Eliminating friction points in health care could save the health system billions of dollars and improve patient outcomes. Optum Insight's Shea Helmle joins the podcast to discuss where that friction exists and how to root it out.
Health care has long suffered from too much friction, which adds billions of dollars in costs to the system and creates more challenges for both consumers and providers. In this episode, Optum Insight's Shea Helmle discusses the biggest friction points in health care and how companies are using data to identifying and eliminate friction to improve patient care.
Ira Apfel
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, Ira Apfel.
Friction is everywhere in health care in duplicative paperwork, data that is difficult to access, and medicines and procedures that cost a lot, but deliver little. The United States spends $4.1 trillion in health care annually. And the U.S. health care efficiency index estimates this could be reduced by $30 billion if we could eliminate the friction of phone based and paper based systems, according to one report. Just by eliminating paper-based checks for claim payments, the United States could reduce the overall cost of health care by $11 billion, according to the Center for Health Transformation.
But if reducing friction was easy, health care organizations and insurers would have already achieved it. In this episode of the Weekly Dose. We'll talk to Shea Helmle about reducing friction in health care. Helmle, you, Senior Vice President and General Manager payer market with Optum. Shea Helmle, welcome to the podcast.
Shea Helmle
Thanks, glad to be here.
Ira Apfel
So let's start with the first question. How do you define friction in health care?
Shea Helmle
So for me, friction and health care, I think is the all the different, you know, parties of this three legged stool, the payer, the provider, the member, trying to get to the outcome that they're looking for, but having impediments in the way, right. So whether that's a member having difficulty understanding their benefits, or gaining access to care or a provider, not understanding what authorization requirements are, or why, you know, claim was paid or wasn't paid, or having access to the right clinical data to provide the care or the payer, not understanding, you know, why all the information isn't provided to them to be able to have a holistic view of the of the member all those different items or friction points, right. So it's that lack of transparency, and those not necessarily competing views or incentives, but not having the ability to get to those items that those particular constituency is critical to, to getting what they need out of the health care system.
Ira Apfel
So what is the impact on patients in the health care system? And does it lead to poor outcomes or deferred care?
Shea Helmle
yet? I think it does, right? I think the, the data proves that out. If you just think logically right, if you've got the different parties here, focusing their time on either smoothing out or overcoming that friction, it's time not spent, you know, doing the things that are needed, right, if you're on the phone, making multiple calls to, you know, different providers to collect historical medical records and information to provide your current care provider to you know, let's say you need to get a, you know, a screening, but they don't have your pet your history, all that time and energy spent there. You could have been doing other things right that are that are critical as the member, whether that's shopping for healthier meal going for a walk or anything like that you think of the the provider themselves, if they're spending time looking at, you know, chasing down authorization requirements, or trying to understand why certain payments happened or didn't happen or get access to that data, that's time that they're not spending face to face with a patient coming up with a care plan, you know, thinking through how to how to remedy that, right? So those the even if you just kind of step back and think of it logically, that time spent there, it increases or adds cost to the system. But it's going to because we have a limited supply of those providers, impact those cares and outcomes if we're spending less time focusing on, you know, making patients healthy and delivering on outcomes for those patients through all these different interventions because we're focused on removing all these other barriers that exist within the system.
Ira Apfel
So with your role with Optum, how are you addressing friction in health care?
Shea Helmle
So within my role at Optum, what what, what we do is, listen to provide listen to our different constituents right. Many times that's the payer speaking on behalf of the member and the providers to be honest, and what we do is hear the pain points here the issues and then and then work to aggregate all that all that input and provide back to the market solutions that are going to reduce the friction, right? And make the dollar investment into that friction be worthwhile for the outcome or the benefit that comes out right. So that can we look at the interactions, payers, to members, members, to providers, payers, to providers, all three legs of that stool, and then take that feedback to them say, Okay, we see the problem. Now, how do we make the investments to pull that friction out, but it can't be at the detriment of any single party has to be for the betterment of all of them, right. And that's what makes the friction such a challenging problem to resolve, because you've got a lot of different constituents to maintain, maintain kind of their their engagement in the system to get to those outcomes.
Ira Apfel
It almost sounds to me, like in your role as as, as an SVP and general manager, you are almost having to act as like the referee, because there might be some kind of, you know, obviously not, you know, not to sound too redundant friction going on between payers and clinicians and, and patients. And you're the one charged with the kind of holistic view saying, Okay, this might have X impact here, but it might have Y impact over there. And you're kind of in charge of seeing the whole picture. Is that correct?
Shea Helmle
Yeah, that is accurate. I think that's a good analogy for in for us. The markets, also the ultimate referee, right? If you provide solutions that have short term benefit, they're not going to provide long term kind of market value or value to the clients and the health care system. Right. So they're there, we try and act as a proxy for the payers, and for the members and the providers in here to say, Okay, what, what would we do in this particular situation? What do we think the knock on effects will be of this change? Right, some of it will be financial, some of them will be behavioral, some of them will be, you know, outcomes. We're trying to triangulate all those pieces to take find the solutions that hit high on all those different constituents. As far as the value add, and the, you know, in the cost or resulting friction, or what the cost can be time, you know, money, your frustration, is low relative to the benefit that they're going to get there. Right. And it's, it is hard to change to thread that needle between all three of those parties.
