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Becker’s Healthcare Podcast
Innovating Consumer Choice and Cost Management at UnitedHealthcare with Dan Kueter
00:24:41
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- [00:02]
A
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- [00:42]
B
Hello everyone. This is Jacob Emerson with the Becker's Payer Issues podcast. Thrilled today to be joined by a very special guest. Dan Keeter is the CEO of UnitedHealthcare's employer and individual insurance business. As an $80 billion division of UnitedHealthcare, and it's the nation's largest company that offers health coverage to employers and consumers nationwide. Dan, thank you so much for taking the time to sit down with me on the podcast today.
- [01:09]
C
Hi Jacob, great to be with you and thanks for the invitation.
- [01:13]
B
Absolutely. And before we dive into everything, we want to talk with you about, Dan, can you tell us a little bit more about yourself, your background in healthcare and what it is that you're doing today at UnitedHealthcare?
- [01:24]
C
Yeah, sure can. As you said, I'm the CEO of our employer and individual business. So that's the commercial business within UnitedHealthcare Care and UnitedHealth Group. I joined the company first back in 2001 and since then I've served in a series of roles across the organization, largely concentrated in the commercial market. However, and enjoy this role, grateful to have it. Grateful to interact with all the employers, distribution channel consumers and other constituents that we have in the healthcare segment. I oversee a diverse portfolio of commercial health plans ranging from traditional fullium plant, fully insured plans across the country, self insured plans, and a full scope of ancillary individual and voluntary offerings.
- [02:13]
B
Fantastic. Well, like I said, Dan, we really appreciate you taking the time to be with us today. I want to get us started by talking about something brand new from UnitedHealthcare just announced and that is the UHC Store. So take us through what this is and how you see this kind of offering changing the way that employers and your members interact with their health benefits.
- [02:35]
C
Yeah, sure, I appreciate that question. UHC store the UnitedHealthcare store, as we talk about was just launched. It's a new direct to consumer and a digital shopping experience. It's an important part of our continued efforts and another step forward in giving consumers more choice. The goal here is to help consumers improve the customization of their benefit plan and do so in a very consumer friendly experience. Tech Enabled Solutions the store is now available to 6 million members and we expect it'll be available to 18 million members as soon as the end of the year. It's available through our app and through myuhc.com as well, of course, and it helps consumers customize the experience for their specific needs, customize the offerings available to them. So let me give you a couple of examples of that. Offerings inside the store include popular weight loss programs, orthopedic management apps, women's health solutions and more. So folks can choose an offering ranging from an everyday health offering like those in women's health and mental health. I think people are quite familiar with some of the leading apps out there. We make those available to consumers. Think of Maven as a perfect example in the women's health space. Family wealth, wellness, resources for family planning for caregivers, pregnancy, postpartum needs, things like that. And then obviously weight management, something that's talked a great deal about in healthcare today and has a lot of consumer interest. So we have offerings out there for weight management, coaching, nutrition, fitness, things like that. And then for other more complicated and consumer specific situations, we offer solutions and enable their easy enrollment and program for diabetes or other gastrointestinal issues, musculoskeletal kind of orthopedic considerations that folks may have. So through the UHC store and enrollment in that way, it allows people to save money, customize the solutions that are best for them and their family. They can save, you know, 15% or more in some of these and by doing so through the UHC store, it allows us and our consumer member advocates to be aware of these enrollments and help better coordinate more comprehensively and in a more customized fashion the care for the consumers. So it's one more example of how I think we're listening to the market, listening to our members, our employers and the distribution channel to bring more customization to consumers and allow them to make choices that best fit their needs. And as you can tell by my example of Maven and others, if I were to go through the list, they would be solutions that people have heard of. We're trying to bring together the best that the healthcare marketplace has to offer consumers and integrate that into their benefits program.
