Latest / Becker’s Payer Issues Podcast / Innovating Consumer Choice and Cost Management at UnitedHealthcare with Dan Kueter

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Innovating Consumer Choice and Cost Management at UnitedHealthcare with Dan Kueter · Becker’s Payer Issues Podcast

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0:42
Hello, everyone. This is Jacob Emerson with the
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Becker's Payer Issues podcast.
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Thrilled today to be joined by a very
0:48
special guest. Dan Keeter is the CEO of
0:51
UnitedHealthcare's
0:52
employer and individual insurance business. As an 80,000,000,000
0:56
division of UnitedHealthcare,
0:58
it is the nation's largest company that offers
1:00
health coverage to employers and consumers
1:02
nationwide.
1:03
Dan, thank you so much for taking the
1:06
time to sit down with me on the
1:07
podcast today.
1:09
Hi, Jacob. Great to be with you, and
1:10
thanks for the invitation.
1:12
Absolutely. And before we dive into everything we
1:14
wanna talk with you about, Dan, can you
1:16
tell us a little bit more about yourself,
1:18
your background in health care, and what it
1:20
is that you're doing today at UnitedHealthcare?
1:23
Yeah. Sure can.
1:25
As you said, I'm the CEO of our
1:27
employer and individual business. So that's the commercial
1:29
business within UnitedHealthcare
1:32
and UnitedHealth Group.
1:33
I joined the company first back in 02/2001,
1:36
and since then, I've served in a series
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of roles across the organization,
1:41
largely concentrated
1:42
in the commercial market, however,
1:45
and
1:46
enjoy this role. Grateful to have it. Grateful
1:49
to interact with all the employers, distribution channel,
1:53
consumers,
1:54
and other constituents that we have in the
1:56
health care segment.
1:58
I oversee a diverse portfolio of commercial health
2:01
plans, ranging from traditional fully employed insured plans
2:05
across the country,
2:06
Self insured plans at a full scope of
2:08
ancillary
2:09
individual and voluntary offerings.
2:12
Fantastic. Well, like I said, Dan, we really
2:14
appreciate you taking the time to be with
2:16
us today. I wanna get us started by
2:18
talking about something brand new from UnitedHealthcare
2:21
just announced, and that is the UHC
2:24
store.
2:25
So take us through what this is and
2:27
how you see this kind of offering changing
2:29
the way that employers and your members
2:32
interact with their health benefits?
2:35
Yeah. Sure. I appreciate that question. United UHC
2:38
store, the UnitedHealthcare
2:39
store, as we talk about it,
2:42
it was just launched. It's a new direct
2:44
to consumer and a digital shopping experience.
2:48
It's an important part of our continued efforts,
2:51
and another step forward in giving consumers
2:54
more choice.
2:56
The goal here is to help consumers
2:58
improve
3:00
the customization of their benefit plan and do
3:02
so in a very consumer
3:04
friendly experience
3:06
with tech enabled solutions.
3:08
The store is now available to 6,000,000 members,
3:11
and we expect it'll be available to 18,000,000
3:14
members,
3:15
as soon as the end of the year.
3:17
It's available through our app and through myuhc.com
3:20
as well, of course.
3:22
And it helps consumers customize
3:24
the experience
3:26
for their specific needs, customize
3:28
the offerings available to them. So let me
3:31
give you a couple of examples of that.
3:33
Offerings inside the store include
3:36
popular weight loss programs,
3:38
orthopedic management
3:40
apps,
3:41
women's health solutions, and and more. So,
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folks can choose an offering
3:47
ranging from a everyday health offering,
3:50
like those in women's health and and mental
3:52
health.
3:53
I think people are quite familiar with some
3:55
of the leading apps out there. We make
3:57
those available to consumers.
4:00
Think of Maven as a perfect example in
4:03
the women's health space.
4:05
Family wellness resources
4:06
for family planning,
4:08
for caregivers,
4:09
pregnancy, postpartum needs, things like that.
