Christine O'Brien, UnitedHealthcare CEO for La.-Miss., wants to lower insurance costs. Here's how

At a time when health insurers are under fire for raising premiums and rejecting claims while health care costs continue to rise, Christine O'Brien is trying to grow UnitedHealthcare's book of commercial business in Louisiana and Mississippi — two of the poorest and sickest states in the country. She has her work cut out for her.

Though UnitedHealthcare is the largest health insurer in the U.S., with nearly 27 million "covered lives" through its individual and employer-sponsored group plans, the company has less than one-fourth of the commercial market share in Louisiana and Mississippi, which are dominated by Blue Cross and Blue Shield.

O'Brien sees opportunities amid the challenges.

A New Orleans native, O'Brien didn't get her start in the health insurance industry. Rather, her first job was at Hibernia Bank in the benefits department, where she learned about group health plans from the inside. She went on to become Hibernia's senior vice president for human resources before being named chief human resources officer at First Bank and Trust.

In 2010, she moved to UnitedHealthcare, where she says her experience working with employees gave her a unique perspective on the real needs of employers and their employees. In November, she was named CEO of UnitedHealthcare's Louisiana and Mississippi markets, where she oversees sales and account management for the company's commercial customers and their 440,000 covered lives.

In this week's Talking Business, O'Brien discusses rising health care costs, what insurers can do about it and the unique health challenges present in Louisiana and Mississippi.

The interview has been edited for clarity and length.

Health insurance rates went up this year for employers by more than 6%. What was behind the increase?

We saw an average increase of about 6.5%, the highest we have seen in about 15 years and that really was because of higher utilization patterns — people are going to the doctor more and getting care more. The specialty drugs, like the GLP-1 drugs (for obesity), and general inflation also factored in. The rates really do vary depending on company, the plans they have and the claims volumes.

Presumably, Louisiana and Mississippi would have high utilization rates because we have some of the worst health outcomes in the country.

Yes, in newly released rankings from the United Health Foundation, Louisiana ranks 50th and Mississippi is 48th. It is based on 37 different metrics — everything from obesity, chronic illness, mental health access to mental health specialists. But our cost of care is not significantly higher. It's very average, per member, per month for Louisiana and Mississippi compared to other states. Outcomes are an overall health indicator, but there is no strong correlation between outcomes and health costs per se.

How is UnitedHealthcare trying to make health care more affordable? What do you tell your teams to say when they are selling these plans to companies?

One way is through plan design. It's important when a client or broker selects a plan that they select one that is affordable for their members. What has happened over time, as premiums have continued to increase, clients opt to increase the deductibles because it makes the plans more affordable. We try to give them several different options, a plan with a $1,000 deductible and another with a $2,500 deductible. Obviously, the premiums for the plan with the $2,500 deductible will be lower. We try to design plans that can provide access but at an affordable price point.

For example?

We have a new plan that completely removes the deductible and only has co-pays. It is an app-driven plan, so when you need to seek care, you go to the app, type in the care you need and get a Zillow-style map that shows the prices in your area for whatever the procedure you need, like an MRI or a knee scope. Then, you choose the provider you want based on the price and you only pay that price. Higher cost does not always equate higher value. What we have been able to do with the data we have through the algorithm behind the app is price the providers by the highest value.

We also have two other plans in partnership with hospital systems. We have value-based contracts with them and are able to tier the benefits so that members are incentivized to go to the higher quality providers.

How do you define value?

Providers that are on a value-based contract with us are encouraged to meet certain value-based guidelines when providing care. For example, they have a lower readmission rate to the hospital. They have higher preventative utilization rates. Their diabetic or high-blood-pressure patients get regular screenings and follow-up care.

So let's say my company wants one of these plans. What does that look like as a practical matter for me, the employee?

You still have the option of going to any provider. I have gone to the same OB-GYN for my entire adult life and I don't want to change. But if I hurt my back, the app will show me which orthopedist is the highest-value orthopedist and I can make a choice based on that kind of data.

A growing number of companies are choosing to go the self-insured route. What percentage of your clients are self-funded and what does that mean?

About 60% are self-funded, which means we administer the plan. But we do more than just pay the claims. We provide the network and the savings that go along with that. Just as important, we provide care management and advocacy programs. For a self-funded client, it is more of a member-based opportunity and there are certain items that a client can choose to offer or not offer

I've written about rising health care costs and all the strategies insurers use, and things are only getting worse, not better.

It is something that keeps me up at night and something I focus on — figuring out how we can make health care accessible and affordable for our clients and our members.

What should employers be thinking about in 2026?

It's important that clients look beyond the premium numbers and focus on things that can actually help their claims trends. That means making sure that their members are getting preventative care and making sure when members choose care, they choose the right site of care and go to a higher value and higher quality provider.