekly Dose Podcast to discuss talk about the growth of technology and analytics in the health care sector.
Evan Sweeney 00:06
Hello and 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. I'm your host, Evan Sweeney this week's episode is the first of a two-part series on OptumInsight in the growth of technology and analytics in the healthcare industry. There is growing interest from healthcare companies and technology companies alike to use analytics and algorithms to streamline healthcare. Just last month, Google signed a deal with HCA healthcare, to develop algorithms to improve clinical decision support, as well as supply chain and physical operations. Meanwhile, OptumInsight, which announced at the beginning of the year that it will acquire change, healthcare is focused on the opportunity to tackle complexities across the health system and reduce administrative waste. Joining us today to talk about the growth of technology and analytics in the healthcare sector. is Rick Hardy, CEO of OptumInsight. Rick, welcome to the podcast.
Rick Hardy 01:02
Hey, thanks for having really glad to be here. And thanks for having me.
Evan Sweeney 01:05
Yeah, great to have you on. So maybe we can start with just kind of your elevator pitch for OptumInsight, what it does, and what the what the business capabilities are?
Rick Hardy 01:14
Yeah, sure, well, you know, OptumInsight, really a business that creates and applies data technology, and analytics to really the processes and the services of healthcare. And, and really what that means, when you think about what the end goal is, is our products and services make the transactions and interactions in healthcare possible. And so these are the transactions interactions between consumers and their providers, between the providers, doctors, clinicians, caregivers, and the payers, and then even, you know, government entities. And really, you know, we want to do two things. One is to make those transactions and interactions possible and flow and as efficient as possible. And then the second thing is to enable better decisions, by those same people in healthcare by putting information at the right place, at the right time for them to make decisions that really, you know, drive and lead to appropriate and better care and outcomes.
Evan Sweeney 02:23
And maybe you can give me an example, sort of, of how that might play out in the real world.
Rick Hardy 02:28
Yeah, sure. You know, there's a couple places where, where we have some pretty tangible interactions in the healthcare, you know, platform like one, you know, we, we work with a lot of health systems to enable what they call revenue cycle management, well, the beginning of what revenue cycle management is, is a patient has to be able to come in, right, there's an intake process. So we have to make an appointment, we have to understand what their insurance coverages, we have to understand why they're coming in, we have to sort of, you know, fill out all that paperwork that you fill out ahead of going in, right, that gets put into technology. And in a lot of times, what we're trying to do is capture that information a little bit better than it's captured today. But, you know, that allows a visit to happen. And then when, when that happens, and then you know, a physician say, prescribes a number of orders, where that patient now has to go through treatment, or they're going to get a script or something else is going to happen. Right, that all gets translated into from kind of the clinical order to what happens on the back end, you know, how does the How does the insurance company know what happened? And what's got to get paid for? How does the doctor know that that patient is eligible or not eligible for those services? And then, of course, you know, there's a whole bunch of things that happen on the downstream that might have to do with not only kind of the claim and the payment for that claim, but also how is that patient managed over time. So you know, when they have to go into something that's fairly complex, right? That's a very lengthy process, we might have care management and disease management programs, or we might have care coordination that happens. And you know, our clients hire us to really provide the analytics to understand what needs to happen with what patient but also then the technology to, you know, help their caregivers really relate to the patient and to give them the right care at the right time.
Evan Sweeney 04:30
So when you say transactions, it's really all these little points along the way, from the appointment from seeing the doctor to after the doctor to who gets paid. I mean, it's all these little points where technology sort of supports that functionality, right?
Rick Hardy 04:44
Yeah, the technology, I think is working along with the workflow if you if you imagine the patient, you know, going through a workflow, the technology is supporting that and putting the information at the right place at the right time, as well as Really, you know, getting to the other part of this, which is how do we help decisions get made in the right way and, you know, quickly and efficiently in that process as well, you know, so a good example of that is, you know, something like a quality program, right, we're where Medicare Advantage patient really, you know, has to what the payers have to do for that Medicare Advantage patient is make sure that the care they're receiving is, you know, meets certain quality measures that CMS, the government who is sponsoring that program really wants them to meet, you know, we provide analytics to a physician that might say, hey, here are gaps in care for this patient. Right? And how do we know that we know that because we know what their treatment has been in the past, we know what their diagnoses have been in the past. And we can put that up against the measures that, you know, that government that government sponsor wants to see, and then we can help the doctor go, Okay, I see, you know, what I'm going to have to do with this patient to meet those quality measures, that helps the physician not only treat their patient better, they also get, you know, incentives, and they get paid by the, the payer program for that. And then obviously, it helps the payer sponsor to meet their requirements to back to CMS and the government program.
Evan Sweeney 06:25
So, you know, arguably the biggest news for OptumInsight this year is the acquisition of change healthcare. Yeah. Can you tell me a little bit more about change healthcare, what that company brings to the table? And how it sort of supplements what you're describing here? That OptumInsight already does?