4:12
And then obviously weight management, something that's talked
4:15
a great deal about,
4:17
in health care today and has
4:20
a lot of consumer interest. So we have
4:22
offerings out there for weight management, coaching, nutrition
4:25
fitness,
4:26
things like that.
4:28
And then for other more complicated
4:30
and consumer specific
4:33
situations,
4:34
we offer solutions and enable their easy enrollment
4:36
in programs
4:38
for diabetes
4:40
or other gastrointestinal
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issues, musculoskeletal,
4:43
kind of orthopedic considerations,
4:46
that folks may have. So through the UHC
4:49
store and enrollment in that way, it allows
4:51
people to save money,
4:53
customize,
4:54
the solutions
4:55
that are best for them and their family.
4:58
They can save, you know, 15% or more
5:00
in some of these. And by doing so
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through the UHC
5:03
store, it allows us and,
5:06
our consumer member advocates
5:09
to be aware of these enrollments and help
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better coordinate
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more comprehensively
5:13
and and in a more customized fashion, the
5:16
care for the consumers. So it's one more
5:19
example of how I think we're
5:21
listening to the market, listening to our members,
5:23
our employers, and the distribution channel
5:26
to bring more customization
5:27
to consumers and allow them to make choices,
5:31
that best fit their needs. And as you
5:33
can tell by my example of Maven and
5:34
and others, if I were to go through
5:36
the list, they would
5:38
be solutions that people have heard of. They're
5:41
we're trying to bring together the best that
5:43
the health care marketplace has to offer consumers
5:46
and integrate that into their,
5:49
benefits program.
5:51
Absolutely. Well, I really appreciate you sharing all
5:53
the details there for us, Dan, about the
5:55
new UHC store.
5:57
And and it's so interesting to hear you
5:59
talk about the all that because
6:01
consumerism is really something we've heard a lot
6:03
about from UnitedHealthcare leaders
6:05
over these last few years in terms of
6:07
where the company is leaning in with innovations
6:10
like Surest
6:11
and a revamped provider search experience recently. So
6:15
I'm wondering if you could tell us a
6:16
little bit about that in terms of lessons
6:19
you've learned from,
6:20
Surest's
6:21
rapid growth and and how that's influencing how
6:24
you're designing other commercial products.
6:27
Yeah. Sure. I really appreciate you raising
6:29
Surest. It is something I like to talk
6:32
about a lot. I'm a Surest member myself,
6:35
and it works great for
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for my family and me.
6:40
And it is absolutely an innovative model, an
6:42
example of where we've listened to the market
6:45
and are delivering to consumers
6:47
what they most want.
6:49
The innovative model certainly delivers cost savings to
6:54
consumers and employers. The 10 to 15% range
6:57
for employers and up to 50%
6:59
for consumers. So we've learned a great deal
7:03
about that while we really deliver to consumers
7:05
and employers what they most want.
7:08
They most want affordability and simplicity.
7:11
That's what we hear from them, and simplicity,
7:13
of course, includes transparency.
7:16
Surest, it delivers
7:17
all of that in a very consumer friendly,
7:20
intuitive digital shopping experience.
7:23
That's really unlike other things out there in
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in health care.
7:27
You know,
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historically, the health care industry
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has been
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accused, maybe rightfully so, of lagging other industries
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in our adoption
7:36
of online
7:38
solutions in contrast to retail or digital banking
7:42
or things like that. And Surest is really
7:44
a big leap forward for us. Our initial
7:46
leap forward and things like UHC store continuing
7:48
to push that forward. So what have we
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learned through this?
7:52
We've learned that indeed consumers do want more
7:55
choice. They do want more transparency.
7:58
They want more of a retail experience in
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health care
8:01
that mirrors what they experience with their online
8:04
shopping, whether that be retail oriented or
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shopping for plane tickets, concert tickets, etcetera, things
8:11
like that. Folks want transparency.
8:13
They want choices,
8:15
and they wanna know the the cost and
8:17
and quality and convenience impacts of those choices.
