[INTRO MUSIC]
[Text On Screen – A panel discussion on women’s health. Part 1: Gender and Ethnicity Differences]
[STEPHANIE FEHR AND A PANEL OF SPEAKERS SITTING ON A STUDIO SOUND STAGE, SPEAKING TO THE CAMERA, WITH A WHITE SCREEN DISPLAYING: WOMEN’S HEALTH]
STEPHANIE FEHR: Welcome. We're so excited to be here with you talking about women's health. This is a topic we are all so excited about and passionate about.
[Text On Screen – Stephanie Fehr, Chief People Officer, UnitedHealthcare]
I am Stephanie Fehr, and I am privileged to lead the people teams at UnitedHealthcare and serve as their chief people officer. I'm also so fortunate to work with an esteemed panel today, people who care deeply about this topic and are really excellent. I'm going to start by introducing them. I'm going to start with Dr. Lisa Saul. Lisa serves as our chief medical officer and the head of women's health at United Healthcare. And I've worked with her for some time, and she's a delightful expert in this area, and we're going to hear from her soon. I'm going to go then to Will Porteus, and he is our the chief growth officer for Maven. Will and I have worked together for some time and Maven has become a really important partner to us, and our relationship with Maven continues to grow. And we'll talk to you about Maven and the services they provide to our employees and our consumers. And then I'm going to go to Alison, who is our chief executive officer for Surest. Alison is really on a rocket ship. Surest is an incredible product and is changing, really, the face of healthcare. And we're super excited to have her here talking about Surest with all of you. So why are we talking about women's health and, really, what is our objective? We have the good fortune of having a lot of data around women's health, and that informs the trends that we see over the course of a woman's health journey. That also informs the type of products and services that will help women navigate their health journeys. As we've gone through the last few years, I know it's been incredibly rewarding for me, and I think all of you, and we've had some incredible discussions and dialogue that, honestly, have really informed how we want to service our customers and our own employees. And that's what we're going to talk to you about today. But let's start with just some high level numbers, and they always astound me because just the scale is incredible. But we'll start with women's health by the numbers. We service, just in our commercial book of business, 5.2 million women age 18 and over. So just getting your head around that is hard. But then when you think about we have 44 million total member interactions in just one year. When you think about that, in itself, the scale is incredible. And it won't surprise you to know that women are the key decision maker, typically, in their household. They not only make the decisions for themselves, but they make decisions for their family. They make 43.3 million healthcare decisions just last year alone. We also supported 192,000 deliveries, 4,206 hysterectomies, and 9,539 fertility treatments. So there is so much going on in women's health. It deserves conversation. It deserves good problem solving and analysis, and that's why we're focused on it and talking about it today. So with that, we want to start with an overview of Surest, Alison, if you wouldn't mind. Surest is a new product for us, and I truly believe it's transforming healthcare, so we'd love to start with you, if you don't mind.
ALISON RICHARDS: Sure, Stephanie. Thank you. What a great opportunity. There's so much going on.
[Text On Screen – Alison Richards, Chief Executive Officer, Surest]
Surest is what I would say is just a different approach to how we're delivering health benefits today. We put it in the market to really take the noise out of the system.
[Text On Screen – (Slide 3) The surest health plan at a glance:
- The fastest growing employer-sponsored UnitedHealthcare health plan
- Members see copays in advance, so they can plan ahead. Lower copays indicate providers evaluated as higher value.
o Copays include the services delivered in that visit/admission, helping to eliminate unexpected bills
o Members see copays up front on the app/website, with additional support through Surest Member Services (chat, email, and phone)
- Access to the broad, national UnitedHealthcare network
- Surest demonstrates sustained lower total cost of care across age groups (5-10%), common conditions, regardless of multiple comorbidities (5-11%)*1
- 54%*2 lower out-of-pocket spend per employee
*1. Aon’s Cost Efficiently Measurement of Surest 2021-2022 March 2024, Results from 2022 only.
*2 Members who migrated from a non-Surest plan into a Surest plan in 2022 compared to those who stayed with a. non-Surest plan.]
So there's no deductibles, no coinsurance, when you look at it. Instead, consumers really have to know their out of pocket choices in advance because it's a copay and we do it in a very simple, intuitive experience on our digital application.
STEPHANIE FEHR: It's like shopping.
ALISON RICHARDS: It is. It's incredible. It's just like shopping. So it is truly a foundational difference of how we're delivering health benefits out there, and we do it all across our largest, broadest network at UnitedHealthcare. So we're seeing, we'll talk a little bit more about it, but we're seeing a lot of great engagement, especially with women in health.
STEPHANIE FEHR: Great interest and great curiosity from our national accounts, our local accounts.
ALISON RICHARDS: We have one in five national account clients that are currently signed up for this. And we're seeing just a tremendous amount of enthusiasm in the marketplace, not only up in the market when we think about national accounts, but across all of our key account markets as well.