Rick Hardy 06:42
Yeah. So, you know, first of all, say we're incredibly excited about the potential of this combination. And, you know, we're working very hard to, to think about how we're going to integrate the two companies, you know, it really is a pretty significant undertaking. From our perspective, if you think about the, the size and scope of change, healthcare, it's about, you know, between employees and contractors is about 24,000 additional people that will come into our organization, that's about a 70% increase for OptumInsight itself, obviously, in the grand scheme of UnitedHealth Group, that's a, you know, of the 325,000 people. But, you know, that's, that's really important in the way that we think about integrating those two companies, cultures, talent, bases, that kind of thing. But to the company itself, you know, as I said, Oh, I OptumInsight is really focused on the transactions and information flow and healthcare making that efficient, frictionless and putting that intelligence in the right place. And really, you know, if I break that down into what are you really talking about, you know, what areas of transactions that we talked about, there's three big ones, it's really clinical information and decisions, claims and administrative information and decisions. And then payments is the last one, it really changed brings capabilities in all three of those areas. You know, examples are, you know, they have, they really have the industry leading claims network, out in the in the industry, and the number of connections they have on both the provider and the payer side is going to be a tremendous augmentation to our existing capabilities. You know, another example. So more on the, on the clinical side is, you know, they have an industry leading evidence based clinical guidelines platform that actually was recently adopted by UnitedHealthcare. Coincidentally, so that all happened before we entered into this transaction, but you know, that is really something that's going to bring a lot to our enterprise, and certainly is a place where traditionally OptumInsight, you know, to be honest, hasn't been as strong, and we're very strong on the, on the kind of clinical or, excuse me on the administrative claims, as well as kind of risk management side of the house, but really clinical itself is something that change is going to bring to us, you know, in a last area is really to point at that payments piece is really an emerging provider and consumer payments platform. They bring, you know, a tremendous amount of volume, as well as some really unique capabilities in that area that, you know, we are going to put together with things we have within OptumInsight. And actually, you know, this deal is even a little bit bigger than OptumInsights are out the Financial Services Unit is also going to benefit from those capabilities. And we're working very closely with them as we pull these things. And so, you know, those are those are real kind of specific things that from a capabilities perspective, you know, and I'll just I'll, I'll add again, I, I think we're, we're very excited to bring this talent base into our organization. It's really complementary to what we have today and, you know, we're very excited about that addition
Evan Sweeney 09:59
So what will that sort of eventually mean for, you know, the clients you serve the companies? The providers? What will that combination kind of mean for them?
Rick Hardy 10:10
Yeah, you know, when we think about better transaction efficiency and decision making and healthcare, a lot of it, it's about the connections between these, you know, as I think of as trading partners, you know, the payers and the providers, and the consumers, you know, it is about how can you increase the number of connections you have between all of those fragmented parties in healthcare, and then it's also about the, the information that you can, you know, the intelligence that you can put into those transactions. And so, you know, the fundamental place to change healthcare brings us a much bigger, multi-site in a multi modal multi-tenant network of connections, and they bring to us content, intelligence, to infuse into those connections that we don't have today, some of which we don't have today. And so, you know, the areas where they're strong, you know, are really good Additions for us, and then we obviously have some things that that they don't have, and we're strong, and we're going to be able to sort of overlay that into their customer base. So I think that's the, the big picture. You know, if we get down into real specifics, you know, there's, there's, there's really a laundry list on this, the, if I think about the actual clients, you know, the our pay our clients, our provider clients, where, you know, our combination, or you know, the combined portfolio's as they come together, are going to be, you know, more powerful from a capabilities perspective, and, and, again, all enhanced by, you know, kind of the addition of a bigger network of, of connections that we can apply it to,
Evan Sweeney 12:06
and really boiling down to it sounds like efficiency, better care, if you're looking at sort of the analytics on the clinical side, and sort of trickling down to that patient care.
Rick Hardy 12:19
Yeah, I think those are, you know, real. You know, what, the nuts and bolts of right, yes, things that we do for payers and providers are really aimed at reducing costs, you know, driving an appropriate level, and in a timely level of reimbursement. Right. So, you know, that that, you know, very fundamental transaction set of transactions that happens between payers and providers, happens much more quickly and with less friction. And I think from the care side, you know, it, it puts the information in the hands of each of those folks at the right time, so that when they do make decisions about not only what care is to be delivered, and or what decisions are made about, about a care episode, but also that it's, you know, we know, it's covered, and we know how much it's covered. And so, you know, the consumer has a much better understanding, you know, earlier in the process about what their responsibilities are going to be, and, and the physician and health system as well, because, you know, those are things that really end up causing all that downstream confusion that people that well, I get my EOB and I pay my bill, I don't know if you know, if the bill is totally right. You know, all that. And, you know, at a fundamental level, those are the kinds of things we're trying to solve. You know, we're trying to make that ubiquitous in the system. It's simple. I know what I'm paying for, for what I'm getting.
Evan Sweeney 13:54
That's it for this week's episode of UnitedHealth Group's weekly dose podcast. Join us next week for the second part of our conversation with as we discuss larger trends in healthcare analytics industry, recent interest from technology companies in the biggest opportunities to improve in efficiencies. Thanks for listening and have a great rest of your week.