8:21
And
8:21
so Surest has delivered that along with the
8:24
economic savings that I described, and it's really
8:28
helped us
8:29
fine tune the UHC store
8:32
to
8:33
carry forward some of those same,
8:36
tendencies, those same capabilities and be responsive to
8:39
what consumers want. So,
8:41
these are our first two forays in this
8:43
area. Most notable built on the back of
8:46
dramatic improvements as you highlighted on our digital
8:49
app over the past few years. But you
8:51
can continue to expect more from us in
8:53
this regard as well.
8:56
Absolutely. Well, that's some amazing numbers you cited
8:58
there in terms of some of the major
9:00
cost savings you're seeing from Surest in terms
9:02
of, employers and and what members are seeing.
9:04
That's fantastic.
9:06
Dan, you you mentioned where the health care
9:09
industry may have fallen behind other industries,
9:12
in the past in terms of,
9:14
consumerism. And one area where we've heard across
9:17
the industry where,
9:19
the health care industry is trying to make
9:20
up some ground here is through the use
9:22
of artificial intelligence. And recently, we heard from
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UnitedHealth Group that the company now has more
9:28
than 1,000
9:29
AI use cases in production across the enterprise.
9:32
So within the commercial business that you oversee,
9:35
where are you seeing some of the biggest
9:37
impacts of of AI and machine learning on
9:40
the member experience and on cost management?
9:44
Yeah. Sure can. So I appreciate
9:46
that, and you're exactly right. I think industry
9:48
wide,
9:50
all of health care is really moving in
9:52
the direction of AI and embracing it in
9:55
so many ways. That's absolutely true inside our
9:57
company and no doubt that the responsible use
9:59
of AI, I think, holds tremendous promise to
10:02
simplify and help us further create value in
10:05
in what we all know is a is
10:07
a more complex American health care system than
10:09
any of us wishes. So we're using AI
10:13
in some of the areas that you identified.
10:15
Let me give you a couple of examples.
10:16
So when it comes to health benefits and
10:19
the experience,
10:21
using AI there a good bit, working with
10:24
partners like Optum, but also others
10:27
to develop applications
10:29
to provide
10:30
for more seamless,
10:32
quicker,
10:33
faster to answer interactions with our advocates, whether
10:36
that be,
10:38
when a member calls in or uses an
10:40
AI chatbot. We now have tens of millions
10:44
of AI enabled searches,
10:46
to help customers,
10:48
consumers,
10:49
and to surely help them with things like
10:52
find a doctor, inquire about a claim,
10:56
determine where they are on their deduct deductible
11:00
accumulation should they have one. But then at
11:02
the same time, also
11:04
helping our agents on the inside be more
11:08
responsive, get faster to answers as I indicated
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as AI is pulling forward to our advocates,
11:16
that are on the phone with a member
11:17
or interacting with them, perhaps in another digital
11:20
form, pulling forward recommended answers, anticipating,
11:24
what the next question and answer is going
11:26
to be. So it is really speeding up
11:29
the process.
11:30
Some other specific areas,
11:32
smart choice
11:33
provider search capability,
11:35
we call it. It leverages
11:37
AI and delivers a more personalized
11:39
experience for a member. You know, four key
11:43
standards,
11:44
come to mind to help a provide help
11:46
a member find the provider that they want.
11:49
Interested in in
11:51
sorting on quality or searching by benefits
11:54
or looking for other convenience factors,
11:56
like schedule,
11:58
opportunities
11:59
or proximity to their home or work,
12:02
and then allowing consumers to search for other
12:04
items of of personal preference and personal choice.
12:08
Perhaps the the language skills and capabilities of
12:11
the provider, gender,
12:13
things of that nature. So and also then
12:16
really using AI to help
12:19
provide,
12:21
assistance to consumers with a members like you
12:25
type of orientation. So things that we know
12:27
about a member that they share with us.