- [05:52]
B
Absolutely. Well, I really appreciate you sharing all the details there for us, Dan, about the new UHC store. And it's so interesting to hear you talk about all that because consumerism is really something we've heard a lot about from UnitedHealthcare leaders over these last few years in terms of where the company is leaning with innovations like Surest and a revamped provider search experience recently. So I'm wondering if you could tell us a little bit about that in terms of lessons you've learned from Surest's rapid growth and how that's influencing how you're designing other commercial products.
- [06:28]
C
Yeah, sure. I really appreciate you raising Surest. It is something I like to talk about a lot. I'm a Surest member myself and it works great for my family and me. And it is absolutely an innovative model and example of where we've listened to the market and are delivering to consumers what they most want. The innovative model certainly delivers cost savings to consumers and employers. The 10 to 15% range for employers and up to 50% for consumers. So we've learned a great deal about that. While we really deliver to consumers and employers what they most want, they most want affordability and simplicity. That's what we hear from them. And simplicity, of course, includes transparency. Suresta delivers all of that in a very consumer friendly, intuitive digital shopping experience that's really unlike other things out there in healthcare. Historically, the healthcare industry has been accused, maybe rightfully so, of lagging other industries in our adoption of online solutions, contrast to retail or digital banking or things like that. And Surest is really a big leap forward for us, our initial leap forward and things like UHC Store continuing to push that forward. So what have we learned through this? We've learned that indeed consumers do want more choice, they do want more transparency. They want more of a retail experience in healthcare that mirrors what they experience with their online shopping, whether that be retail oriented or shopping for plane tickets, concert tickets, et cetera, things like that. Folks want transparency, they want choices and they want to know the cost and quality and convenience impacts of those choices. And so Surest has delivered that along with the economic savings that I described. And it's really helped us fine tune the UHC store to carry forward some of those same tendencies, those same capabilities, and be responsive to what consumers want. So these are our first two forays in this area, most notable built on the back of dramatic improvements as you highlighted on our digital app over the past few years. But you can continue to expect more from us in this regard as well.
- [08:56]
B
Absolutely. Well, that's some amazing numbers you cited there in terms of some of the major cost savings you're seeing from Surest in terms of employers and what members are seeing. That's fantastic. Dan, you mentioned where the healthcare industry may have fallen behind other industries in the past in terms of consumerism. And one area where we've heard across the industry, where the healthcare industry is trying to make up some ground here, is through the use of artificial intelligence. And recently we heard from UnitedHealth Group that the company now has more than 1,000 AI use cases in production across the enterprise. So within the commercial business that you oversee, where are you seeing some of the biggest impacts of AI and machine learning on the member experience and on cost management?
- [09:44]
C
Yeah, sure can. So I appreciate that and you're exactly right. I think industry wide all of healthcare is really moving in the direction of AI and embracing it in so many ways. That's absolutely true inside our company and no doubt that the responsible use of AI I think holds tremendous promise to simplify and help us further create value. And what we all know is a, is a more complex American healthcare system than any of us wishes. So we're using AI in some of the areas that you identified. Let me give you a couple of examples. So when it comes to health benefits and the experience using AI, there a good bit working with partners like Optum, but also others to develop applications to provide for more seamless, quicker, faster to answer interactions with our advocates, whether that be when a member calls in or uses an AI chatbot. We now have tens of millions of AI enabled searches to help customers, consumers and to surely help them with things like find a doctor, inquire about a claim, determine where they are on their deductible accumulation should they have one. But then at the same time also helping our agents on the inside be more responsive, get faster to answers. As I indicated, as AI is pulling forward to our advocates that are on the phone with a member or interacting with them, perhaps in another digital form, pulling forward recommended answers, anticipating what the next question and answer is going to be. So it is really speeding up the process. Some other specific areas, Smart choice provider search capability we call it. It leverages AI and delivers a more personalized experience for a member. You know, four key standards come to mind to help a member find the provider that they want, interested in sorting on quality or searching by benefits or looking for other convenience factors like schedule opportunities or proximity to their home or work and then allowing consumers to search for other items of personal preference and personal choice, perhaps the language skills and capabilities of the provider, gender, things of that nature. And also then really using AI to help provide assistance to consumers with a members like you type of orientation. So things that we know about a member that they share with us, what are the choices that other members like them may have made about using our app, about seeking a provider, and things like that. So as AI gets more data within our systems at its disposal, it will continue to improve with these predictive capabilities. It will continue to deliver a richer experience for our members that I think they will find to be more seamless, quicker to answer, really much more like that retail experience that we keep talking about.
