Will Payers Lead Digital Health?

This year's International Consumer Electronics Show featured a healthy dose of healthcare, with United Healthcare one of the biggest exhibitors at CES's Digital Health Summit segment. I spoke with Reed Tuckson, MD, UnitedHealth group executive vice president and chief of medical affairs.

HealthLeaders Media: How disruptive is it for you to be here with this huge booth at CES when we're used to seeing you at something like HIMSS?

Tuckson: I can't tell you how excited I am to be here, because we've just finished releasing in early December the “America's Health Rankings” annual report, and yet again, it shows this really frightening increase in the risk factors that are leading to and also increasing documentation of preventable chronic illness, especially as we look at hypertension and diabetes. I am so tired of the same old tools, the same old strategies and approaches. We have got to bring innovation into this space where we're helping people make better choices and decisions, so being here makes all the sense in the world, because we really are trying to be a part of recruiting an army of innovation in this space.

Now given that you've mentioned that we are also normally at places like HIMSS, we clearly see our value added as being the integrator—being able to connect the guidance, the tools, and the data flows that come from the individual digital health world as consumers into a more holistic, integrated, interoperable database. That connects with the delivery system that connects with the care management, care coordination, and takes all of that experience, that data, that feedback, and then continues to refresh and refine personal identification of risk and closing gaps in medical care. So the more that we take the data from the different places, pull it, stitch it together, reanalyze it, and then repump it back out again in ever-more precise, more meaningful, more actionable chances for individuals to take better engagement over diminishing risk factors, and the more you can connect the delivery system to identifying gaps in care that you can then close, the better it is. So for us, the two worlds of the more traditional HIMSS clinical data world and the consumer wireless digital revolution are becoming more holistic in our mind, and we sort of see ourselves as pulling all of that together. So I don't see it in any way as dichotomies. I don't see it as being dyssynchronous. For me it's synchronous.

HealthLeaders Media: I went to South by Southwest last year, and Aetna was there giving a big talk and exhibiting. Are payers leading the charge here? What about the providers? Should Kaiser have a booth at CES next year?

Tuckson: I think that it's hard for delivery systems per se to be in this space, because they've got a lot on their plate now. The opportunity that at least we see is being a facilitator, an intermediary to help make all that happen for all the players. We are clearly seeing our role as, first of all because of our Optum company, very much involved in sharing the aggregated and analyzed data back with the delivery system for action by them. We also see our role as being helpful in developing and integrating the software necessary to make that data actionable and useable at the point of care delivery, so we have to help them in that regard. So we see our role as sort of enablers to getting all of that done.

Would I expect small practices or even fairly large medical groups to be here yet? It is very tough for them to make the health IT decisions, the capital investments in all of that world right now. I think what I would see our opportunity is to help make it easy for them as we go through this transition period. The other thing about it is that what you also see, at least for United, is that we are trying very hard to be product-agnostic. The delivery systems, especially the large integrated hospital and medical systems, have a harder time being flexible and fluid. They get locked into systems. We want to be the ones that help make it easy for you, depending on whatever system you use, to feel that the data flows, the engagement flows, the interoperability flows, and the coordinated care delivery flows, so that's probably the space that companies like ours can better occupy.

HealthLeaders Media: Is this the year we're going to see employers say, 'Hey, you do this, you wear this, you're going to get cheaper insurance'?

Tuckson: Absolutely. We're already seeing it now, and the curve has got to go up. I think it'll go up, because we're going to be able to have more data to be able to prove to employers that it works, and secondly, we're going to have to convince employers that for the tipping point to occur, it's going to take employer engagement in terms of being cajolers, leaders, cheerleaders, information disseminators, but then ultimately building incentives into the benefit package. We're doing it at our company. We're seeing, with our own employees, that the consumer-directed health plans are really taking off, showing great results.

But then, it's not good enough just to say, Okay, here is your consumer-directed health plan. You've got to give them two things. Number one, you've got to give them the opportunity to engage successfully in turning around those modifiable risk factors—thus the digital health revolution—and secondly, you've got to give them the health cost estimator, because you want them to be able to know how much is out of pocket when they make health choices. So granular data around costs and granular and actionable information around modifying preventable risk factors. Those are the two things that we get excited to bring forward, and hopefully that will all convince and get enough employers to get us to the tipping point.

HealthLeaders Media: You've got a whole bunch of other people here at CES showing technology to help people get healthy. They're all cranking out data, and the patients might be UnitedHealth customers, they might be Kaiser customers. Who knows where they are. But how do you know which patient you're dealing with, whether you have the same patient in your system twice? We don't in this country have a national patient identifier. This seems like a big issue.

Tuckson: I think it is obviously good to have tools to help you to be precise, but we are not intimidated now by the challenge and ability to know enough about unique people to give them back information that's reliable and trustworthy. We're operating at massive scale with very granular information about people, and we have not faced an overwhelming hurdle in that regard.

HealthLeaders Media: How many million do you serve?

Tuckson: At least 35 million people insured, and 75 million touched in one way or another. We feel pretty good about that.

HealthLeaders Media: My sense is that payers have it under control better than the providers do.

Tuckson: I think we may well. But I'll tell you what I'm excited about is, we're now being able to not only accumulate information about the person, claims, pharmacy, and labs, but we're also including health risk assessments, biometry, data from care management, and care coaching. We're also getting closer to really being able to meaningfully include EMR data and health information exchange data. What boggles the mind for a non-propeller head is that there are these people in companies like ours who have the ability to smash together these very disparate data sets and make sense out of them. So I think we're probably much less anxious about some of the hurdles and more positive about what we're able to produce.