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Changing U.S. health care for good

The covid-19 pandemic has validated opportunities to close care gaps in our fragmented system. Doctors, innovators and advocates are hard at work creating a more united approach.
The covid-19 pandemic has validated opportunities to close care gaps in our fragmented system. Doctors, innovators and advocates are hard at work creating a more united approach.
By Dan Schumacher, President/COO, Optum

When a physician suspects a patient has heart disease, they put their patient through a stress test. By monitoring the patient’s heart function while exercising, the physician can more effectively diagnose and treat the problem.

Covid-19 has been a stress test for our entire health system. Over 2 million people in the United States have been diagnosed with the virus, while doctors, nurses and first responders have served under the most extreme conditions to provide patients and families with the compassionate, high-quality care they need.

While our frontline health professionals performed heroically, the outbreak has put a spotlight on a persistent and long-standing challenge: health care in the United States is fundamentally disconnected. The system is composed of care providers, health plans, pharmacies and others that lack a unified technology infrastructure needed to share data and communicate with each other efficiently and effectively. The ability to rapidly share information and coordinate across the health system is especially important during a major pandemic, as health officials attempt to accurately report cases, detect outbreaks and help hospitals prepare for a possible surge.

A connected, informed and effective system—one that relies on data and actionable insights to put the right information in the right hands at the right time—is essential to improving patient care and well-being. Because while many health professionals may deliver quality services, the lack of coordination among them often leads to inefficient and inconsistent care for patients and wide variation in local health system performance. Covid-19 has put these realities under a microscope and they will continue to impact patient care in the future…unless we act now and together seize this moment to build a health system that truly works better for everyone.

Optum is bringing the health system closer together with health intelligence, data interoperability, leading-edge technology and deep clinical expertise. And we don’t do it alone. We bring distinct and broad capabilities to the people we serve—including through direct care delivery, advanced technology and pharmacy care services—and collaborate with forward-thinking customers, care providers, health advocates and other health system leaders to deliver better care and experiences to everyone, at more affordable costs.

The costs of disconnected care

A fragmented health system impacts millions of American every day. The United States lags behind other developed nations on both health outcomes and access to care. Six in 10 adults in the U.S. have a chronic disease. Meanwhile, the country has a higher rate of hospital admissions for preventable diseases than its peers. This isn’t for lack of investment. The U.S. spends $3.6 trillion annually on health care, nearly 18 percent of our gross domestic product—more than any other developed nation.

In an efficient, coordinated health system, primary care physicians are the hub for patient care delivered by a network of providers. They collaborate with laboratories to test for conditions, specialists to dig deeper into diagnosis and treatment, and pharmacists to dispense the right medications. Unfortunately today, according to a recent study, only about half of primary care providers in the U.S. say that they receive patient information—changes to medication lists, for example—from specialists outside their practice.

Medical care received in a doctor’s office or hospital is just part of the picture. It accounts for only 10 to 20 percent of overall health outcomes. Other key factors include a wide range of social determinants such as income, housing security, even access to basic transportation services.

Today, much of our health system isn’t equipped to consider a more complete range of inputs. Doctors can deliver top-notch medical treatment to a patient with diabetes in their office, but any progress may be short-lived if dietitians, pharmacists and other health providers aren’t working hand-in-glove with providers to support the patient at home.

The future is whole-person care

A connected health care system is one that advances whole-person care, an approach that synchronizes medical, behavioral and social interventions to address all of the factors that affect health outcomes. Optum teams have been at the forefront of whole-person care long before the pandemic, advancing new approaches and solutions that are driving better health for people today, including among the most vulnerable patients.

One example is integrated pharmacies. Because people with serious mental illness face multiple barriers to recovery, Genoa Healthcare—part of OptumRx—brought pharmacy services into community mental health clinics. Physicians, pharmacists and mental health professionals work together with patients to ensure they have the support they need to follow their treatment plans. As a result, more patients take their medications as prescribed—reducing emergency room visits and hospitalizations. OptumRx research shows that coordination among pharmacies, providers and health plans results in better care for patients at lower costs—including finding that individuals who use integrated pharmacy services save 15% on inpatient medical costs.

Innovations in data analytics and technology are also helping doctors deliver more cohesive and proactive patient-centered care. Optum, for example, is enabling clinical data exchange that improves the collaboration between payers and providers. On the technology side, Optum is among a number of organizations that have developed advanced telehealth solutions, allowing patients to speak with their care providers live through digital devices. These services vastly improve access to care for those who may be homebound, like disabled and elderly individuals.

Another example is remote patient monitoring. With the help of smart devices, providers can keep track of important patient information, such as fluctuating glucose levels, and detect problems before they escalate. This type of real-time, intelligent care coordination helps ensure the patient is getting the right treatment, when and where they need it.

Community outreach is a key piece of the puzzle, too. For instance, a program in Chicago—a collaboration of care providers and housing organizations—connects the dots between good health and a safe place to live. The initiative, which isn’t affiliated with Optum, provides support for chronically ill patients who are homeless, combining treatment coordination, housing case management and other services. The benefits were significant: One hospital linked with the program reported a 57% reduction in inpatient stays among participants.

There’s a lot of work ahead to build a more connected health system, and to the challenge we are bringing the full dedication of our people, our distinctive capabilities and our relationships with everyone we are privileged to serve across the health system.

Like a heart patient’s stress test, covid-19 has helped make the diagnosis clear: we have to embrace new ideas, partnerships and technologies to build a more unified, responsive and effective health system—one that improves care, one patient at a time.

To learn more on how to change health care for good, visit https://www.optum.com/how 

Dan Schumacher serves as president and chief operating officer of Optum, a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone.


Sources:

Centers for Medicaid and Medicare Services

The Commonwealth Fund

Peterson-KFF Health System Tracker

Credits: By Dan Schumacher, President/COO, Optum.