{"subscriber":false,"subscribedOffers":{}} New Health Care Symposium: Transformation To High Value Health Care---Build On Your Core Competence | Health Affairs
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New Health Care Symposium: Transformation To High Value Health Care---Build On Your Core Competence

Editor’s note: This post is part of a Health Affairs Blog symposium stemming from “The New Health Care Industry: Integration, Consolidation, Competition in the Wake of the Affordable Care Act,” a conference held recently at Yale Law School’s Solomon Center for Health Law and Policy. Links to all posts in the symposium will be added to Abbe Gluck's introductory post as they appear, and you can access a full list of symposium pieces here or by clicking on the "Yale Health Care Industry Symposium" tag at the bottom of any symposium post.

With the Institute of Medicine’s estimate that 30 percent of all U.S. health spending is waste, stakeholders are demanding more value out of health care. Our health care system is plagued with pervasive and unexplained variations in care, and consumers often find their experiences complex and frustrating.

So what is the path forward to advance high-value, consumer-friendly health care experiences? Purchasers, payers and care delivery systems are beginning to embrace payment and delivery transformations that emphasize quality outcomes. They are supporting new delivery models such as accountable care organizations (ACOs) and Patient-Centered Medical Homes (PCMHs), and providing patients and consumers with new tools such as cost calculators and transparent information on quality to inform care choices. Public and private payers are moving quickly to accelerate payment transformations through efforts like the Health Care Learning and Action Network, align quality measures through the Core Quality Measures Collaborative, and promote transparency tools for consumers through initiatives like The Catalyst for Payment Reform.

As markets evolve and respond to demands for higher quality and value in health care, it is important to recognize that there is no one-size-fits-all remedy. Health policy can have a tendency to gravitate toward single “magic bullet” solutions that do not fit the complexity of health care and the diverse nature of local markets. There is also a tendency to generalize from particular examples, which may be promising but won’t always represent scalable solutions.

Changing market dynamics have prompted consideration of strategies such as integration (horizontal or vertical), new partnerships and collaborations, and exploration of entering adjacent or entirely new markets. How should payers, provider, delivery systems, consumers, and other stakeholders view such efforts? Perhaps the most important lesson, based on experience both in health care and in other sectors, is to focus on core competencies, capacity to execute transformation, and a sober, clear-eyed view of what constitutes real value.

At UnitedHealth Group, we have organized our enterprise into a health benefits business (UnitedHealthcare) and a separate, distinct health services business (Optum), with both enterprises leveraging core competencies in clinical insights, technology, and data/information. Both UnitedHealthcare and Optum have achieved success in a changing marketplace by listening carefully to their customers and offering solutions that meet their needs. For example, UnitedHealthcare realized that consumers can be frustrated by having to call multiple 800 numbers to get their issues resolved – they wanted a simpler, easier experience. In response, UnitedHealthcare developed Advocate4Me, a one-call, one-stop approach to health, wellness, and benefits support.

The Growth Of Optum

Optum, which started as a business focused on data and analytics, has grown into a diversified health services business that serves all stakeholders in health care. It was designed to be payer-agnostic; while Optum provides services to UnitedHealthcare (and vice versa), it also provides services and solutions to other health plans, hospitals, physicians, governmental units, employers, and consumers.

Optum also leverages core competencies in clinical insight, technology, and data/information. For example, ACOs and other delivery systems realized they did not have the information infrastructure needed to successfully implement new payment arrangements and accountability for quality outcomes. Such systems need the capacity to analyze and predict individual and population health risk; support outreach, care coordination, and care management functions; and identify and close gaps in care. So Optum developed a set of solutions that support ACOs such as Cornerstone Health in North Carolina and Westmed in New York.

Optum also is involved in care delivery directly, supporting patient-centric care in local markets. These care delivery systems include walk-in centers for urgent care, primary care networks, multispecialty group practices, and nurse-led programs such as Housecalls that support Medicare Advantage plans. Optum also offers services that meet the needs of federal, state, and local governments, including support for federal and state insurance exchanges, health information exchanges (HIEs), and outreach/support programs for service members, veterans, and emergency responders.

Optum Labs

Experience in working with diverse stakeholders and markets has taught us that fragmentation, a lack of useful information, and cross-stakeholder barriers need to be overcome to accelerate progress. To address these issues, Optum Labs was launched in early 2013 in collaboration with the Mayo Clinic as a founding partner. Optum Labs brings together data and analytic resources, human capital, and organizational acumen in a collaborative structure to accelerate research and innovations that improve health.

Optum Labs now has 11 collaborators and a database of de-identified information on more than 150 million people. It recently added the US Department of Health and Human Services (HHS) as a partner.

The Path Forward

As the U.S. health care system continues its journey toward higher value, transparency, and consumer responsiveness, all participants in the marketplace will face both challenges and opportunities. Strategies that are conceptually appealing may crash on the rocks of execution or may clash with entrenched culture or management practices. Participants may misread local market dynamics or be directionally correct but off in their timing. The best way forward is to ask ourselves these questions:

  • What are our core competencies?
  • Where do we add value?
  • With whom and how can we partner to create real value?
  • What is the market saying is needed?

By asking these questions, listening carefully to the customer, and building on core competencies, the path to high-value health care becomes clear.

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