UnitedHealth Group: Who We Are UnitedHealth Group s Family of Businesses Provides a Highly-Diversified and Comprehensive Array of Health and Well-Being Products and Services that Enable Us to Transform Data into Actionable Intelligence and Leverage the Latest Technologies to Enhance the Consumer Experience, Improve Access, Drive Quality Outcomes, and Reduce Health Care Costs UnitedHealth Group By the Numbers More Than 133,000 Employees 27,000 Physicians, Nurses, and Clinical Practitioners and 12,000 Technologists on Our Staff Added More than 60,000 Jobs in the Last Five Years Manage Over $300 Billion in Health Care Annually Process 82 Billion Transactions a Year at Very High Levels of Automation and Accuracy Invest Over $2 Billion Annually in Technology, Including New Development Operate the Health Information Exchange for Nine States Manage Medical Groups, Hospice, and Direct Clinical services to Seniors and Persons with Special Needs Process 750 Million Transactions Through Our Web Portals and Mobility Devices Annually Manage Over 24 Million Personal Health Records Data Covering 109 Million Lives, Spanning 19 Years Database of 170 Million Consumers 23 Retail Store Locations Throughout the U.S. UnitedHealth Group: Who We Serve 250,000 Plan Sponsors Employers Government Agencies Labor Unions Department of Defense 83 Million Consumers Employees and Individuals Medicare and Retirees Medicaid Active Military and Dependents 777,000 Care Providers Physicians and Allied Professionals Hospitals Pharmacies Labs 2
Our Businesses OUR HEALTH BENEFITS BUSINESS: UNITEDHEALTHCARE OUR HEALTH SERVICES BUSINESS: OPTUM Helping People Live Healthier Lives UnitedHealthcare Community & State UnitedHealthcare Employer & Individual UnitedHealthcare Medicare & Retirement Making the Health Care System Work Better for Everyone OptumInsight OptumHealth OptumRx Health care information technology Consumer engagement and support Integrated care delivery Pharmacy Health financial services Health in Numbers Serving 35 million Americans at every stage of life Innovation-driven growth Well positioned to evolve and grow through health care reform Good for the System A dedicated and independent business providing services to: 6,000 hospital facilities, 250,000 health care professionals, 60 million consumers FOUNDATIONAL COMPETENCIES Domain knowledge around care management and care resources Actionable health care information and intelligence Advanced, enabling technology 2
Payment for Children s Health Care Services - Sources Employer Based Insurance Fully Insured Plans Employer Based Insurance Self-Funded Plans Individual policies Self Pay Medically indigent Medicaid State Health Insurance Programs Military Health Care Health Care Services for Special Populations Children with Special Health Care Needs Foster Children Children under the direction of the State Juvenile Justice System Indian Health Services
Children and Private Health Insurance - Demographics Source: http://kff.org/other/state-indicator/children-0-18/
Payment for Children s Health Care Services - Challenges Resources are limited Large number of children covered by private plans Difficulty with coordination between carriers Difficulty in identifying responsible parties Lack of population based health system responses Lack of accountable organizations for care / financing Payment processes that have traditionally focused on transactions Variable, Ineffective, inefficient or inadequate public private partnerships Expectations that exceed ability to respond by any single organization
Private vs Public Coverage Disasters Highlight Differences Private Eligibility Dependent on parent Unemployed Parent no income COBRA Available, not affordable Benefits - Defined by employer Employer can make exceptions Benefits May not meet child needs Dental - Usually accidental only Therapy Standard limits Private Duty Nursing- Not covered Social Services Not covered Transportation Only ambulance Not linked to other medical plans Employer - May have foundation Public Eligibility Independent of parent May qualify for independent income Benefits defined by state, feds Eligibility defined by state State does not usually make exceptions Dental covered, availability? Special Waiver Programs for PDN Therapy may not have annual limits Transportation Emergency, non-emergency Social Services Public agencies Other Public Services Can be eligible
Issues for Children in Disasters In many locations, the employer or individual based insured are the majority of children They may be separated from parents (at school, day care) They may not have identification They likely do not have insurance card or confirmation They may not be good historians Clinical records may be with private practitioners and not in state or other databases Immediate specialized care may not be available Systems can be quickly overwhelmed without proper planning. Funding issues for planning and preparation are a challenge. 7
Enterprise Resiliency & Response Mission The Insurer Perspective Provide for the safety of our employees in the event of a business disruption or disaster Demonstrate our consumer-focus and service excellence when our customers and members are vulnerable after a crisis Minimize service disruptions Meet customer and other stakeholder expectations Preserve customer information Preserve UnitedHealth Group's organizational assets, including people, process, technology and information Comply with laws and regulations regarding the continuity of operations Maintain UnitedHealth Group's reputation as a good corporate citizen in the communities that are served 8
