Interview: UnitedHealth Group on mobile health

By Brian Dolan

Dr Migliori UnitedHealth GroupMobiHealthNews recently interviewed Dr. Richard Migliori, executive vice president of UnitedHealth Group, about the payor's mobile health strategy, activities, apps and services. Migliori said that mobile health can help improve access to care and help the increasingly overburdened physician base better meet the needs of patients. Migliori explained the role of mobile apps backed by employer incentives in bringing about the payer's vision for mobile health. Interestingly, United, itself, is among those employers that are using mobile health apps to help employees achieve wellness benchmarks.

Here's an edited transcript of our interview with Dr. Migliori:

What is UnitedHealth Group's mobile health strategy?

For us, our mobile health strategy is one in which we try to make the healthcare system work better for more people. Currently, the ability for people to access more sophisticated tools that we and others in our industry have built has been constrained to just a few different routes. One of which is nurses calling patients to share insights about healthcare analytics. Another is mailings to peoples' homes, and those frequently get ignored. Still another route is through [Internet] portals that tend to have varying levels of adoption. What we look at mobile health as is an opportunity, not as an end in itself, but as a means by which people can take advantage of the informational assets that we can bring to help them make better health decisions.

Also, we are starting to recognize that there is an opportunity to link better with the physicians that are serving our clients (their patients) by providing them with better access to our data. Day to day decisions made by both patients and physicians are the greatest determinants of effectiveness of healthcare. We have spent the last few decades building decision support capabilities by analyzing claim data and other data streams, including pharmacy data, laboratory data, health risk assessment data,  biometric data, and the like. We provide people a reflection back on the data that has been submitted on their behalf so that they can recognize the challenges that are confronting them on a personal level. We can then provide them with some -- if not advice -- at least some recognized opportunities that they should consider.

As I said, we have been providing people with those insights through various routes, but what we have found is that when we use mobility -- telecommunications and other forms of electronics -- we are able to reach more people. So, what we are focusing on is using this mobile health technology to help people make better decisions.

So far, what kind of insights or information has United provided through mobile platforms?

Well, here's an example of one of the most important: Picking a physician. We have a tool that works with Android, BlackBerry and iPhone devices called DocGPS. It's a simple tool that helps people use GPS technology to recognize which physicians (by specialty) are located in their immediate location. That's wherever they are. The physicians are ranked not only by distance but also by quality scores so that when people make decisions about physicians they are fully informed about who is available and where. They are also informed as to how each physician compares with the others based on the quality data we have on each of these physicians.

We started building the data sets on physician quality in 2005. Then in 2006 we made that information available on an online portal. During the past 12 months we released these free applications through the mobile app stores.

What triggered the move to mobile twelve months ago?

Well, it's both an existing and anticipated trend. One of the things we recognize is that for the healthcare system to succeed, it is going to have to become more sustainable. We are doing the right thing in terms of healthcare reform by expanding coverage, but in order for that coverage to be sustained, we really need to make that coverage more affordable. One of the things we have found is that doctors who practice at a high degree of reliable quality are also some of the most cost efficient physicians.

Let me give you a case in point: Orthopedic surgeons who rank in the highest quartile of performance are 21 percent less expensive than physicians who rank in the lower quartile of quality. Our highest quality orthopedic surgeons, because they have fewer complications and their patients do well more quickly, have a patient base that is far less expensive. So we spend quite a bit of time helping people to recognize the difference amongst orthopedic surgeons so that they can make choices about where they go.

About 44 percent of our physicians enjoy that kind of rating and are seeing about 70 percent of our care volume. We start looking at that kind of selective use of physicians, and it helps us have an interest in transparency and helps us see an opportunity to use mobile health technology to make that kind of transparency more readily available to the user. We know that people have these mobile technologies on them on a regular basis. Instead of trying to get people to use tools that we grew up on, we found it more important for us to adapt to the way in which people use things. That's why we adapted more conventional tools to these more exciting forms for engagement.

Has United developed other mobile health services besides smartphone apps?