STEPHANIE FEHR: It's really exciting, and the satisfaction has never been higher. And your leadership is a huge part of that. So thank you, Alison.
ALISON RICHARDS: Thank you. Will, can we go to you and talk a little bit about Maven? Maven's such a success story, and we're so appreciative of all the service you provide our own employees. Talk a little bit about Maven.
WILL PORTEOUS: Maven's been in the market for over 10 years now, and we were brought to bear to really service a gap in the market.
[Text On Screen – Will Porteous, Chief Growth Officer, Maven]
And so our founder and CEO, Kate, who's used Maven herself through three pregnancies, really wanted to fill that gap with a digital solution. And I think we've been very fortunate, both in terms of serving your own employees, but now many thousands of your clients as well.
[Text On Screen – (Slide) We collaborate with Maven to deliver more equitable, higher quality maternal health support.
Fertility & Family Building
- IUI/IVF, Adoption, Surrogacy, Male fertility, Preservation
Maternity & Newborn Care
- Pregnancy, Postpartum, Infant care, Partner support, Miscarriage & loss
Parenting & Pediatrics
- Parent coaching, Special needs, Childcare navigation, Pediatric care, Family medicine
Menopause & Midlife Health
- Perimenopause, Menopause, Postmenopause, HRT support, Low T support
2,00 Employer clients, 96% Retention rate, 24/7 Platform access, 1 hour Appt. wait time, 4.9/5 Average appt. rating]
And I think the thing that's important to us is the family health journey begins in a lot of the places people on ramp into the healthcare ecosystem, which is sometimes preconception, fertility treatments, myself, going through surrogacy. And then it's going into the delivery itself. And then they give you your baby and say, good luck. Keep it alive. We'll see you in six weeks. And then you got 18 years to figure it out somewhere. I got a three year old now. I'm in the thick of it. And then also thinking about the bookend to that and how members are going through the end of their family building journey, through the menopause piece of life. Maven was really built, and is truly the only end to end solution on one platform, that can serve you as a member throughout that entire journey.
STEPHANIE FEHR: It's incredible.
WILL PORTEOUS: And it's been fantastic through our partnership and kind of our broad market efforts, we're serving over 2,000 employers, over 20 million members. I think the cool thing about the platform is it spans decades of a member's life, but it is just one platform, and it's customized.
STEPHANIE FEHR: Easy to navigate.
WILL PORTEOUS: Very easy to navigate, and it's customized to every individual based on what they need in terms of clinical, socio economic support, but then also where they are on that journey.
[Text On Screen – (Slide) Maven Member Experience, With Maven, employees get surround-sound support.
- On-demand care:
o Access to specialists, such as OB-GYNs, Nutritionists, Mental Health, and Career Coaches
- Advocacy & Coaching
o Dedicated Care Advocates who proactively supports members and refers to in-person care
- Dynamic learning
o Personalized actions, articles, community, and live classes for education and connection
- Financial Admin
o Benefit to augment plan coverage, such as adoption services or doula expenses]
It’s anchored by everybody getting a custom care team. Anchored to that is a care advocate, that you can think of as a quarterback for all things navigating Maven, but also navigating your in-person care through your health plan. But then also a care team that's specific to where you're on that journey. These are individuals we would expect for you to meet with on a regular basis, build a relationship with. But you have access to over 1,500 providers that are available 24/7, 365 days, usually within less than an hour wait time, for everything ranging from an OB GYN, a pediatrician, a sleep coach, child care consultant. It's really a robust set of specialties that they can access. They also have a robust set of content, as well as communities for them to engage with other members. And then we also have an embedded benefit component where, financially, employers can support their members through non medically covered services like adoption, surrogacy that can be embedded completely within the app. And that's what I mean when I say end to end. It's not just servicing the full spectrum, but it's also doing it, under one, simple member experience. Which is so nice to be sitting next to you because it's our thing.
STEPHANIE FEHR: It is. We have a lot in common. We have a lot in common. And we hear a lot from our employees about both Surest and Maven and the fact that they're tailored to each individual, which is so amazing. And we are individuals. Everybody's different. Thanks, Will and Alison. Let's go to Craig.
CRAIG KURTZWEIL: Thanks, Stephanie. I’m Craig Kurtzweil.
[Text On Screen – Craig Kurtzweil, Chief Data & Analytics Officer UnitedHealthcare Employer & Individual]
I lead our customer analytics department and my team's job and my job is how do we translate massive amounts of data into insights that we can act upon? And so for today's discussion, my team dove into our book of business and started to look to see what are some of the differences we see when we look at different genders and different ethnicity differences across our population. I'll jump into the data and show you what we found. First of all, let's take a look at the female, the women's role in healthcare across the family.
