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UnitedHealth Group (NYSE: UNH) is one of the largest and most pioneering health care organizations in the country. As such, one of its main strategic priorities is bringing more care into the home.
Internally, it’s clear that UnitedHealth Group and its different departments view investments around home-based care as a way to deliver cost-effective, highly impactful care to vulnerable populations. Externally, however, the company also sees “the home” as a key way to differentiate itself from its peers.
“We are helping people navigate care from everywhere — in the comfort and convenience of home, in a provider’s office, online and across every touch point in between,” Dr. Philip Painter, UnitedHealthcare’s CMO for Medicare and retirement, told Home Health Care News. “This flexibility is particularly important for our Medicare members, who may have complex care needs or mobility challenges.”
An internal medicine physician by training, Painter has spent decades caring for patients and working to develop programs for care delivery in the home.
He previously served in a senior-executive role focused on home-based clinical care. In his current role, he focuses on providing strategic and clinical guidance for UnitedHealth Group’s vast Medicare business.
The Minnesota-based UnitedHealth Group is one of the handful of companies that control the majority of Medicare Advantage (MA) market share in the U.S. UnitedHealthcare is the insurance arm of UnitedHealth Group, but the company also operates as a provider through Optum, a population-health focused segment that makes over 1 million in-home visits through its “HouseCalls” program each year.
UnitedHealth Group’s CEO Andrew Witty touted the company’s commitment to caring for patients inside the home during its Q2 earnings call in July.
Specifically, Witty mentioned how home- and community-based services have helped reduce post-acute medical care costs significantly. That includes lowering unnecessary hospital readmissions by 20% and overall hospital admissions by 25%, according to the top executive.
Painter reiterated those points in his conversation with HHCN.
“UnitedHealth Group brings unique capabilities to this space,” Painter said. “For example, the many decades of experience we have serving tens of millions of members at UnitedHealthcare coupled with the advanced clinical, data and analytics capabilities offered by Optum. These are cutting-edge technologies and tools we leverage in-house, allowing us to pivot to meet demand and new circumstances.”
Leading the way
It’s not just about a shift toward the home, Painter said.
More so, it’s a realization that 80% of what impacts a person’s health happens outside of a doctor’s office. Reaching seniors during that 80%, oftentimes at the home, is critical to making a difference, he emphasized.
“Our focus is on leading the way in creating a modern, high-performing health system,” Painter said. “An important part of that roadmap is transforming the way care is delivered. And ultimately, [it’s working] to improve quality, health outcomes and patient experience.”
Among the steps it is currently taking, UnitedHealth Group is aiming to do just that through disease management programs, innovative digital tools and 24/7 on-demand access to registered nurses or in-home care with a licensed provider.
One example includes UnitedHealthcare’s Rx Online Marketplace program, which allows Medicare members to save money on prescriptions and have them delivered to their home.
“This year, most UnitedHealthcare MA plans offer $0 copays for Tier 1 and Tier 2 drugs ordered through the OptumRx home delivery pharmacy,” Painter said. “Home-delivery pharmacy benefits can be a great way to save money and a trip to the pharmacy.”
“Our focus is on leading the way in creating a modern, high-performing health system.”
Dr. Philip Painter, UnitedHealthcare’s CMO For Medicare and retirement
Another is the aforementioned HouseCalls program that Optum provides. The program works by offering Medicare members yearly visits with a clinician from home, coordination for further care with the patient’s primary care provider, general health screenings and education on chronic conditions management.
While Optum’s HouseCalls clinicians conducted over 1 million in-home visits in 2020, they eclipsed that mark in just the first half of 2021, more than doubling the number reached after the same period last year.
“Besides the usual needs for regular preventive care, HouseCalls visits are especially crucial as some older adults may have put off necessary care during the COVID-19 pandemic,” Painter said. “That person-to-person connection and rapport helps create a friendly environment where getting care can become that much easier and convenient — helping to keep people healthy.”
To that point, data from Epic Health Research Network shows that hospital admissions remained below expected levels through at least April 9 of this year. In the week beginning on April 3, hospital admissions were 85.5% of what would be expected based on historic patterns.
Averaged over the first quarter of 2021, hospital admission rates were 89.4% of what would have been expected in the absence of the pandemic.
UnitedHealthcare has now provided more than 10 million HouseCalls visits since introducing the program in 2012, according to the company.
“The bottom line is more people are looking for ways to access care outside a strictly clinical brick-and-mortar setting,” Painter said.
Health plans leading the charge
The top 10 MA plans in the U.S. control over 75% of the market. But then there are dozens of others outside of those that are trying to make their mark.
Other than UnitedHealthcare, some of the larger ones include Humana Inc. (NYSE: HUM) and CVS (NYSE: CVS).
A commitment to home-based care solutions is not a differentiator between larger MA plans and smaller ones. Both groups are striving to do more work in the home, through their own providers — like UnitedHealth Group and Optum — or through provider partnerships.
Yet a similarity among those that are committed to home-based care solutions is that all of them believe it could be a true differentiator in the marketplace.
“I do think that plans think about these benefits as a way to differentiate themselves in a crowded marketplace,” Tyler Cromer, a principal for the Washington, D.C.-based research and advisory firm ATI Advisory, told HHCN earlier this year. “And providing the right combination of benefits that really meet member needs could result in a competitive advantage in any individual market.”
Some plans are leveraging proprietary technology to do so, while others are using innovative and unique supplemental benefits. Some are doing both.
The supplemental benefits allow these smaller plans especially to be more creative.
Painter helped explain why he believes it’s so important to be honed in on home-based solutions right now.
“First, the convenience of telehealth has always been apparent, yet adoption rates weren’t widespread — until now,” he said. “Many health plans are encouraging the use of virtual visits, including for behavioral health, to help keep people safe in their homes during the pandemic, which has introduced the convenience to a wider audience.”
The prevalence of telehealth has created more touch points for insurers and providers, and helped them reach patients in their homes more often.
In addition, COVID-19 has turned the home into the most desirable place of care for a lot of seniors who traditionally would have been seeking care in brick-and-mortar offices or facility-based settings.
“Similar to how telehealth enables efficient and accessible care, the response to the pandemic has created momentum around the concept of a patient’s home as a site for medical services,” Painter said. “This idea relies heavily on the adoption of technology and advanced digital tools. Some areas where home health is advancing [include] chronic disease management and infusion services.”
Health plans dictate, in many ways, how and why health care is delivered in the U.S.
Their attention being paid to home-based care will — maybe more than any other factor — shift care into the home.
Those plans believe they, and the health care system overall, will benefit from that. And indirectly, so will home-based care providers.
“Similar to how telehealth enables efficient and accessible care, the response to the pandemic has created momentum around the concept of a patient’s home as a site for medical services.”
Dr. Philip Painter, UnitedHealthcare’s CMO for Medicare and retirement
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