- [13:06]
B
Absolutely. It makes a lot of sense. And really at the core of things, it sounds like you're looking to provide quicker information, better answers about care and benefits to your members and to your customers. Dan, I want to switch gears here for a second and talk a little more macro context about what's affecting the industry right now, especially as we head into next year. We're hearing from employers all over the country and from groups that analyze what employers are saying at large about the healthcare cost increases that they're estimating that they're bracing for as we go into next year. We're seeing anywhere from 6% to 10% cost increases in 2026 driven by factors like catastrophic claims, specialty drugs, coverage of chronic conditions. So what are you hearing most consistently from your jumbo and large employer clients right now about how they're preparing for this?
- [14:05]
C
Yeah, boy, it's something that we listen really closely to, take very seriously. And at the same time, we're obviously always analyzing our own data, listening to what our competitors in the marketplace are saying about their visibility to trend, and just working always to get a comprehensive view of that and share it with our employer customers, prospects alike, and obviously the distribution channel. And this, as I said earlier, customers and consumers are most interested in affordability and then simplicity right behind that. So employers are absolutely concerned about rising costs and you quoted 6 to 10%. And I think in places we're going to see it above that. I've heard recent commentary from some other leaders in the industry, counterparts of mine, if you will, in various places where they're expecting rates to be well above that in some pockets of the country. And I think that's right. There's always geographic variation, there's certain employer circumstances obviously that dictate, if you will, where a specific rate increase for an employer is going to fall, certain benefits, et cetera, the utilization patterns of the group and so forth. But costs are elevated. They have been elevated for a couple of years, and it sure looks like they're going to continue to be elevated with even some acceleration of that elevation into 2026. So when prices for health care products and services increase year over year, there's no doubt that it impacts employers, it impacts us as insurers, it impacts the government in their programs like Medicare. And so there's a lot of factors that have an impact on this. You quoted some of those. We're absolutely seeing costs in that area of specialty drugs and pharmacy in general. So all sorts of pharmaceuticals, but with a focus on specialty drugs. And that's coming in a number of ways. It's just coming through cost increases from pharmen, also coming through increased adoption of some of the more expensive drugs that are replacing less expensive drugs, Certainly continuing to see chronic conditions, as you indicated, in continued elevated utilization of behavioral health. We really saw that start in Covid. It's continued since then. That's an example of where spending more on behavioral health for the people that need it appropriate. And it's something that we work hard every day to enable. So costs are up? Yes, through some things that we really need to be careful about and sensitive to. And I would put the pharmaceuticals in that category. And there are other things where costs are up because people need the care. And I put behavioral health in that category. So we seek to manage across all of those areas, containing cost as much as we can in negotiations with, with pharmaceutical manufacturers and others, ensuring that we're balanced in payments to providers and continuing to lead to broad access to our members. But at the same time, fare increases from an employer's perspective as well. And then making the increased needs for care like behavioral health, doing so in the most efficient way, working really hard and using technology to help us align the needs of a consumer with the capabilities of a provider. And you can think about the needs of. Of different folks in behavioral health situations. And not everyone needs a psychiatrist. Many of them need a counselor, a specialized counselor. Some can have all of their needs met through digital interaction. And so working really hard to align best resource with needs of the patient is helping us manage those costs as well. So we've got a broad effort that approaches all of these things in a number of ways. And at the same time, I'm also sensitive and aware of what Surest is doing. We talked about that and we talked about how Surest drives savings. It does so by also helping manage this appropriateness of resource to the needs of the patient a couple of examples in that area we have, you know, 14% lower ER utilization on surest, but then three times higher virtual visits utilization. So that's just one example in one product of how we seek to align the needs of the consumer with the resources available. That's an example of something that helps us mitigate costs. So savings come through insurers. They gave you the behavioral health example. There's many others of examples like that as well that we're using to help get after this elevated trend in appropriate ways.