12:30
What are the choices that other members like
12:33
them may have made
12:34
about using our app, about seeking
12:37
a provider,
12:39
and things like that. So as
12:42
AI gets more data within our systems at
12:45
its disposal,
12:47
it will continue to improve with these predictive
12:50
capabilities. It will continue to deliver a richer
12:54
experience for our members that I think they
12:56
will find to be more seamless,
12:59
quicker to answer,
13:01
really much more like the retail experience that
13:04
we keep talking about.
13:06
Absolutely. It makes a lot of sense. And
13:07
it really at the core of things, it
13:09
sounds like you're looking to provide quicker information,
13:13
better answers about care and benefits to your
13:15
members and to your customers.
13:18
Dan, I wanna,
13:19
switch gears here for a second and talk
13:21
a little more macro context about what's affecting
13:24
the industry right now, especially as we head
13:26
into next year. We're hearing from employers,
13:30
all over the country and from,
13:32
groups that analyze what employers are saying at
13:34
large about, the health care cost increases that
13:38
they're estimating, that they're bracing for as we
13:41
go into next year. We're seeing anywhere from
13:43
6% to 10%,
13:45
cost increases
13:46
in 2026
13:48
driven by factors like catastrophic claims,
13:51
specialty drugs, coverage of chronic conditions.
13:55
So what are you hearing,
13:57
most consistently
13:58
from your jumbo and large employer clients right
14:01
now,
14:02
about how they're preparing for this?
14:04
Yeah. Boy, it's something that we listen really
14:06
closely to,
14:08
take very seriously. And at the same time,
14:10
we're obviously always analyzing our own data,
14:14
listening to what our
14:15
competitors,
14:16
in the marketplace are saying about their visibility
14:19
to trend,
14:20
and just working always to get a comprehensive
14:23
view of that and share it with our
14:25
employer customers, prospects alike, and obviously the distribution
14:29
channel. And as I said earlier,
14:31
customers and consumers are most interested in affordability
14:34
and then simplicity
14:36
right behind that. So
14:38
employers are absolutely concerned about rising cost, and
14:41
you quoted six to 10%. And I think
14:43
in places, we're gonna see it above that.
14:45
I've heard recent commentary,
14:48
from some other leaders in the industry, counterparts
14:50
of mine, if you will,
14:52
in various places where they're expecting rates to
14:54
be well above that in some pockets of
14:57
the country. And and I think that's right.
14:59
There's always geographic variation. There's
15:02
certain employer circumstances, obviously,
15:05
that dictate, if you will, where a specific
15:09
rate increase for an employer is gonna fall,
15:12
certain benefits, etcetera, the utilization patterns of the
15:15
group and so forth. But,
15:18
it it costs are elevated. They have been
15:20
elevated for a couple of years, and it
15:22
sure looks like they're gonna continue to be
15:24
elevated with even some acceleration
15:27
of that elevation into 2026.
15:30
So
15:30
when prices for health care products and services
15:33
increase year over year,
15:35
there's no doubt that it impacts employers. It
15:38
impacts,
15:39
us as insurers. It impacts the government in
15:41
their programs like Medicare. And so there's a
15:44
lot of factors that have an impact on
15:47
this. You,
15:48
quoted some of those. We're absolutely
15:50
seeing costs in that in that area of
15:53
specialty drugs and pharmacy in general. So all
15:56
sorts of pharmaceuticals, but with a focus on
15:59
specialty drugs and that's coming in a number
16:01
of ways. It's just coming through
16:03
cost increases from pharma and it's also coming
16:06
through increased adoption of some of the more
16:08
expensive drugs that are replacing
16:10
less expensive drugs.
16:12
Certainly continuing to see chronic conditions as you
16:15
indicated
16:17
in continued
16:18
elevated utilization of behavioral health. We really saw
16:21
that in start in COVID. It's continued
16:24
since then.
16:26
That's an example of where spending more on
16:28
behavioral health for the people that need it
16:31
is appropriate and it's something that we work
16:33
hard every day to enable. So
16:36
costs are up. Yes.
