Health insurance company uses scans to spot members in need


UnitedHealthcare uses predictive analytics to research patients’ social determinants of health needs, then work with them to help them improve their social and health outcomes.

Karen Roby of TechRepublic spoke to Rebecca Madsen, Consumer Director for UnitedHealthcare, about how the company is using predictive analytics to improve the social determinants of health. The following is an edited transcript of their conversation.

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Karen Roby: Tell us a bit about how it all works together, and ultimately how does it help people lead better lives?

Rebecca Madsen: Absoutely. And you hit the nail on the head right there, how do you identify people in need of help, then provide the help to them, and connect them to needed resources at low cost or at no cost in the community? And we know the health disparities in what we call the social determinants of health, that 80% of what determines your health doesn’t come from what happens in the doctor’s office, those are all the other factors. And we saw that especially during COVID, that it was even, in the pandemic, last year and a half, even more accelerated. We have seen 41% of people avoid medical care; and this was disproportionately the case for people with a need for a social determinant of health. And so, we’ve had a program in our Medicare and Medicaid population for a long time, and now we are paying even more attention to our business population or our employer population.

Karen Roby: And when we talk about the needs of people, Rebecca, are you saying those who may not have access to the care that they need, the interactions that they may need? What exactly do they need help for, which they may not be able to reach and ask for?

Rebecca Madsen: Sure. Thus, some examples of social barriers to health are having adequate nutrition. Have food insecurity, transportation, adequate housing, a safe environment, internet access. And then also social support; and we’ve seen it, especially over the last year and a half, but the trend has accelerated when it comes to mental health needs and the impact of those needs on an individual in a more holistic way, by terms of health and well-being in general.

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Karen Roby: I would certainly think, Rebecca, that this year is more important than ever, especially with this focus on mental health; because people have been confined and separated from loved ones, and our mental health has taken its toll. There is no doubt that we have experienced and are still experiencing something that we have never had to face before.

Rebecca Madsen: Absoutely. And what we’ve also seen is that this trend has been picking up steam for some time now. And people think there are new directions there, but in general we are on the other side of the pandemic. But your health needs don’t change overnight; that if you are insecure about a number of issues, if you are anxious, if you are worried, if you are worried about certain things, it has long term implications, especially for people who have already have mental health needs. And so by doing a lot of this work, we are able to connect with people in a different way.

And the way we really do it is that we have three different levels of program operation, or three different stages. The first is predictive analytics. This generates a health risk score, aggregating a lot of information. And one of the things we did was we worked with the American Medical Association to develop new ICD-10 codes. And what that means is you go to a provider’s office, and they can code you if you have a social determinant of health need. So 23 of those ICD-10 codes, along with other information about you. And then, we are able to see through these scans, that you may be more likely to have a need for a social determinant of health and to need more support. This is then fed into an agent dashboard. So when you call me, as an agent speaking to you, I am more aware that this may be a need. And through thoughtful, sensitive conversation, I’m just more in tune with that so I can support you in a different way.

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The second area is what we call active listening; only if you have a conversation with me and say things like “I’m hungry. I’m afraid. I don’t have to eat ”. That we know what those trigger words are and that we train our advocates to then be able to say, “OK. Let’s have a conversation, and here is the medium I can connect you to. “

And then the last part is a questionnaire, where we ask you a number of questions to identify if you have a need.

Karen Roby: Rebecca, really before predictive analytics, these are people, a lot of them would fall through the cracks, so to speak; they would not get the care they need. And now you can, and in a much easier way, identify them sooner.

Rebecca Madsen: Absoutely. And that’s exactly it. And we know you could be food insecure today, but not three weeks from now. And that’s why we are very sensitive to how we use the information we have. We don’t email you, we don’t outreach. All it says is, “You might be more likely to fall into this category. And so we’ll have a conversation with you so that we can … And we won’t say, “Hey, I saw you might be food insecure.” We will say, “How are things going in your life? Do you need more support? And with a lot of issues related to the social determinants of health, it’s very complicated. There is a lot of shame where people don’t want to talk about it; or they don’t know they can talk to their insurer about it. Or, more importantly, they don’t want their family or friends to know about it. So by creating a safe space, using predictive analytics, we bring the two together.

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