Accelerating a future where health care is closer to home
Welcome to a new era in health care, where digital health tools and approaches enable more connected experiences.
Kristi Henderson | May 21, 2021
As the COVID-19 pandemic increased consumers’ desire for health care access from the comfort and safety of their homes, industry stakeholders scaled services to meet demand. While I’ve helped organizations build and deploy these strategies for years, virtual care was still used infrequently up until that point.
So it was incredible to see everyone — from clinicians and industry executives to care provider and health plan organizations — embrace the change together, removing barriers, reinventing our care delivery model practically overnight, and supporting clinical teams and consumers at an unprecedented pace.
And what many imagined would be a heavy lift wasn’t as cumbersome as they had expected.
For example, supported in part by Optum technology, UnitedHealthcare facilitated more than 33 million telehealth visits in 2020,up from 1.2 million in 2019.1 That’s a 2,500% year-over-year growth.
And our Optum Care clinics had less than 1,000 telehealth visits in 2019, which grew closer to 1.5 million visits in the last nine months of 2020. More generally, virtual visits spanned all age groups nationally, with the average individual being 55–63 years of age.
2020 was a pivotal year that will forever change health care because the long-held possibility of digital health quickly became a reality. While a desire to meet demand in a crisis fueled our ability to deliver on that demand, there’s more to the story.
For years, Optum has made and advocated for investments in emerging technologies to drive digital health forward. But we are building on the momentum from the past year to increase the pace of shaping better care with digital health.
Growing a connected digital health foundation
What enabled us to act quickly and initially meet the digital health demand was a collection of in-house tools coupled with our advanced data and analytics capabilities.
For example, Optum-provided internet-connected health monitoring devices and wearables can feed information into the UnitedHealth Group Nerve Center to monitor for early indicators and intervene sooner to avoid preventable deterioration of chronic conditions.
The real-time data that flows into the cloud helps build a better picture of an individual’s health status. Contrast the quality of those insights against the limited view that emerges from in-person visits to a clinic (which happen less than three times a year on average) and it’s easy to see the opportunities to improve health that emerge.
If the remote monitoring data show signs of someone needing immediate attention, care navigators can take quick action.
In 2020, we created a Center for Digital Health, which will serve us in 2021 and beyond as we harness our capabilities to offer the level of care and convenience people have now come to expect. It's all about supporting a continuous spectrum of care rather than only episodic and urgent telehealth visits used in the past.
Our new and planned programs and technologies will enhance routine health care, behavioral care, transitions from the hospital and chronic disease management.
Health care without walls?
Tune into a recent episode of the Until it's Fixed podcast for a talk on the ongoing shifts in the digital health landscape.
Improving care access without sacrificing quality
At the onset of the COVID-19 pandemic, UnitedHealthcare expanded telehealth access to 6.5 million Medicare Advantage and dual-eligible Medicare/Medicaid members.
To put this into perspective, in 2019 just 0.1% of their Medicare members had used telehealth. By the end of 2020, nearly 40% had completed a telehealth visit.
The level of virtual care visits has since leveled off; we know telehealth can’t fully replace the doctor’s office. However, if aligned the right way operationally, it can complement the standard approach to care to create a hybrid system that expands consumers’ choice and convenience while increasing engagement and access to care.
A pre-pandemic survey of patients showed that high numbers of people found no difference in the quality of care between virtual visits and office visits. Many preferred virtual visits for their convenience and reduced travel time.
Putting this into practice, this spring we’ll further expand telehealth access with the launch of the new Digital Health @Home experience.
Digital Health @Home, which will roll out to 4 million individuals with a UnitedHealthcare Medicare Advantage plan, harnesses the power of more than 100 data streams from sources like the IHR and Nerve Center to help build out an individual’s complete and personalized health dashboard.
Individuals with a qualifying health plan will get one-stop access to virtual care options through Digital Health @Home. Plus, using artificial intelligence (AI) and other advanced technologies, the service makes personalized “next best action” recommendations to help people manage their health.
Digital Health @Home will also support our network of Optum Care providers, giving them the data they need to engage individuals under their care proactively.
Combining data and digital tools to enhance behavioral health care
One in five U.S. adults has a mental health diagnosis. Despite this high and growing number, many people still find it challenging to access behavioral health services. COVID-19 only amplified these challenges.
To deliver mental health care to people when and where they need it, we’ve partnered with AbleTo. Founded in 2008, AbleTo uses data analytics technology to identify someone at risk for a behavioral health challenge, coordinates clinician visits, and informs them of their care options, health insurance and employer benefits.