[Text On Screen – (Slide 7) A woman’s role in her family’s health care, According to a 2017 Kaiser Family Foundation Survey, mothers are much more likely to manage their children’s health than fathers
Share of Mothers and Fathers Reporting who Usually: (bar graph)
- Makes decisions about selecting children’s doctor
- Takes children to doctor appointments
- Assures children receive doctor recommended care
- Takes care of sick child
*Source: Kaiser Family Foundation, 2017 Kaiser Women’s Health Survey and 2017 Kaiser Men’s Health Survey: https://www.kff.org/womens-health-policy/issue-brief/women-work-and-family-health-key-findings-from-the-2017-kaiser-womens-health-survey. Accessed July 13, 023. ©2024 United HealthCare Services, Inc. All Rights Reserved.]
So we know we're going to jump into specifics around what we see around women's health and how women are utilizing the healthcare system in different diseases and patterns that we see for women themselves. Before we jump into that, we know that women play a unique role in the family and, in general, across most families, we see that women play a leadership role when it comes to health care, making the decisions not only for themselves, but for their family and especially for their children. So as we look into the ways that women use the health care system, just keep in mind that it goes beyond just how they're caring for themselves, but dives into the overall impact that this has across the family.
[Text On Screen – (Slide 8) Gender differences in health care utilization
When comparing women’s health care utilization to men’s:
- 24% higher office visits PMPY (Excluding OB/GYN)
- 36% higher urgent care visits per 1K
- 27% higher outpatient surgeries per 1K
- 94% higher inpatient admins per 1K
- 36% emergency room visits per 1K
- 69% higher 24/7 virtual visits per 1K
Insights:
- There are significant differences in utilization patterns between men and women
- Women tend to have more interactions with health care system than men
o Need for reproductive services
o Differences in attitudes towards seeking care
o Certain conditions impact women disproportionately
*Source: UnitedHealthcare book of business. Based on claims incurred Oct 1,2021-Sept 30, 2022, and paid through Nov. 30, 2022. ©2024 United HealthCare Services, Inc. All Rights Reserved.]
As we look at women's health across our book of business, and this is going to be just for adults, we see that women utilize the healthcare system very different from their male counterparts. In general, you can see a bunch of stats on the slide, but across the board, women use the healthcare system more. There's more primary care utilization, more inpatient utilization, more emergency room utilization, more utilization across the entire continuum. And that's even excluding pregnancy. In general, women are more engaged in healthcare in leveraging the healthcare system.
[Text On Screen – (Slide 9) Decision-making by gender
- Overall decision making is more optimal among women, particularly for well-being and prevention
- Men outperform women in chronic condition management compliance for asthma, heart disease and diabetes
Overall Health Activation Index® Score:
- Female 64%, Male 62%
Health Activation Index® by Category:
- Asthma: Female 88%, Male 89%
- CAD: Female 86%, Male 89%
- Diabetes: Female 74%, Male 76%
- Engagement: Female 54%, Male 52%
- Other Conditions: Female 82%, Male 81%
- Prevention: Female 71%, Male 61%
- Resources: Female 47%, Male 47%
- Site of Care: Female 54%, Male 57%
- Well-being: Female 75%, Male 59%
*Source: UnitedHealthcare book of business. Based on claims incurred Oct 1, 2021- Sept. 30, 2022. ©2024 United HealthCare Services, Inc. All Rights Reserved.]
As we look about at decision making, it's not just about if you're utilizing the system, but are you utilizing the system appropriately? And, yes, in general, the stereotype holds true. Women do make better decisions than their male counterparts. You can see that utilizing our activation index, that women are making the right choice about 64 percent of the time and men making the right choice about 62 percent of the time. On the right hand side, you can see the different types of decisions that we score, and the two areas where women make much better decisions than men is specifically focused on prevention. So the preventive care and wellness screenings are the biggest areas where women make much better choices than men. And that's specifically focused on doing something before there's a disease, before there's a wake-up call. You can see when you look at conditions, like heart disease and asthma and diabetes, after the wake up call, after disease is prevalent, we start to see men catch up and in some cases, overtake their female counterparts. But in general, prevention is much stronger within the female population.
[Text On Screen – (Slide 10) Gender differences in disease prevalence, In addition to conditions such as infertility, menopause and pregnancy, women have a unique set of health care concerns and are at a higher risk of developing certain conditions and disease than men.
Condition Prevalence: Women vs. Men
- Musculoskeletal conditions
o 38% higher back pain
o 27% higher osteoarthritis
o 12x higher osteoporosis
- Autoimmune disorders
o 1.7x higher multiple sclerosis
o 1.7x higher rheumatoid arthritis
o 6.5x higher lupus
- Thyroid and other conditions
o 4x higher thyroid disorders
o 1.7x higher. Headache
o 12x higher fibromyalgia
- Behavioral health
o 66% higher any BH diagnosis
o 2x higher anxiety, depression
o 6.5x higher eating disorders
- Cancer
o 64% higher any cancer diagnosis
o 146x higher breast cancer
o 3.2 higher thyroid cancer
*Source: UnitedHealthcare book of business. Based on claims incurred Oct. 1, 2021 – Sept. 30, 2022, and paid through Nov. 30, 2022. ©2024 United HealthCare Services, Inc. All Rights Reserved.]