16:39
Through some things that
16:40
we really need to be careful about and
16:42
sensitive to and I would put the pharmaceuticals
16:44
in that category and there are other things
16:46
where costs are up because people need to
16:47
care and I put behavioral health in that
16:49
category. So we seek to manage across all
16:53
of those areas
16:55
containing cost, as much as we can in
16:57
negotiations
16:58
with with pharmaceutical manufacturers and others,
17:02
ensuring that we're balanced in payments to providers
17:06
and continuing to lead to broad access to
17:09
our members, but at the same time,
17:11
fare increases from an employer's perspective,
17:14
as well.
17:15
And then making the increased needs for care
17:19
like behavioral health, doing so in the most
17:21
efficient way, working really hard and using technology
17:25
to help us align the needs of a
17:27
consumer
17:28
with the capabilities
17:29
of a provider.
17:30
And you can think about the needs of
17:32
of different folks in behavioral health situations, and
17:36
and not everyone needs a psychiatrist.
17:38
Many of them need a counselor, a specialized
17:40
counselor.
17:41
Some can,
17:43
have all of their needs met through digital
17:45
interaction.
17:46
And so working really hard to align best
17:49
resource with needs of the patient
17:52
is helping us manage those costs as well.
17:55
So,
17:56
we've got a broad effort that approaches all
17:59
of these things in a number of ways.
18:01
And at the same time,
18:03
I'm also sensitive and aware of what Surest
18:05
is doing. We talked about that, and we
18:07
talked about how how Surest drives savings. It
18:11
does so by also
18:13
helping manage this appropriateness
18:15
of resource to the needs of the patient.
18:18
Couple of examples in that area.
18:20
We have, you know, 14% lower e r
18:22
utilization
18:23
on Surest, but then three times
18:27
higher virtual visit
18:28
utilization.
18:30
So that's just
18:31
one example in one product of how we
18:34
seek to align the needs of the consumer
18:37
with the resources available.
18:39
That's an example of something that helps us
18:41
mitigate costs. Those savings come through insurance. They
18:43
gave you the behavioral health example.
18:46
There's
18:47
many others of examples like that as well
18:50
that we're using to help get after this
18:53
elevated trend in inappropriate ways.
18:56
So many detailed insights for me there, Dan,
18:58
about what is ultimately driving up health care
19:01
costs, especially as we look into next year.
19:04
And you touched on pharmaceuticals, and and that
19:07
is really one area where we are constantly
19:09
hearing from insurers right now about what is
19:11
driving up premiums
19:13
for their members in part.
19:15
So so let me follow-up on that with
19:17
you about GLP ones specifically.
19:20
It it's, of course, it's top of mind
19:21
for employers given their high costs, the adherence
19:25
challenges we we hear about.
19:27
So how are how is UnitedHealthcare
19:30
considering the balance for that employer demand for
19:33
access to these medications
19:35
with the need for long term sustainability
19:38
with plan design and and the cost trends
19:40
that we're seeing?
19:42
Yeah. Boy, you're absolutely right to touch on
19:44
that topic and absolutely on point as far
19:47
as one of the things most talked about
19:48
with employers.
19:50
We get questions about GLP ones from employers,
19:53
all the time. I would suggest that it's
19:56
nearly every every employer has questions about GLP
19:58
one, and and we really work hard to,
20:02
help understand the needs of each employer and
20:05
customize solutions
20:07
for them.
20:08
It's
20:09
demand for GLP ones from consumers
20:12
at the current price point is absolutely
20:15
outpacing
20:16
the employer's ability to cover those costs. So
20:20
that's why employers are interested in various solutions.
20:23
So,
20:25
it's not a single solution, just
20:28
GLP one coverage or not,
20:30
is
20:31
is it's more complex than that. It's not
20:33
as simple as looking at it from an
20:35
employer perspective
20:37
of covering it or not. And the the
20:39
reasons behind that is it's a, you know,
20:41
upwards of a thousand dollars per patient per
20:43
month is the cost.