Ira Apfel
What sort of data do you use? I imagine you don't just look at numbers on a spreadsheet? Do you actually sit down and observe customers or physicians to kind of get a better idea of what they're doing? And where the friction really is?
Shea Helmle
Yeah, absolutely. We partner with our pair clients on a regular basis, right, we just today we had a payer come, you know, asked us about a particular issue around how to you know, how to deal with, you know, a certain certain issue related authorizations, right. So our next step is, hey, let's, let's roll around on that with you for a little bit. Let's look at those transactions. Let's talk to those providers. Right, let's, you know, in this instance, we wouldn't talk to members, but let's understand what's happening across the board so that we can contextualize that, not just through the payers lens, but through the, you know, the parties that you're speaking on the behalf of right, which will be the members, which will be the providers, you know, in many times, we'll, you know, knock on the door of our, of our friends over on the provider side person, often to get their perspective. So that as we construct these, you know, here's what we think will happen in the market, here's how they will react to these solutions and this removal of friction, that we have a better beat on that versus running out, you know, just within our own echo chamber, to provide some to the market that doesn't actually meet that need, which then kind of perpetuates the friction and cost of the system.
Ira Apfel
Now, Optum and UnitedHealth Group have been talking about reducing friction for a while, but it seems like the concept of reducing friction is really kind of coming to a head in the health care industry at large. Why is that?
Shea Helmle
So from my perspective, I think the the market is now demanding that right there, they're looking for the outcomes that outcomes are going to there's only a finite number of dollar resources available. I think it's all coming to realize that if we're going to continue to be able to provide care and have a sustainable financial model that we've got to take this for this Waste, there's friction out of the system to allow us to focus on that care and those outcomes right in the consumers demand, right? There's all kinds of competitors that are looking at this, this this, you know, market and that we'll look at, hey, how can we help solve that? Right? There's a lot of innovation happening in the space, there's a lot of innovation that I think will will, will nudge this along. But I think that the market is coming around to that, as you know, we've seen consolidation within payers, you know, you're starting to see more, more of a focus on the consumer, right, in the past five years or so I think that's really, really taken off. And you have more intelligent consumer right in the member that is looking at demanding better outcomes, better experience. You know, NPS is huge, obviously, for Optum and UnitedHealth Group. All of our customers pay attention to NPS as well. You know, that promoter score. So that is something that is just the starting point, right, it's no longer a nice to have that as a minimum requirement to be able to participate in this business, and the market is expecting it based off of, you know, the continued downward pressure on cost, and to deliver an outcomes from the ultimate consumer. Right, that the number
Ira Apfel
Are there areas where Optum has made progress in the area in the realm of reducing friction.
Shea Helmle
Yeah, there are right, and there's a without getting into too many of the specifics. You know, we've got several, you know, products that are, you know, about to be in market or in beta in the market around, you know, there's there's one more we've got a consolidated clinical data, right, where they providers would learn about unilateral, or animus Lee, but consistently provide feedback that we don't have access to the data easily, to understand where the members are at what their what their history is, you know, how to develop a care plan, just how to get to that information more quickly, or even share that information out with payers more consistently, right or more easily. So we developed products that would that will aggregate you know, some of that clinical data and provide that out right to payers, right. That's not, that's, that's a fresh new item on the market that we've discussed. But that is one instance, right? You start to instead of having, you know, 300, some odd pairs have to solve for that problem, or, you know, 1000s of providers often has the ability to consolidate and then package and deliver that information, which then can then reduce the burden on any individual party. Another is just I think that this is not an individual product, but the transparency by which, you know, optim payer operates, transparency of rules, decision making, providing that transparency further up in the value stream, to the member to the provider, is something that we we have, I think always done, but are starting to put that into more and more of our products, because that transparency, reduces the, you know, the time spent on the Why did you do this? Why did you do that?
Ira Apfel
What does success look like to you? When it comes to friction in health care?
Shea Helmle
To me, success is when I'd say every member has access to their care, every provider has access to the answers that they are the questions that that has access to the answers to the questions that they have of the health plan, with minimal downtime or weight, right, like the overall speed of that, of that, you know, transaction from member not feeling great to provider, you know, getting paid for the delivery of that care, speeding that up. And then having all those you know, customers and I think the members or customers and the providers, be pleased with the the time that it took to get from point A to point B, that to me is his success, right? removing friction, there's always going to be individual friction, and I wish you could do X or, you know, I would obviously want a better outcome here. But being able to provide, you know, a quicker path along that care journey. And ultimately, like the you know, revenue to the provider as a result, I think is key and then obviously the the ultimate outcome and I think for all of us is you want to have the best, you know, clinical outcome for every member possible. Because you know, the end of the day, I think that's what matters most right? I think all these things all the work that we're doing here is a creative to that ultimate goal. And removing that friction will will be a huge step in that direction.
Ira Apfel
Shea Helmle. Thanks so much for being on the podcast today.
Shea Helmle
Thank you. Pleasure to be here.
Ira Apfel
That's it for this episode of UnitedHealth Group's Weekly Dose podcast. Please remember to subscribe to this podcast on Apple podcasts or Spotify. Thanks for listening and have a great rest of your week.