If we go a little bit further and start to look at conditions, we start to see some differences. And again, these are adults to adults. We're comparing like populations. But, in general, we see key conditions, like musculoskeletal conditions, being much higher prevalence within the female population, back pain, knee surgeries, hip surgeries, and so on. We'll look at autoimmune disorders in a few different ways, but those are the conditions. A lot of those are driving some of the specialty medication costs that are so expensive, much higher prevalence in the female population. Thyroid and other conditions, specifically here, just dramatic increases in utilization and prevalence, specifically thyroid conditions. Females are more than four times more likely to be diagnosed and be treated for thyroid conditions. And if you look at behavioral health, we'll dive into this a little bit further later, but obviously skews dramatically into the female population, much higher than males. And even cancer, and obviously some of these are skewed specifically to female specifics, but generally cancer, as well, is more prevalent within the female adults.
[Text On Screen – (Slide 11) Common conditions prevalence by age
- The prevalence of hypertension, hyperlipidemia and diabetes increases with age, especially after age 40, while behavioral health conditions are most common among women under 40
- Normal pregnancy/delivery peaks in the 26-29 age range
Claimants per 1,000, (graph)
*Source: UnitedHealthcare book of business. Based on claims incurred Oct. 1, 2021 – Sept. 30, 2022, and paid through Nov. 30, 2022. ©2024 United HealthCare Services, Inc. All Rights Reserved.]
If we look a little bit further and start to timeline this out, when you look at some of the core chronic diseases across our population, you can see that some of this is what you would expect. It varies by age. As our adult females become older, you naturally start to see a rise in diabetes and heart disease and high blood pressure and hypertension start to escalate. We start to see prevalence of things like pregnancy, obviously, start to change and decrease over the patterns. Follows a similar pattern to what you'd expect. The one line then on this chart that I think is a little bit different than maybe you would have expected is behavioral health. So behavioral health starts as a dominant condition early in years in younger females, and especially if we go into teenage females, being much higher. But that condition starts to become less and less prevalent as a diagnosis later in life. a lot of that is just due to generational differences in stigma in some of the older populations compared to the younger millennial and Gen Z populations being much more open to be treated for behavioral health conditions.
[Text On Screen – (Slide 12 and Slide 13) Common cancer prevalence by age
- The prevenance of both breast and colon cancer increases with age, especially after age 40
- Cervical cancer prevalence peaks in the late 20’s and continues to decline with age
Claimants per 1,000 (graph)
- Autoimmune diseases, illnesses in which the body’s immune system mistakenly attacks its own cells and tissues, often arise in women after key life transitions such as pregnancy and menopause
- Prevalence of MS, RA and lupus all increase with age, especially after 30
- Women’s X chromosomes and differences in the gut microbiome may also play a role in the development of autoimmune disorders]
*Source: UnitedHealthcare book of business. Based on claims incurred Oct. 1, 2021 – Sept. 30, 2022, and paid through Nov. 30, 2022. ©2024 United HealthCare Services, Inc. All Rights Reserved.]
If we go a little bit further and look at specifically types of cancer, specifically breast and colon and cervical, what you would expect. As again, women age, we see some of these cancers start to dramatically increase. And the one that really catches your eye is breast cancer starts to escalate a bit in the 30s and then starts to ramp up extremely as you go into the 40s and 50s and beyond. I said we'd come back to autoimmune disorders and you can see some of that here. Autoimmune disease becomes very prevalent in the female population after age 30. So we're looking at lupus, we're looking at MS and rheumatoid arthritis, again, the conditions that drive a lot of the high cost that you see in the specialty pharmacy area starts to rapidly increase in that population. And as you start to think about what do you do to solve for some of these issues, obviously this becomes very concerning and a differentiator in how we need to communicate and support the female population.
[Text On Screen – (Slide 14) Chronic uterine conditions prevalence by age
- Both uterine fibroids and endometriosis are issues that affect the uterus and can share symptoms such as heavy menstrual bleeding and pain as well as fertility issues
- Studies have shown that up to 80% of women will develop uterine fibroids, which become common during the 30s and 40s through menopause: an estimated 10-15% of women in the US are affected by endometriosis
Claimants per 1,000 (graph)
*Source: UnitedHealthcare book of business. Based on claims incurred Oct. 1, 2021 – Sept. 30, 2022, and paid through Nov. 30, 2022. ©2024 United HealthCare Services, Inc. All Rights Reserved.]
Finally, in the timeline view, we also look at specific issues diagnosed within the female population, in this view, looking at chronic uterine conditions. A vast majority of females are going to have an issue in this area across their lifetime, specifically with uterine fibroids. And you can see the peak of that occurring in the early 30s into the late 40s is where we see the peak of the diagnosis of these conditions. Everything I just showed you over the past couple slides, just keep in mind, it's all based on the diagnosis of these issues. We know that there are more females that struggle with these conditions, but aren't seeking care, or aren't being treated for those types of conditions. So just keep that in mind, that there's always the undiagnosed part of the population that I can't speak to.