Business Continuity Plans The Business Continuity Plans focus on critical business functions and planning for the worst-case scenario so that we can react quickly and efficiently. This worstcase scenario covers all forms of disasters, both natural and man-made. The following scenarios are used for recovery planning: - Loss of Facility: Complete interruption of facilities without access to its equipment, local data and content. The interruption may impact a single site or multiple sites in a geographic region - Loss of Critical Resources: Complete interruption with 100% loss of personnel within the first 24 hours and 50% loss of personnel long-term. The interruption may impact a single site or multiple sites in a geographic area - Loss of Critical Systems: Complete interruption and/or access of critical systems and data located at the various UnitedHealth Group Data Centers for an extended period of time - Loss of Critical Vendors: Complete interruption in a service or supply provided by a third-party vendors Plans are created with consistent standards in order to meet customer/regulatory requirements as well as minimize cost associated with overall testing, maintenance and support of the program
Preparation is Key To support our emergency response continuity of operations plan and to address pandemic preparedness and natural disaster recovery, we maintain policies and procedures based on the following: Employee training on preparedness, natural disasters, and recovery Identification of essential business functions and key employees to implement them Contingency plans for covering essential business functions should key employees be incapacitated or the primary workplace is unavailable Communication processes established for staff and suppliers should normal services be unavailable Continual monitoring for the potential of network disruption, so, whenever possible, the disruption can be averted and/or its impact minimized Adequate and timely care during periods of temporary network disruption for members, including health care facility closure(s) or loss of major provider(s); Post-disruption processes, including payment of claims, are addressed and operational, financial reconciliation, member reconciliation, and claims payment issues are minimized when the network returns to normal Testing to ensure plan preparedness
Private Insurer Involvement in Disaster Preparedness Triage Resource during Acute Phase Volunteer medical personnel nurses, physicians, clinical resources Facilities can serve as shelters, auxiliary medical facilities Can provide non-clinical service food, water, other volunteers Sources of Employment during and after acute phase Tax Base for Community Provides revenue for health care system during and after disaster Support for schools during and after disaster Community Partner in service delivery Community Partner in short and long term recovery Political advocate Fund and test alternative methods of delivering care to populations
Public Health Emergency Planning for Pandemics & Natural Disasters Coordinated through the Event Management Team (EMT) Inputs / Notifications Event Management Team Customer Request Medical Directors Clinical Recommendation Business Decision Communication Approval and Distribution Business Implementation Natural disasters such as hurricanes, wild fires and pandemics can expand very quickly and arrive with little or no warning, therefore companies need to be vigilant and prepared The Public Health Emergency program is designed to demonstrate our consumer-focus and service excellence when our customers and members are vulnerable after a crisis Following a disaster, clinical recommendations are made to provide additional support for our membership. These recommendation typically involve benefits such as providing early refills on prescription medication, removing prior authorizations and providing out of network service at innetwork benefit. Business operations are consulted before benefit changes are made and communicated to customers. Business, operational and communication approvals to be made by a small group of key executives Ensure all affected departments are in communication flow, from large groups like our call and claim operations, to specialty services such as Vision and Dental operations Timely and thorough implementation of medical benefit changes for those impacted
Case Study Joplin, Missouri Tornado Significant Health facility was incapacitated Food, Water and Shelter were first concern. Businesses were lost Business owners were among the deceased The fog of war Identification of wounded Unable to identify children transferred long distances in critical condition. Some were children whose parents were lost Tying insurance policies to parents, closed businesses and identification challenges Ability of insurers to rapidly issue substitute policies when necessary Implementation of special work around processes to assure payment of providers Provision of crisis and grief services.