20:45
Perhaps there are some situations that can bring
20:47
that cost down,
20:49
and the high demand and the in some
20:52
employers, a relatively high percentage of employees
20:55
that would be eligible for suitable for for
20:58
such,
20:59
treatment,
21:01
really makes that unaffordable. So that's why we
21:03
work together with employers to put together more
21:06
comprehensive
21:07
weight loss solutions when they do seek to
21:09
cover GLP ones.
21:11
Help them think about the criteria by which
21:13
they want to cover those GLP ones.
21:17
And we've seen a good amount of innovation.
21:20
We've seen a good amount of innovation
21:22
emerge in that area with weight loss programs
21:25
taking a whole person approach.
21:28
So those include
21:30
pharmaceuticals, obviously, the GOP won many times, but
21:33
also clinical and behavioral support,
21:35
can be more effective.
21:37
You know, that's why we've developed a total
21:39
weight support program,
21:41
built to help encourage members to approach weight
21:44
loss, you know, more holistically,
21:46
more than just taking,
21:49
the medication itself. So
21:51
that's how we work through it with employers.
21:54
It's a difficult decision for them to cover
21:56
it. And you've seen in in,
21:59
your publications and others
22:01
how some insurers have moved to broad coverage
22:05
and then step back. You've heard of employers
22:08
who have stepped to broad coverage
22:10
and then step back.
22:12
So this is continuing to evolve. You know,
22:15
I'm encouraged
22:16
by what I read and hear from my
22:19
colleagues in the pharmacy space about the emergence
22:23
of
22:23
of more GLP ones,
22:26
perhaps moving to pill form, perhaps,
22:29
more manufacturers
22:30
of the injectable GLP ones
22:33
coming to the economy in the years ahead.
22:35
So I'm optimistic
22:37
that the cost of GLP ones will continue
22:40
to come down. I really do think that
22:42
is necessary. I think employers have told us
22:45
that. I think we and other insurers have
22:48
told the marketplace
22:50
that as well, that for widespread adoption to
22:52
be affordable,
22:54
we're gonna need more treatment options. We're gonna
22:57
need more
22:59
manufacturers, more delivery mechanisms getting to the pill
23:01
form,
23:02
perhaps. And and in the meantime,
23:05
however,
23:06
I think it's the solutions are more comprehensive,
23:09
whole person approach as I mentioned,
23:12
continued working with the manufacturers,
23:14
and then,
23:15
really information,
23:18
shared decision making, if you will, with employers
23:21
through distribution
23:22
channel and and employers with their employees as
23:24
well
23:25
to
23:26
try and find,
23:28
the most appropriate
23:29
offering
23:30
that still delivers affordability
23:32
for consumer,
23:34
and the employer. So,
23:36
much more to be talked about, and the
23:39
full full book on GLP one has many,
23:41
many chapters let to be written. But,
23:44
it's an issue for employers, and I think
23:46
it's gonna be one,
23:48
for years to come. That said, I am
23:50
optimistic that several years from now, we end
23:53
up with
23:54
the ability to offer
23:56
broader adoption
23:57
at affordable prices.
24:00
Absolutely. So clearly a very pressing and evolving
24:03
issue. It'll be fascinating to see how UnitedHealthcare
24:06
continues to tackle this and offer new solutions
24:09
to the markets.
24:10
Dan, as you said, there's so much more
24:12
we could talk about, but I know you're
24:14
a busy man. So I wanna thank you
24:16
for taking the time to chat with us
24:18
about all the latest happening under your leadership
24:21
at UnitedHealthcare
24:22
and for sharing your thoughts with us about
24:24
what's going on in the wider industry. We
24:26
truly appreciate it. Thank you, Jacob. I appreciate
24:29
the opportunity.
24:30
And to our listeners, if you'd like to
24:32
listen to more podcasts from Becker's Healthcare, you
24:35
can visit beckershospitalreview.com.