[Text On Screen – (Slide 15) Women’s health status by ethnicity
- Black, Hispanic and AIAN women were more likely to report fair or poor health status than their white counterparts
- Asian women are least likely to report fair or poor health
% of Women Who Report Fair or Poor Health Status:
- White 15%
- Black 22%
- Hispanic 24%
- Asian 10%
- AIAN 30%
- Other 18%
*Source: KFF State Health Facts, Women’s Health, ©2024 United HealthCare Services, Inc. All Rights Reserved.]
We also know that there is differences when you look at when we bring race and ethnicity into the equation. We know that culture and race and ethnicity makes a big difference in how anybody leverages care. And culture and history matter a lot. And you can start to see that in this view. As you look at adult women and look to see, do they identify as having poor health status, you see some wide discrepancies on here. You see the Asian populations, only 10 percent of those females identifying having poor health status. But you go into the other extremes in the Hispanic and Black population having much higher rates of at least perception of having poor health status.
[Text On Screen – (Slide 16) Women’s health status by ethnicity
- Black, Hispanic and AIAN women were more likely to report fair or poor health status than their white counterparts
- Asian women are least likely to report fair or poor health
% of Women Without a Personal Healthcare Provider
- White 8%
- Black 9%
- Hispanic 23%
- Asian 15%
- AIAN 14%
- Other 12%
$ of Women 40+ With a Mammogram
- White 73%
- Black 79%
- Hispanic 68%
- Asian 63%
- AIAN 63%
- Other 65%
% of Women Without a Doctor Visit in Past 12 Months
- White 7%
- Black 12%
- Hispanic 18%
- Asian 8%
- AIAN 16%
- Other 15%
% Of Women 18-64 With a Pap Smear
- White 73%
- Black 79%
- Hispanic 72%
- Asian 61%
- AIAN 68%
- Other 68%
*Source: KFF State Health Facts, Women’s Health, ©2024 United HealthCare Services, Inc. All Rights Reserved.]
If we go a little bit further into the utilization patterns around preventive care, you can start to see that culture. plays into these aspects as well. In general, utilizing the healthcare system. Do you have a healthcare provider? Have you seen that healthcare provider in the last 12 months, 24 months? You can see in the upper portions of the chart the Hispanic women in this population seek care and have that have a disconnect with their provider at a much higher rate. If you look at the lower portion around compliance and are you seeking care in the right ways, specifically around cancer screenings, you see, in general, the Black population does much better than the Asian population. And that's actually a known issue. There's different stigma and cultural sensitivities to some of these more sensitive screenings that again, we just need to be aware of and recognize and be able to communicate and send and engage the female Asian population a little bit differently to make sure that we can get them engaged in the healthcare system.
[Text On Screen – (Slide 17) Metabolic syndrome by ethnicity
- Metabolic syndrome is a cluster of risk factors associated with increased risk of multiple chronic diseases including cardiovascular disease and chronic kidney disease
- Black and Hispanic women experience higher prevalence of metabolic syndrome compared to white women
% of Women with Metabolic Syndrome (graph)
*Source: CDC’s Metabolic Syndrome Prevalence by Race/Ethnicity and Sex in the United States, National Health and Nutrition Examination Survey, 1888-2012, ©2024 United HealthCare Services, Inc. All Rights Reserved.]
Another broad issue that impacts everyone across the population, but specifically our female population, is metabolic issues. And for this, we're talking about high blood pressure, hyperlipidemia, as well as diabetes and heart disease. In general, as you would expect, as we get older, we start to see that there's more metabolic issues across any population. But in females, you can start to see it rapidly escalate. As you move from the 30 to 50 population to the 50 plus population, you basically see a doubling of metabolic issues within those populations. We've also split this data by ethnicity, segmenting out the white, Black, and Hispanic populations. You can see that variance exists throughout every age group. But I would specifically point to the 50 to 69 population, where in that age bucket, we start to see the Hispanic population, which historically was at or below the metabolic issues we saw in other ethnic groups in the past, now that starts to overtake in the 50 to 59, 69 and 70 plus populations. We see the highest rates in the Hispanic population.
[Text On Screen – Wellness, prevention, access to care
Women on the Surest plan accessed more preventative care than a comparison group
Women on the Surest plan are high utilizers of telemedicine
- Women on Surest had:
o 4.9 times more virtual care visits than a comparison group
o 2.2 times more virtual care visits and 2.3 times more telehealth visits than men
86% of female Surest members had a primary care visit in 2023 – 26% more than a comparison group
Percent of adult women with a visit or screening:
- Primary Care Visit: (including wellness visits), Comparison 68%, Surest 86%
- Wellness visit: Comparison 46%, Surest 61%
- Mammograph screening: Comparison 44%, Surest 45%
- Cervical cancer screening: Comparison 22%, Surest 29%
Data was taken from Surest claims database and a large market national health insurance claims database. Claims were incurred January – December 2023 and paid through January 2024, The denominator for wellness and primary care visits were female members ages 18 and over, The denominator for mammograms were females ages 40-74, The denominator for cervical cancer screenings were females ages 21-65, The denominator for colon cancer screenings were females ages 45-75. *Surest, © Bind Benefits, Inc. d/b/a Surest. All rights reserved.]
