UnitedHealthcare pilots predictive analytics model for SDOH, sets out plan to transform into ‘high-performing health plan’

UnitedHealthcare and its parent UnitedHealth Group (UHG) have been busy in the past few weeks. Of most interest to our Readers with an interest in data analytics is UnitedHealthcare’s pilot of a social determinants of health (SDOH) initiative that uses de-identified claims data to identify members at high health risk due to social factors. UnitedHealthcare call center staffers then contact members to further determine needs and to assist them with appropriate community resources. These can include assistance with childcare, obtaining internet access, financial assistance with medical bills, healthy food options, and local support groups. Staffers are also trained to extend the conversation beyond the first call.

SDOH factors can impact up to 80% of a person’s health, according to research performed by the Robert Wood Johnson Foundation.

The predictive analytics model for SDOH was developed with Optum from data gathered from 300 markets and across 100 metrics. Call center staff are also clued to members with needs through keywords or phrases that indicate a need for assistance: “I’m hungry” or “I’m struggling to make ends meet”. The initiative also allows employers to design interventions for their employees.

The pilot is for two employer products, Advocate4Me Elite and Advocate4Me Premier. About half of the contacted members in the pilot have accepted assistance. UnitedHealthcare plans to roll the program out to other fully insured employer plans later this year. Release, FierceHealthcare

UnitedHealth Group, the parent of UnitedHealthcare and Optum, published its annual corporate Sustainability Report. where SDOH has a considerable part. It’s a roadmap for transformation into a high-performing health plan that is part of a modern, high-performing health system–a very high bar for UHG as the largest US health plan. This builds on six points detailed on page 9, most of which SDOH affects:

  • Expanding access to care
  • Improving health care affordability
  • Enhancing the health care experience
  • Achieving better health outcomes
  • Advancing health equity
  • Building healthy communities

SDOH has become significant enough to become the subject of a House bill, HR 2503, the Social Determinants Accelerator Act of 2021, to support community groups in coordinating health and social services through grants, technical assistance, information exchange. It, of course, would not be complete without a federal inter-agency technical advisory council. There is a similar bill in a Senate committee and funding made available to the Centers for Disease Control and Prevention’s Social Determinants of Health Program. FierceHealthcare

CVS Aetna testing social determinants of health with Medicaid HealthTag pilot

The meshing of payer, retail, and service enhancements to improve health outcomes is the aim of CVS Aetna’s HealthTag pilot in Louisiana and West Virginia. It’s not terribly complicated. Aetna Medicaid (state health program) members picking up their prescriptions at CVS pharmacies will receive tucked into their prescription bag information on social and community services that may be useful to them, services such as food, housing, and transportation. An outside organization, Unite Us, is the resource for these social care programs. 

HealthTag is part of a broader and older ongoing program, Destination: Health [TTA 27 July 19] with Unite Us and a five-year affordable housing initiative. Unite Us’ community organizations had to do quite a bit of adjusting to virtual assistance from in-person after the pandemic hit. R.J. Briscione, senior director for social determinants of health (SDOH) strategy at CVS Health, told Fierce Healthcare that the objective of the “program is designed to identify Aetna Medicaid members who could use additional interventions to address their social needs, but who might otherwise not receive those potential services.” The pharmacy is a logical place as the members may have frequent interactions with their pharmacists for medications. (What is not said that frequent medication use is a leading indicator of multiple chronic conditions which may be mitigated by improvements in food sources, housing, and transportation to work and doctors, and possibly reducing cost.) 

Unite Us is also working with Lyft car service to provide non-emergency patient transportation to referred health appointments [TTA 13 Mar].

SDOH is not new to US payers, but the CVS Aetna integration and delivery is much more seamless than distribution through a practice office or mailers.  (This Editor worked on a WellCare program delivered through participating practices in their Maryland accountable care organization unit, and it was hard to get traction.)

Is Uber fit to deliver healthcare transport? Healthcare organizations may want to check.

Healthcare-related organizations have codes of conduct pertaining to suppliers. Does Uber meet compliance standards? As we reported a few days ago in our article on the burgeoning area of non-emergency medical transport (NEMT) [TTA 9 Mar], Uber Health’s debut with a reputed 100 healthcare organizations has led this Editor to a further examination of Uber, the organization. Uber has had a hard time staying out of the headlines–and the courts–in the past two years, in matters which might give healthcare partners pause.

  • On 21 Nov, Uber reported that the personal data of 57 million users, including 600,000 US drivers, were breached and stolen in October 2016–a full year prior. Not only was the breach announcement delayed by over a year, but also in that year it was made to go away by Uber’s paying off the hacker. Reuters on 6 December: “A 20-year-old Florida man was responsible for the large data breach at Uber Technologies Inc [UBER.UL] last year and was paid by Uber to destroy the data through a so-called “bug bounty” program normally used to identify small code vulnerabilities, three people familiar with the events have told Reuters.” The payment was an extraordinary $100,000. “The sources said then-CEO Travis Kalanick was aware of the breach and bug bounty payment in November of last year.” The Reuters article goes further into the mechanism of the hack. It eventually led to the resignation of their chief security officer, former Facebook/eBay/PayPal security head Joe Sullivan, who ‘investigated’ it using encrypted, disappearing messaging apps. Atlantic.
  • CEO and co-founder Travis Kalanick was forced to resign last June after losing the confidence of the company’s investors, in contrails of financial mismanagement, sexual harassment, driver harassment, and ‘bro culture’. This included legal action over Uber’s 2016 acquisition of self-driving truck startup Otto, started by former Googlers who may or may not have lifted proprietary tech from Google before ankling. These are lavishly outlined in Bloomberg and in an over-the-top article in Engadget (with the usual slams at libertarianism). Mr. Kalanick remains on the board and is now a private investor.
  • The plain fact is that Uber is still burning through funds (2017: $1bn) after raising $21.1bn and its valuation has suffered. The new CEO Dara Khosrowshahi, who earlier righted travel site Expedia, has a tough pull with investors such as SoftBank and Saudi Arabia’s Public Investment Fund. Also Mashable.

Healthcare and NEMT, as noted in our earlier article, are a strong source of potential steady revenue through reimbursement in Medicare Advantage and state Medicaid programs, which is why both Uber and Lyft are targeting it. The benefits for all sides–patients, practices, these companies, sub-contractors, and drivers–can be substantial and positive in this social determinant of health (SDOH).  

Healthcare organizations, especially payers, have strict codes of compliance not only for employees and business practices but also for their suppliers’ practices. Payers in Medicare Advantage and Medicaid are Federal and state contractors. While Uber under its new CEO has shown contriteness in acknowledging an organization in need of righting its moral compass (CNBC), there remains the track record and the aftermath. Both deserve a closer look and review.