2015 Optum Day: An overview

On April 30, 2015, leaders from health care and life sciences organizations gathered in Eden Prairie, MN, for
Optum Day: From Evidence to Action. This invitation-only event brought together experts from OptumTM,
UnitedHealth Group and life sciences organizations to share insights on evolving issues within the health care
ecosystem. The goal was to demonstrate sources of evidence that enable life sciences companies to better
anticipate and navigate these important issues.
Plenary sessions
Plenary 1: UHG priorities in the evolving health care
system
Presenter: Lewis G. Sandy, MD, FACP, Senior Vice President,
Clinical Advancement, UnitedHealth Group
Lewis Sandy, MD, set the stage for Optum Day with a discussion
of the challenges and opportunities in our evolving health system.
As an enterprise, UnitedHealthcare (on the health benefits side)
and Optum (on the health services side) bring foundational
competencies of clinical care insight, technology, and real-world
data and information, all of which can be used together to drive
innovation. This gives us more flexibility and adaptability to
think broadly about whats needed in the health system, said Dr.
Sandy, particularly in terms of achieving the triple aim: improving
individual experiences in health care, improving population health
and controlling costs. Its easier to optimize one at a time, but
to the detriment of the others, Dr. Sandy noted. Doing it
simultaneously is the goal of the triple aim. Currently, 30 percent
of health care spending is wasted. Addressing wasted spending
and variation in care will also improve individual and population
health.

UnitedHealthcare is uniquely positioned to collaborate and

innovate. The scale and scope of the enterprise 190 plan
sponsors, 100 million consumers, 850,000 network care
providers makes it possible to collect real-world data
produced in everyday interactions across the health system and
turn it into actionable information. Dr. Sandy cited HealthPlan
Manager and the eSync platform as examples of these innovative
collaborations.
He noted two megatrends that were discussed in breakout
sessions throughout the day: (1) the move from volume-based
payments for services to value-based payment models and (2) the
rise of the consumer and the move to a more consumer-centric
world. On the latter point he noted, There is an opportunity
and a challenge in having consumer engagement to help inform
decision-making. The Health4Me app from UnitedHealthcare is
an example of engaging with consumers on their smart phones.
As part of a learning health system, Optum Labs was built on
the principle that the health system needs to learn from its own
experience. Optum Labs is an open platform to support research
on improved patient care and patient value. Sort of the Bell Labs
of health care, added Dr. Sandy.

2015 Optum Day: An overview

He concluded by stressing the need for multiple, multi-level

strategies to promote affordability: Im an optimist, he said. I
think we can afford to innovate. But we have to address issues
of waste and variation in care and use data, analytics and
innovation to accomplish this. We can only accomplish this
through collaboration. No one actor can do this alone. Were in
a really exciting time when this is becoming recognized that
we have to work together to promote high-value innovation.

Plenary 2: Strategies for high-quality, affordable

cancer care
Dr. Lee Newcomer, MD, MHA
Senior Vice President, Oncology, Genetics and Womens Health,
UnitedHealthcare
Its estimated that medical costs account for 50 percent of
household income. At the same time, Americans have not seen
their incomes rise because employers are struggling to pay their
portion of medical benefits. This places a disproportionate burden
on consumers. All of us have to pay attention to this problem,
Dr. Lee Newcomer said. Everybodys involved hospitals,
insurers, pharma, you name it. We are all going to have to do
more with less.
As more costs have been shifted to the consumer, theyre being
crushed. Dr. Newcomer cited a recent report from the National
Bureau of Economic Research that found that half of Americans
cant get their hands on $2,000 in 30 days. Yet consumers
are choosing higher-deductible plans in an attempt to keep
their costs down. Then when they get sick, they discover their
coverage wont provide the kind of care people got used to get in
the 70s and 80s.
In the past weve said the solution is to throw more money at
the system. So we charge a higher premium, you charge a higher
rate for the drug, and hospitals charge a higher rate for a bed.
But eventually that chicken comes home to roost and it has.