Now, back to what Alison was talking about with Surest, we start to see that females in the Surest population leverage care very differently than what we see in traditional health care plans. And a couple numbers just jump out to me as you look at this slide. First of all, in the Surest population, when we compare like females, we see that women in the Surest plan are leveraging the health care system in a much more virtual way. We see five times the rate of virtual care visits within females in the Surest population compared to traditional plans. And on the right hand side, you can see, when you look at general utilization of primary care physicians, urgent care, cancer screenings, across the board, we see that some of the barriers are taken away and the Surest population sees much more utilization in some of the patterns that we're hoping to see.
[Text On Screen – Good care choices
Women on the Surest plan had high use of primary care and preventative services and low utilization of high-cost health care services
Female members on Surest plan vs. females in a comparison group:
- 44% higher primary care physician visits per member, per year
- 4% lower admits per 1,000
- 32% lower surgeries per 1,000
- 4% urgent care visits per 1,000
Note: Data is descriptive. No matching or testing was done on either population. The average ages of the population were comparable. Surest-34. Comparison group-33.6. Emergency room visits for the two populations were comparable.
Data was taken from Surest claims database and a large market national health insurance company claims database. It included women ages 18 and over. Claims were incurred January-December 2023 and paid through January 2024.
1. Adult women on Surest had 2.0 primary care visits per member in 2023 compared to 1.4 for a large market national health insurance company.
*Surest, © Bind Benefits, Inc. d/b/a Surest. All rights reserved.]
You can see a summary here. In general, PCP utilization jumps up by about 44%. We see lower admissions, lower surgeries, and lower urgent care utilization across this population.
STEPHANIE FEHR: Thank you, Craig. Such great data and so insightful, and it gives us a lot of reason to be here today. Panel, let's jump into gender and ethnicity differences. I'm going to start with you, Dr. Saul, if that's okay.
DR. LISA SAUL: Of course.
STEPHANIE FEHR: As Craig highlighted in the data, Black and Hispanic women are more likely to report far poorer health conditions and health status and their white counterparts. What do you think the key drivers are and what types of solutions are we looking at to counter counteract that?
[Text On Screen – Dr. Lisa Saul, Chief Medical Officer, Women’s Health UnitedHealthcare]
DR. LISA SAUL: One of the other things that Craig pointed out in the data, too, is the engaging, the engagement with health care, when we're looking at women of color, those numbers were definitely lower than their white counterparts as well. And I think it's been pretty well documented that women of color have a different experience in the health care system than their white counterparts as well. With regard to feelings of being dismissed, not listened to, I think women in general have that experience, but it's particularly profound for women of color, which then may make the engagement with health care a little more reluctant. And then when you marry that to women of color, disproportionately in the poverty bracket, and we think about socioeconomic differences, a lot of times too, it is you're making a choice between going to the doctor or going to work, or just regular, active daily living things that you need to choose. And sometimes that's a choice that people make. What we've done as a company over the years, starting in 2011, we've invested over 800 million in areas of economic disadvantage to try to close some of those disparity gaps with regards to housing insecurity and food insecurity. And then looking, too, at particular populations where we see disparities in outcomes, such as diabetes in the Latino population. And then cancer screening in general, the United Health Foundation has invested almost $5 million in grants last year to particularly look at areas of distinct disparities and try to address that. So I think all of that is really important, but recognizing that it really is a lot of the underlying sort of social factors, biases that exist that, that get in the way of appropriate care.
STEPHANIE FEHR: And feeling like they can identify with their provider, finding someone they really feel comfortable with.
DR. LISA SAUL: Absolutely.
STEPHANIE FEHR: Thank you. That's great. Okay. Let's move on to Alison. Alison, Surest is such a great product. Can you talk about how transparency is impacting health equity, inequities?
ALISON RICHARDS: Sure. You saw a lot of data, that right at the end, that Craig just talked about, but when you think about inequities in healthcare, that is core to what Surest was actually set up to do. It really was around reducing the treatment prices for those conditions that were most prevalent with underserved populations. Think about allergies, think about asthma. There are great examples of these things that are happening out there and they affect populations in heavy social determinant burdened areas, where the re's urban air quality or in low housing and income neighborhoods. That care is driven, and has a lot of different health outcomes, related to inequities. The Shure's plan design was really set up to include an equity discount. And if we think about it that way, for allergy testing, or reducing the copay when it comes to asthma inhalers because we have the flexibility in the plan designed to make that happen. But we couldn't do that without great data, like we're just sitting here thinking about, and that was just done. And we can target those types of plans and plan designs, whether it's in specific areas or it's across the board, enabling these services to really happen at a greater level. And that's where you're starting to see that engagement because we can offer up a zero copay, for things like inhalers, that are out there today. It’s really something that putting the benefit of what I would say, changing the way benefits are delivered and making them available to populations that might not get the care that they need.
