BHCG & UHC Partnership Overview Events Summary

UnitedHealthcare (UHC) and the Business Health Care Group (BHCG) recently held two events – one for the broker and consultant community and one for employers – at the Harley-Davidson Museum® to introduce the elements of the 2016 BHCG/UHC partnership and answer questions about the transition. The following is a summary that includes information presented at both events.

Introduction

UnitedHealthcare (UHC) President & CEO Dustin Hinton welcomed attendees to the events designed to help them learn more about the newly announced UHC/Business Health Care Group (BHCG) partnership effective January 1, 2016.

BHCG Strategic Process and New Direction with UnitedHealthcare

Dianne Kiehl, former executive director, Business Health Care Group, described the extensive and thorough strategic planning process the BHCG underwent that resulted in its selection of UHC as its partner beginning in 2016 (Humana remains as the BHCG’s administrative partner throughout 2015):

  • The strategic planning process begun in February 2012 was impacted by many market developments and included considerable input from member employer CEOs.
  • BHCG member employer CEOs approved a balanced approach strategy that would drive accountability of both consumers and health care providers.
  • The decision to terminate the partnership with Humana was due to a lack of strategic alignment with this new approved direction and not because of dissatisfaction with Humana as a partner.
  • The focus on consumer information regarding quality and cost, employee health and wellness engagement and pay for performance contracting will help the BHCG continue to drive meaningful change in the market.
  • The new model will demonstrate to providers the BHCG values quality and will reward them to deliver it and that we are committed to consumer engagement.
  • Benefit plan incentives based on provider tiering are encouraged but not required.
  • Employer-sponsored health care (e.g., onsite/shared site clinics) continues to be important to BHCG member employers and the overall strategy.
  • The new BHCG/UHC partnership’s value proposition also includes exclusivity, designated customer service and clinical units, advanced analytics, administrative oversight, performance guarantees, open access to ACO strategy and innovative pilots.
  • There are additional benefits for BHCG “legacy members (those who are members in 2015)” such as audit allowances and credit for growth.
  • There will be a solution developed for fully insured employers.

UnitedHealthcare Premium Overview

Dr. Bruce Weiss, UnitedHealthcare’s market medical director, gave a description of UHC’s premium designation program. The program is a system to evaluate annually the quality as well as the cost of care provided by primary care and specialty physicians:

  • Physicians are first evaluated on quality against nationally accepted standards and must be in the top 50th percentile.
  • The program then reviews cost on a population management basis and compares cost at the market level.  Physicians who are in the lowest cost quartile are designated as Tier 1.  The remaining physicians are then evaluated at an episodic level and the lowest cost physicians are also designated as Tier 1.
  • Risk-adjustment and case mix are factored in the assessment process.
  • Physicians must achieve both the quality and cost standards to receive the premium designation as a Tier 1 physician.
  • A great deal of interest in the premium designation program and tiered benefits has been shown on the part of all stakeholders in the last six months.
  • Physicians are able to use the data (provided with a 23-page detailed summary) to find opportunities to improve and also have the ability to appeal their designation.
  • Forty-three percent of primary care physicians and 34 percent of specialists in the Milwaukee market are currently Tier 1-designated; the list of Tier 1 physicians has shown good stability.
  • UHC has documented a 16 percent lower cost between Tier 1 physicians and non-Tier 1 physicians for all specialties, with some specialties experiencing even lower costs and significantly less complications and number of redo procedures.

Choice Plus Advanced Benefit Tiers & Fully Insured Solution

UnitedHealthcare’s vice president of key accounts, Tom Kunst, discussed the Choice Advanced product and commented on the fully insured initiatives for the BHCG:

  • The Choice and Choice Plus national network (161 markets in 42 states) has delivered considerable value for both local and multi-state employers.
  • The premium designation program covers 27 specialties representing 80 percent of costs.
  • More than 50,000 UHC members are currently in tiered benefits plans.
  • UHC will work with brokers to determine potential network disruption.
  • Choice Plus Advanced incentivizes members to choose Tier 1 providers, creating a “virtual narrow network” of the highest quality, most efficient providers in the market while maintaining consumer choice.
  • Choice Plus Advanced has delivered an absolute cost savings between three and eight percent, depending on benefit design.
  • Self-funded employers can maximize savings opportunities by utilizing incentives at the physician level and at the place of service.
  • Tier 1 physicians are listed first when searching for providers on the website.
  • Employers should encourage members to use the tools on myUHC.com to educate members (e.g., the difference in costs for free-standing providers, etc.).
  • UHC is working on solutions for fully insured groups, however, all BHCG groups, regardless of size, will be serviced by the BHCG designated service center, designated clinical unit and Virtual Health Plan teams. Unique benefit funding arrangements will be available for fully insured employers with 100 or more employees, as well as some specific solutions for small employers.

Consumer Engagement Tools

John Elliott, vice president of client development for UnitedHealthcare, spoke about the consumer side of the “balanced approach” strategy, discussing consumer resources and engagement:

  • The program is designed to make sure there are resources (with many access points) available for people regardless of the type of decision they need to make throughout the health care system (e.g., open enrollment health plan election, making smart health care decisions using transparency tools, learning about health care, managing health, etc.), including various technology components.
  • Mobile applications are available and have demonstrated three times the level of member engagement as the website.
  • A designated advocacy and clinical team is available to help guide consumers. Advocate4Me (BHCG will have access to an exclusive launch of the program) uses personalization technology to match consumers to the exact resource they need when they call, in an effort to engage them at an optimum level.
  • Portable Health Score – a consumer scorecard similar to a FICO credit score – will be exclusive to BHCG members in this market and utilizes minimal self-reported information to give a more factual record of health.

Implementation and On-Going Account Management

UnitedHealthcare’s director of account management, Amy Klawitter, explained the structure and responsibilities of UHC’s account team assigned for BHCG groups and discussed the planned implementation process:

  • A BHCG designated team has been put together of people with varied backgrounds, strong insurance experience and long tenures with UHC.
  • Six different team members make up a client’s account management team, covering all aspects of a client’s relationship with UHC (e.g., client service, member engagement, service experience, strategic direction, implementation and troubleshooting, etc.).
  • Key implementation milestones have been scheduled to ensure a smooth implementation for BHCG groups.

Introduction of New BHCG Executive Director (employer event)

Attendees at the employer event were introduced to new BHCG Executive Director Geoffrey Schick who addressed the group:

  • Through the Kenosha Community Health Care Initiative, Geoff served on the BHCG Executive Steering Committee representing Daimler Chrysler in 2002 to help develop the organization.
  • The stability of the BHCG membership and employer commitment, tremendous accomplishments and cost savings are impressive.
  • The BHCG has remained responsive to the entire employer community and provided an opportunity for smaller, fully insured employers to participate.
  • Collaboration works – there is tremendous value in having a voice at the table through BHCG membership.
  • The new BHCG/UHC partnership should open doors and opportunities for many new members.

For more information on the BHCG/UHC partnership, please contact Tom Kunst at 414-443-4094 or Thomas_c_kunst@uhc.com or Geoff Schick at 414-433-4719 or gschick@businesshealthcaregroup.org.




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