UnitedHealthcare expands use of data to manage chronic conditions

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A major health insurer says it will increase its use of data from digital devices to help Medicare Advantage plan members manage chronic conditions.

UnitedHealthcare says it plans to increase its footprint in providing personalized, holistic support through its Navigate4Me program, which it started in the fall of 2017 and is expanding this year. It’s part of the insurer’s effort to build a more effective care management program.

UnitedHealthcare’s Navigate4Me program is intended to better serve people enrolled in its Medicare Advantage plans who are facing complex health issues such as diabetes, congestive heart failure, multiple chronic conditions or sudden health events, such as joint replacement surgery or a new cancer diagnosis.

Navigate4Me enables holistic, whole-person care—nurses and highly trained customer service advocates serve as health navigators who reduce the burden of managing a serious health issue. Navigators provide support with both clinical and administrative needs, ranging from answering health questions and resolving claims or billing issues to helping people follow a personalized care plan, coordinating care and helping to address social determinants of health, such as connecting people with reliable transportation or housing assistance.

"We're building the next generation of care management by moving away from traditional models to a holistic approach that harnesses the power of real-time data and technology to deliver the right kind of individual support that can help people get well and stay well," said Brian Thompson, CEO of UnitedHealthcare Medicare & Retirement. "Combining new data-driven insights with the human touch of our care teams will deliver a more personalized health experience."

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UnitedHealth Group Inc. headquarters stands in Minnetonka, Minnesota, U.S., on Wednesday, March 9, 2016. Photographer: Mike Bradley

The initiative will use what the insurer calls its UnitedHealthcare Nerve Center, a digital platform and data hub that operates like a command center for UnitedHealthcare navigators, pulling data from a variety of sources, including claims, clinical and demographic information, and digital devices such as wearables and sensors, to build comprehensive health profiles for plan participants.

The profiles give health navigators the full picture of a person's health, including everything from routine checkups and recent emergency department visits to information transmitted via wearables and sensors showing how well they are managing their conditions or adhering to their doctor's treatment recommendations.

Based on analysis of the health profiles, the Nerve Center helps navigators identify future health actions that could be appropriate for each person and anticipate upcoming care needs, while continuously screening for risk factors. That enables health navigators and other members of the care team to focus engagement efforts on the people in most need of support, based on their likelihood of experiencing a negative health event, such as a hospitalization or a worsening of their symptoms.

It also provides navigators with personalized information that can help patients and care providers choose the best clinical approach and close gaps in care. When appropriate, the Nerve Center will also integrate data directly into doctors' electronic medical records, helping them deliver more evidence-based care for their patients.

Navigate4Me and the Nerve Center are part of UnitedHealthcare's efforts to modernize the way it manages care for those enrolled in its Medicare Advantage plans. About 40 percent of the people enrolled in UnitedHealthcare's Medicare Advantage plans have four or more chronic conditions, and nearly the same percentage live alone.

“These individuals are especially vulnerable when dealing with serious health issues and trying to navigate a complicated healthcare system,” Thompson says. “Yet many are digitally savvy and accustomed to leveraging technology and mobile tools to manage other areas of their lives.”

For example, patients with congestive heart failure may use a Bluetooth-enabled tablet, scale and blood pressure monitor to manage and monitor their condition in partnership with their doctor and with support from the UnitedHealthcare care team. Daily prompts to record their weight and answer questions via the tablet can identify sudden spikes in weight that could signal that the heart isn't pumping properly, putting the patient at risk of hospitalization.

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