- [18:57]
B
So many detailed insights from you there Dan, about what is ultimately driving up healthcare costs, especially as we look into next year and you touched on pharmaceuticals. And that is really one area where we are constantly hearing from insurers right now about what is driving up premiums for their members in part. So let me follow up on that with you about GLP1s specifically. Of course it's top of mind for employers given their high costs, the adherence challenges we hear about. So how are, how is UnitedHealthcare considering the balance for that employer demand for access to these medications with the need for long term sustainability with plan design and the cost trends that we're seeing?
- [19:42]
C
Yeah boy, you're absolutely right to touch on that topic and absolutely on point. As far as one of the things most talked about with employers, we get questions about GLP1s from employers all the time. I would suggest that it's nearly every employer has questions about GLP1 and we really work hard to help understand the needs of each employer and customize solutions for them. Demand for GLP1s from consumers at the current price point is absolutely outpacing the employer's ability to cover those costs. So that's why employers are interested in various solutions. It's not a single solution, just GLP1 coverage or not. It's more complex than that. It's not as simple as looking at it from an employer perspective of covering it or not. And the reasons behind that is it's upwards of $1,000 per patient per month is the cost. Perhaps there are some situations that can bring that cost down and the high demand and the in some employers, a relatively high percentage of employees that would be eligible for suitable for such treatment really makes that unaffordable. So that's why we work together with employers to put together more comprehensive weight loss solutions when they do seek to cover GLP1s, help them think about the criteria by which they want to cover those GLP1s. And we've seen seen a good amount of Innovation. We've seen a good amount of innovation emerge in that area with weight loss programs taking a whole person approach. So those include pharmaceuticals, obviously the GLP one many times, but also clinical and behavioral support can be more effective. You know, that's why we've developed a total weight support program built to help encourage members to approach weight loss, you know, more holistically, more than just taking the medication itself. So that's how we work through it with employers. It's a difficult decision for them to cover it. And you've seen in your publications and others how some insurers have moved to broad coverage and then step back. You've heard of employers who have stepped to broad coverage and then stepped back. So this is continuing to evolve. You know, I'm encouraged by what I read and hear from my colleagues in the pharmacy space about the emergence of more GLP1s, perhaps moving to pill form, perhaps more manufacturers of the injectable GLP1s coming to the economy in the years ahead. So I'm optimistic that the cost of GLP1s will continue to come down. I really do think that is necessary. I think employers have told us that, I think we and other insurers have told the marketplace that as well, that for widespread adoption to be affordable, we're going to need more treatment options, we're going to need more manufacturers, more delivery mechanisms, getting to the pill form perhaps. And in the meantime, however, I think the solutions are more comprehensive. Whole person approach. As I mentioned, continued working with the manufacturers and then really information shared decision making if you will, with employers through the distribution channel and employers with their employees as well, to try and find the most appropriate offering that still delivers affordability for consumer and the employer. So much more to be talked about in the the full book on GLP1 has many, many chapters left to be written, but it's an issue for employers and I think it's going to be one for years to come. That said, I am optimistic that several years from now we end up with the ability to offer broader adoption at affordable prices.
- [24:00]
B
Absolutely. So clearly a very pressing and evolving issue. It'll be fascinating to see how UnitedHealthcare continues to tackle this and offer new solutions to the market. Dan, as you said, there's so much more we could talk about, but I know you're a busy man, so I want to thank you for taking the time to chat with us about all the latest happening under your leadership at UnitedHealthcare and for sharing your thoughts with us about what's going on in the wider industry. We truly appreciate it.
- [24:28]
C
Thank you, Jacob. I appreciate the opportunity.
- [24:31]
B
And to our listeners, if you'd like to listen to more podcasts from Becker's Healthcare, you can visit Beckershospitalreview.com.