UnitedHealthcare expands in northwest Ohio market

UnitedHealthcare (UHC), a national healthcare insurance provider that serves two million people with a network of 270 hospitals and 56,000 physicians and other care providers just in Ohio, is expanding in the northwest Ohio market for its commercial line of business, employer-sponsored health coverage.

Leading this UHC expansion is Rick Sudėtie who shared in an interview with Toledo Business Journal that the mission is to deliver effective strategic solutions for prospective customers and agents.

"We've been here, but we've kind of been stagnant. The idea is to re-energize the market. We've got a lot of great things going on and a lot of success in other parts of the state that really hasn't been engaged in northwest Ohio, so there has been kind of a vacancy in a regular sales team here. My job is to be a catalyst to stimulate business growth for us in the commercial lines in northwest Ohio and we want to work with local agents and bring solutions to their customers," said Sudėtie.

According to Sudėtie, UHC is aiming to capitalize upon a market that hasn't had enough of the company's attention. He noted that the market he's involved in - businesses with 51-3,000 employees covered by healthcare - has about 600,000 covered members with health benefits. UHC's market share is less than 8%.

"The opportunity for us is over a half million members, and particularly in that 100-plus niche, a lot of these groups are selffunded, which we have a very good value proposition through two different platforms through UnitedHealthcare," said Sudėtie.

According to Sudėtie, groups can sign up with UnitedHealthcare for what it calls an administrative services agreement (ASA). The groups use UHC's network and claims processing just like they would be if they were fully-insured, but they have a little bit of exposure on the claims and fund those through UHC.

The company also has another platform, UMR, which is a separate third party administrator (TPA) that it purchased.

"It's been a very good growth niche for UnitedHealthcare and it's particularly best situation is for that 100-employer group size up to about 500. The third party administration model gives a little bit more nimbleness and flexibility to manage the risk, to manage how the pharmacy is delivered, care programs, clinical programs, and wellness," said Sudėtie. "Whereas with the administrative services agreement with UnitedHealthcare, that's oriented towards larger companies and it's kind of very packaged. Everything's built into one program that they would subscribe to where you kind of plug and play with the UMR model. So our niche being in Toledo, you have this opportunity of a half million members where 70% of that is self-funded. It's perfect for what we want to do with our UMR platform, so self-funding is very attractive and it helps avoid some of the costs, taxes of healthcare reform, health insurers paying premium taxes, and things like that."

According to Sudėtie, the company also offers valuable tools, services, and resources to help its members manage their health effectively. Some of these include:

* OptumRX - a pharmacy benefit manager (PBM) that focuses on connecting total condition spend and pharmacy's impact across benefits by offering a suite of pharmacy cost management offerings, synchronizing benefits, and helping guide better member decisions

* BriovaRx - a specialty pharmacy, an educational resource, a 24/7 support system, and an advisor to the members UHC serves

* Virtual Visits - receive care by connecting with a physician via video chats and get a prescription if needed

* UnitedHealthcare Motion - using wearable devices, the program helps participants track steps, set goals, and earn financial incentives when they reach daily walking targets

* Real Appeal - a personalized, interactive, online weight-loss program that provides numerous tools and resources people need to succeed, including technology to deliver real human interaction, education, and entertainment

* myuhc.com - 24/7 access to a personalized website that helps people manage their health plan and health information

* Health4Me mobile app - instant access to view health plan details, generate a health plan ID card, check claims, or find a doctor

* Health savings accounts - combine health savings account (HSA) with an eligible health insurance plan that allows people to pay for qualified medical expenses tax-free.

"We're really about a mission of improving people's health and we have beliefs to make healthcare affordable and we do it with these tools, support, and programs. We have 270 hospitals under contract - basically every single hospital in the state - and we have almost 56,000 providers under contract. The total lives that we cover in Ohio - which includes employer sponsored plans, Medicaid members, and Medicare Advantage members - is just under two million. As a large national network, UnitedHealthcare can cover anyone within our footprint in our network.

"Whatever happens down the road, as a company, we are committed to working with the federal and State leaders to address any challenges. From that point of view, our motto is to help people lead healthier lives and help the healthcare system work better for everyone. So we use that motto and everything just boils down to how we implement our plans and how we think about policy issues. It's just really exciting to be out in the market and meet with prospective customers with new ideas and introduce ourselves to them," concluded Sudėtie.