Benefit Clients

Deliver value to clients to help manage and contain cost and show focus on high-cost claimants and cancer as a priority.

Benefit Members

Improve the high-cost member experience by identifying high-impact, holistic solutions.

Benefit UHC

Focus on solutions that decrease impactable costs to demonstrate value to UHC and clients.

16

UHC Internal Interviews

16

Market Scan Offerings Reviewed

5

Social Media Platforms Scanned

5

Client Interviews

1

Consultant Interview

22

Member Interviews

Care Delivery Optimization

Improving where and how care is delivered to reduce waste & variability

• Steerage

• Network Management & COEs

• Site of Care Optimization

Clinical Oversight & Management

Ensure that care is medically necessary, coordinated, and effective

• Complex Case Management

• Care Coordination

• Utilization Management

Member Engagement
& Incentive Design

Influence member behavior through plan structure, education, support tools

• Advocacy & Navigation

• Member Engagement & Education

• Treatment adherence

• Gap Closure

Data, Evidence, & Continuous Improvement

Data, analytics, & research to refine decisions and policies over time

• Predictive Analytics

Solid Tumor Cancers

Hematologic Malignancies

Advanced Cardiovascular

Solid Organ Transplants

MSK

Autoimmune / Specialty Drug

Predictability of Spend: Clients are frustrated by backward-looking reporting: they want forward looking reporting to help manage their P&L.

Demonstrated Containment: While clients don’t expect savings per se, they do expect UHC to be the best at containing trend.

Spend That’s Good For Members: UHC is expected to justify outlays by continuously demonstrating that it is ‘good spend’ – that the member received necessary and high-quality care.

HR Wants Employees Taken Care of During a Crisis: They prefer savings to emerge from better outcomes, not restrictions.

Open Enrollment Amnesia: Employees ignore benefit details when they are healthy.

HR is the 'Emergency Release Valve' for System Bureaucracy: In moments of medical crisis, some escalate directly to their internal HR leaders for help.

High Costs are Increasing Clients’ Risk Exposure: Some clients fear the stop-loss safety net is fraying, citing increased lasering. Some are optimizing plans for catastrophe.

Case Rates De-Risk Trying Innovative but Expensive Programs: Case Rate feels more financially efficient, and it psychologically lowers the barrier to trying innovative or high-cost, high-touch programs.

Seeking Holistic Condition Care, Not Piecemeal: Clients feel like they’re buying components of care, what they want is the outcomes and member experience of care.

Simplify & Remove Roadblocks: Reduce friction in the ‘block & tackle’ of delivering high-cost and cancer care.

Send an Olive Branch: Proactively make a small gesture to show members you are available to them.

Evaluating Quality Care: Help our members evaluate and choose high quality care in high-cost and cancer care.

Aggressive Steering to Optimal Sites of Care & Clinical Path: The best way to steer a member to a preferred UHC provider is by finding it for them.

Round Out the Team: Offer ‘clicks ins’ to clinical care that doctors don’t have time for.

Administrative Assistant Wanted: A nurse navigator to explain things is nice, but an administrative assistant is needed.

Take Care of the ‘Backburner’ and Help the Member’s Village Help Them: Help the member and caregiver recover some bandwidth. Friends and family want to help but don't know how. Caregivers struggle to ask for help or delegate.

Close the Mental Health Gap: HCCC members often underestimate or defer the mental health impact as they rush into treatment. Typical mental health support falls short: effective support must be proactive and disease-specific.

New Tech for Adherence, Persistence, & Flareups: Tracking and monitoring of symptoms and the member’s condition to better triage care.

Early Detection as a Core Competency: Once a member becomes high cost, the ability to control costs is marginal.