STEPHANIE FEHR: Right, right. Such a great point. Having just seen it demonstrated, it's so easy to navigate and such an immediate closure in gap in care. Such a great example. Will, can I go to you next? Let's talk about the data that Craig shared around women being at higher risks for autoimmune disorders and behavioral health diagnosis like depression. Can you talk about solutions and support that address the unique set of health concerns that they experience?
WILL PORTEOUS: I think first off, it's acknowledging and capturing the data. All things lead back to data. But knowing and understanding what conditions are affecting the individual is really key to then developing a plan for how they're going to actually address it. And if you look at Maven's population across our entire book, 25 percent of our members have some comorbidity that will affect some aspect of their family journey.
Almost 50 percent of our members in the maternity track. are considered high risk pregnancies. You have to identify that first.
STEPHANIE FEHR: That's amazing. You would never guess that.
WILL PORTEOUS: You really wouldn't, but, if you think about with an aging maternal population, increasing of comorbidities broadly in our society, it starts to play out. But, oftentimes, there isn't a holistic view for an individual. They're talking to their PCP about one thing, a specialist for another, Maven was a way for us to collect all that information and figure out what and how that will impact their family health journey. And then every single one of our members, 100 percent of them, get an adoptive care plan that helps address those comorbidities and conditions that might affect their family health journey.
STEPHANIE FEHR: Amazing, amazing.
WILL PORTEOUS: It's pretty cool because I've worked a lot of my career in value-based care, and there's a lot of care management programs that do a lot of great things. The problem is the members don't engage with it. And that's what's really cool about an app-based solution. It has a heavy human touch element to it because you want to use it. You want to talk to your care advocate. You want to talk to specialists that are really hard to get appointments with, much less find one that looks like you, sounds like you, believes like you.
STEPHANIE FEHR: Right. You build a relationship with that person.
WILL PORTEOUS: So having that virtual element of it enables higher degrees of access, much more trusted relationships, honestly a little bit of addictiveness, the fact that we all live with our phones in our pockets. So knowing that information, developing a care plan, and then providing them with access to individuals that they can relate to, you then can actually start to address the core of what that might do in terms of affecting their health. And I think that's where Maven has had an amazing opportunity to drive real outcomes because of putting all that together.
STEPHANIE FEHR: That's terrific. Thank you. Lisa, from a clinical perspective, anything to add?
DR. LISA SAUL: Listening to Craig and the data that he was presenting too, we're seeing these different curves in terms of when women are presenting for care. And what I know, from taking care of women for almost two decades, is when women present for a complaint or a complication, it's usually been predated by, often, years. And so I think what's also nice about the Maven solution and having something in the palm of your hand that is also providing education, is it can turn light bulbs on as well. This is not a normal thing that you're experiencing and maybe you should seek help. Exactly, and connecting the dots to then to dig a little bit further to see if there's something that can be done about the way that you're feeling or what you're experiencing.
STEPHANIE FEHR: I love that. When you think about how much time you spend in a doctor's office, when you go for a typical appointment, it's so quick. But when you have that interface, that's more constant, that's so powerful.
WILL PORTEOUS: It’s 9 to 12 minutes. So you want to have a really educated member who is going to use that 8 to 10 minutes as effectively as possible.
STEPHANIE FEHR: I don’t know about you, but when I go in, I forget everything I was going to ask the doctor. So it's such a great point. Alison, back to you. And we talked a little bit about this earlier, that 80 percent of women drive the health care decisions for themselves and their family. They often kind of neglect themselves in this process. They put themselves last. Women make better decisions that are more informed by data?
ALISON RICHARDS: When I think about how this has been working and think about how women are out there, it is the decision making process. One of the things I know that we've done at Surest to make this work a little bit differently is in the open enrollment side of it. So there's usually, if we're the decision makers, data says, I'm not making – but data so shows us that the women are decision makers for the families.
STEPHANIE FEHR: It does. It does show us that.
ALISON RICHARDS: AS it is out there, how do we make that decision a little bit easier? So one of the things we set out to do with Surest is at open enrollment, what are the two questions that are being asked at any given time? Where can I go and how much is it going to cost? And making that a very simple way to invite those types of areas is how we've actually put that together. So the information is right there at their fingertips at open enrollment. I'm not guessing about it. I'm not guessing about, hey, I might have an event coming up, like I'm going to have a baby this year. What's it going to cost me to go to the hospital to make that happen? The price is right there, and it tells you what's included. I think information is powerful. I think we're able then to take that to the next step. Are we going to a high value, high quality facility or physician? And thinking about the experience that Maven brings to the table, as we bring that and marry those two things together, I have the knowledge base, I have everything that's around there. I think those are two powerful things, with Surest, with the price transparency and the coaching and the availability that your teams bring together. It's a win when we think about it.