The service mixes the right blend of human and digital support by aligning each person’s unique needs with a personalized behavioral health program. Individual care may be delivered via a digital solution that offers a coach’s virtual support or a multi-week program via telehealth sessions.
Using the AbleTo digital tool and clinical services — proven to reduce depression and improve chronic disease management and medication adherence — we’ll be able to expand access to 235,000 providers with Optum Behavioral Health services.
Strengthening virtual care delivery
Medications and ongoing monitoring are critical to chronic disease management. During the height of COVID-19, virtual solutions were necessary to ensure access to the routine care required by those with chronic diseases.
Remote patient monitoring (RPM) offers a continuous health care experience, keeping people connected to their care team and empowering them to manage their health from the convenience of their homes. Many people realized it was possible to do more through telehealth quite easily with access to RPM tools at the pandemic’s height.
The Vivify Health platform gives providers the ability to monitor patients remotely and intervene in their care as needed. Adoption of these tools grew exponentially during the pandemic: as my colleague and CEO of Vivify Eric Rock estimates, we likely leaped three years ahead on the RPM adoption curve.
RPM programs like Vivify Health can help keep patients out of the emergency room or hospital and reduce the overall cost of care. They are already used by some of the most respected health care organizations in the U.S.
Less than a week after the World Health Organization (WHO) declared COVID-19 to be a global pandemic, Vivify released its first set of screening and monitoring tools. They were quickly adopted by over 60 health systems and organizations.
Vivify made most of these COVID-19 screening tools available to all providers free of charge for support early on. The Vivify Pathways platform was then offered at a discount to extend that support.
RPM is also a part of the solution to rising costs related to chronic disease management, as are pharmaceutical advancements and digital therapeutics.
Digital therapeutics have the potential to impact chronic disease care, specifically diabetes care, positively. For some, digital therapeutics could help eliminate the need for medications.
Digital therapeutics can empower people to manage their health while also creating an ongoing, direct connection with their care team, creating more continuity in care.
Backed by data from UnitedHealth Group® researchers, we’ve developed a digital therapeutic solution to help people with Type 2 diabetes to reduce spikes in blood sugar levels and even achieve remission.
Level2 is an example of the integration of human support with data-informed services and digital health technologies to encourage healthier lifestyle choices.
Level2 combines continuous glucose monitors (CGM), activity trackers, app-based alerts and one-on-one clinical coaching. It can help participants better recognize the connection between lifestyle choices, such as nutrition, exercise and sleep, and blood sugar levels.
Level2 uses an AI algorithm to alert care providers and enrollees to potential disease changes or complications.
The AI-derived insights can drive care recommendations at the micro level. For example, Level2 may prompt someone to take their medication at a different time of day based on specific blood glucose reading trends.
Through Level2, certain participants achieved a clinically meaningful reduction in their A1c within 90 days. People with the most significantly elevated A1c (above 8.0%) experienced the greatest reduction (more than 1.6 percentage point decrease on average).
A “continuous care” future
As an industry, our goal is to improve health. The possibilities unleashed by digital technologies are new ways of thinking, simplifying and improving experiences, and new inventions that increase mobility and convenience.
We need digital care, we need in-person care and we need connected devices to achieve this goal. It’s all about bringing this triangle together to achieve continuous care through connected health.
We’re talking about redesigning how, where and when care is delivered — and now we can achieve that in ways that meet newfound consumer experience expectations without sacrificing the delivery of high-quality value-based care.
Access at your fingertips through phones, tablets and other internet-connected devices, which have come about in the last decade, will continue to open opportunities to do things better.
However, this will require a multi-prong approach to garner permanent and full adoption among the health plans, government payers, clinicians and the consumer, while also requiring organizational infrastructure investments.
Kristi Henderson, DNP, NP-C, FAAN, FAEN
Senior Vice President, Center for Digital Health and Innovation, Optum
Henderson is a health care change agent and clinician with more than 25 years of experience. She has designed, implemented and optimized the health care delivery system using digital health tools and technology throughout her career.
In her current role, Henderson focuses on modernizing the Optum care delivery organization using digital health tools and telehealth.
A few of her other leadership roles include service as an executive board member for the American Telemedicine Association; AAMC Telehealth Committee member; ANA co-chair for Committee on Connected Health; and member of the NQF Telehealth Committee. She is a Fellow in the American Academy of Nursing and the Emergency Nurses Association.
Sources
- UnitedHealthcare internal analysis, 2021.
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