Other things we do with mobile health: We send messages to people reminding them about preventive screenings when our data shows it may be time for them to get a mammogram or colonoscopy or something. Likewise, for patients on medications who may have stopped refilling those prescriptions, we have the ability to send prompts or reminders to them to talk to their doctor about continuing it.

Some have said that payers are interested in mobile because it increases their one-on-one relationship with their customers. Is that a fair statement in terms of the key driver here?

I think it's a fair statement. Health is built on intimacy. Whether we are sharing this information with a patient or physician, we think that mobile technology will allow us to become a greater part of their lifestyle, because we are joining their lifestyle not trying to redirect it. For physicians we are trying to become more deeply embedded in their workflow rather than distracting them. We knew we had built robust and precise tools that people could use to improve their health status. What we needed to do was step up the game in terms of getting people to take advantage of it. To do that it wasn't a matter of doing something more sophisticated, it was a matter of becoming a bigger part of their lives.

How does United let their customers know about its mobile health services? How do you drive adoption?

OptumizeMeThat's a great question. There are a few components. One is: Make it simple by using simple and attractive mobile technology. Last week one of the premier applications at the Windows Phone 7 launch was OptumizeMe. It's a game that takes advantage of social media and enables people (who have similar equipment) to exchange cooperative or competitive challenges around certain health parameters. It can also support the application of incentives that an employer may put in place. So, first step to drive adoption: Make it simple and attractive to use.

Second: Make it relevant and personalized. The information that is there should be about them and pertinent to them. It should also be delivered under very secure circumstances, of course. Distributing broad public health messages about getting a flu shot are one thing, but to be able to talk to somebody about their specific healthcare challenges, makes it much more relevant and valuable.

Third: Incentivize use. We are seeing some advanced employers use incentives coupled with mobile. With United Health Group's own employees we measure biometrics for the employees and their spouses. We collect blood sugar, body mass index, fasting blood sugar and cholesterol levels -- all of which are indicative of health status on a sophisticated level. People who have abnormal readings are required to get into a wellness program to normalize the metrics. Those employees with higher biometrics who enroll in programs and those who have normal readings get a significant contribution towards the following year's health insurance premium out of their paycheck. The amount will be about $900 next year. If you ignore the management of biometric abnormalities you may have such as blood pressure, glucose, BMI,  you could spend as much as $900 more for your insurance next year. We had a 600 percent increase in the use of wellness programs when we did that.

By using mobile applications we are making it easier for people to comply with those programs.

How would an app like OptumizeMe tie into the employer side of it?

Let's say the employer has an incentive program in which your body mass index should be below 25. If it's not then you need to get involved in a program to normalize your body mass index. We know that two-thirds of people have a body mass index in excess of 25. One of the ways of satisfying it is to use the OptumizeMe program to get engaged in challenges that are collated to certain markers of performance for exercise and weight that you have recorded into the system. The app's user can record activity and other accomplishments and find engagement and trending tools all in one program. Using OptumizeMe can satisfy your participation and earn the rewards points you need to get a subsidization of your following year's insurance plan.

It's often said that payers don't reimburse for many mobile health services, particularly remote monitoring services. The general consensus is that payers have been slow to get onboard. Fair?

That may be the case with others. In fact, right now there are physicians that do telemedicine visits for our own employers at our headquarters and these physicians are reimbursed at the same rate as if they were sitting in the same room at the patient. So, we see well past that. We believe Medicare is also going to be changing things, although they will go through their own deliberations on that. We have gone well past it. It's a documented visited. The only thing that's different is that the patient and physician are not in the same room. We know that the same things are going on. In fact, we even now have a digital recording of it.

Thank you, Dr. Migliori for your time today. Any closing thoughts?

Yes, I'd like to leave you with a few thoughts. When we look at mobile technology and what it has allowed us to do, we find that it has enabled us to engage more people in prevention and wellness programs. It has helped people to make decisions when they need to access the health system, as is the case with our DocGPS app. The third thing we are looking at in terms of use cases for [mobile health] is in managing chronic care both in the hospital and at home. Finally, we are looking at connected care with out-clinics and looking at the ability to improve access in areas where wait times for physicians are only going to grow.  These programs are needed what with more covered lives and an unchanged physician base.