STEPHANIE FEHR: I completely agree. Can you imagine going shopping and not having the price of something? That's the interesting thing about health care.
ALISON RICHARDS: Right? It is. I have used that example. Sometimes people say, well, health care is different than buying a TV. But you know what? It is, but we all do our research. So do our research in health care. We have to do it.
DR. LISA SAUL: Don’t you think too that sometimes people think it's going to cost more than it actually is so that might delay seeking that care. So I think it plays both ways, in terms of it might be cheaper, surprisingly, than you expect it to be.
ALISON RICHARDS: It might be cheaper. And that's what we have found. Think about it, I have had so many examples of people coming up to me saying, I wish I would've had Surest when I had my children.
STEPHANIE FEHR: I have too. I’ve heard the same thing. Absolutely.
ALISON RICHARDS: I've had my anesthesia bill, I had my doctor bill, I had this bill, I had that bill, and all of a sudden, $8,000 later.
STEPHANIE FEHR: And it’s a surprise.
ALISON RICHARDS: And then all of a sudden I have a copay that's $1,200 or three, depending upon where you want to go, whatever it is. I know this is what it’s going to cost.
STEPHANIE FEHR: Not to mention, you have a new baby.
ALISON RICHARDS: Right?
STEPHANIE FEHR: We're running out of time.
ALISON RICHARDS: I know. Sorry.
STEPHANIE FEHR: No, no.
ALISON RICHARDS: I’m so excited.
STEPHANIE FEHR: It's a great conversation. Very good conversation. So I'm going to just go to the quick lightning round of advice, and I'm going to start with you, Dr. Saul,. One piece of advice that you would give everybody.
DR. LISA SAUL: I think it's important to know who your population is that you're dealing with. We were talking about gender and gender disparities and the way that women really seek care and want to receive care. I think digging deep into really getting a sense, as you're talking about, is what do people want? If it's just asking two questions, what would those two questions be right to get that information as quickly as possible, in terms of what would people prioritize. That’s what I would say.
STEPHANIE FEHR: Good advice. That's great. Thank you. Will?
WILL PORTEOUS: I'd say for employers who are looking to enhance their benefits in the women's and family health space, it can be really overwhelming. The cost is astronomical, if you really wanted to truly support it in holistic ways, and there's just a lot you have to tackle.
STEPHANIE FEHR: It's hard to prioritize.
WILL PORTEOUS: You don't need to do that. What you need to do is show that you're paying attention to it, show that you have an understanding of the needs, and show that you have a plan for how, over time, you will better support it. And work with your partners, like your health plan or a Maven, and help look into your population and see what's going to be most impactful, weigh the costs against that. Find good partners that will help you develop that plan. But you don't need to do it overnight. And, honestly, showing progress and an awareness of the need goes a long way.
STEPHANIE FEHR: No, it's great, great advice. Thank you. I think we're an example of that, actually. Yeah, great. Alison.
ALISON RICHARDS: The only thing I would add is, we are consumers of our health care. Educate yourself. We've heard some great examples here. And I would just say, empower yourself to educate what is around you. UnitedHealth Group offers a ton of available resources when we think about the resources that are out there. All of that comes together, where we could look at the Maven examples, or we can look at any example that's out there. But we need to take and empower ourselves to educate ourselves as consumers.
STEPHANIE FEHR: Such a great point. Absolutely.
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Thank you very much. Thanks for sharing all your wisdom, as always, and it's been a pleasure.
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[Text On Screen – UnitedHealthcare, There for what matters™, Insurance coverage for fully insured plans is provided by All Savers Insurance Company (for FL, GA, OH, UT, and VA), by UnitedHealthcare Insurance Company of IL (for IL), by United Healthcare of Kentucky, Ltd. (for KY), or by UnitedHealthcare Insurance Company (for AL, AR, AZ, CO DC, DE, CA, IA, ID, IN, KS, LA, MI, MN, MO, MS, MT, NC, NE, NH, NV, OK, PA, RI, SC, SD, TN, TX, UT, VA, WV, AND WY). These policies have exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact either your broker or the company. Administrative services for insurance products underwritten by All Savers Insurance Company and UnitedHealthcare Insurance Company, and for self-funded plans, are provided by Bind Benefits, Inc. d/b/a Surest, its affiliate UnitedHealthcare Services, Inc., or by Bind Benefits, Inc. d/b/a Surest Administrators Services, in CA. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Maven and Maven Wallet are products of Maven Clinic Co. Maven is an independent company contracted to provide family-building support including care advocacy, virtual coaching, and education. Maven does not provide medical care and is not intended to replace your in-person health care providers. Use of the services is subject to terms of service and privacy policy. Maven® is a registered trademark of Maven Clinic Co. All rights reserved.]