People are dropping insurance and employers are moving people

to exchanges or those jobs are going offshore.
Turning specifically to cancer treatment, Dr. Newcomer outlined
several initiatives that UnitedHealthcare has undertaken aimed at
finding the right courses of treatment while reducing unnecessary
costs.
Episode payments: Instead of paying physicians on a fee-forservice basis, this program rewards physicians for improved
quality and reductions in the total cost of cancer. It severs the
tie between an oncologists income and drug sales. Its also a
learning system in that it provides a feedback loop to identify best
practices for quality and cost control. The results are promising:
a 34 percent reduction in total medical costs. Dr. Newcomer
said that one of the best side effects of the program is the
collaboration that ensued: When we sat down with these teams,
the whole-days discussion was How can we make patients
care better? The program is expanding to six medical groups
this year.
Bundled payments: Another program offered bundled payments
for one years worth of care for head and neck cancer. The
incentive is to avoid complications, said Dr. Newcomer, since
complications can cause costs to skyrocket. This approach also
enables the multidisciplinary team to talk with each other, and
offers a huge advantage to consumers because they know at the
outset exactly what their care will cost. Now when a patient
comes in, hes able to talk with the team about the options and
tradeoffs of each approach, and theres no longer an incentive
for providers to push a certain treatment. This program is also
expanding to providers treating other types of cancer.
Prior authorization: To make the process more efficient and
reduce the amount of denied claims, UnitedHealthcare introduced
prior authorization for cancer drugs. This is a big step forward
in giving patients and providers alternatives if the drugs theyre
considering dont match our coverage policies, which are based
on the NCCN guidelines. If a regimen is not approved, the process
provides recommended alternatives. Oncologists receive timely
pre-service approvals for chemotherapy coverage: 60 percent
are immediately approved and the average time for the rest is
3.9 hours.
Comparative effectiveness: Were collecting the data on
cancer patients with the long-term goal of understanding the
comparative effectiveness of the treatment they received. In a few
years this data will be available to providers and patients so they
can see hospitalization rates for each regimen, the total cost of
care and the average length of therapy.
Value-based networks and benefits: In choosing facilities for our
networks, UnitedHealthcare looks at which ones achieve the
best results. A center may no longer be in our network because

2015 Optum Day: An overview

their treatments have been shown to be expensive without

adding value. The question is: where can patients receive the best
possible care?
In conclusion, Dr. Newcomer cited five key takeaways: costs must
come down, risk will shift to providers in limited forms, results will
determine value, quality is almost always improved with lower
costs, and collaboration is essential to effectiveness.

Plenary 3: Opportunities to partner with

UnitedHealth Group
Brian Kelly, President, Life Sciences, Optum
In closing, Brian Kelly emphasized the notion of partnership and
collaboration. As an organization that strives to effect clinical
change, we know that we cant do it alone, said Brian Kelly.
We also know that you think about disease and about patients
very differently than we do. Its not a matter of right or wrong;
its just the orientation of our competencies. Your competencies
in disease are far better than our own. Your knowledge of the
basic biology and the cascade is better than our own. Your
knowledge of treatment is better than our own. And we need
that. We need many of the tools that youve developed to be able
to achieve the kinds of things we want to achieve.

Mr. Kelly returned to a slide that Dr. Sandy showed in the opening
plenary, that shows the amount of money thats wasted in
health care: $210 billion on unnecessary services, $130 billion on
inefficient delivery services, $191 billion in excessive administrative
costs. These are markets, he said. There are payers out there
willing to pay for nothing, and these numbers show up in our
own book of business. So dont you think people would be
willing to pay a little bit less for nothing? And as we reduce these
numbers, we create an opportunity to fund innovation.
As an example of tackling two of those waste buckets, Mr. Kelly
cited a provider collaboration that Optum began several years
ago that identified patients who were getting inappropriate
diagnoses and receiving unnecessary care. This partnership also
enabled contracting discussions about how to change the basis
of financial transactions to help remove excessive administrative
costs.
Were trying to understand the world of data and technology
as much as anyone. But were also going to find a way to use
our expertise to change clinical practice. Were going to take the
evidence and the knowledge that weve developed and make a
difference. Were going to change episodes of care. Were going
to work together to change the site of care. And we know we
cant do that by ourselves.
3

2015 Optum Day: An overview

Optum can speed the application of evidence-based insights

through the addition of direct channels. In this world of realworld evidence usage, we think about new channels and new
approaches, Mr. Kelly said. These include Optum One, patient
physician programs from UnitedHealthcare, OptumHealth and
OptumRx, and alternative benefits and payment models. All of
these effect changes in clinical practice.

Breakout tracks and sessions

Track 1: Real-world data (RWD) and analytics
Using real-world data and analytics to address clinical
challenges and effect real change in clinical care
Session 1. Optum Labs research constellations:
Collaborating to address health system challenges
Presented by Paul Wallace, Chief Medical Officer, Senior Vice
President of Clinical Translation, Optum Labs
Located in Cambridge, Massachusetts, Optum Labs is an open,
collaborative research and innovation center with the goal of
accelerating change in health care that leads to improved care
and value for patients. Optum and Mayo Clinic are its founding
partners. Now, all have a seat at the table of health care
innovation: life sciences companies, health care providers, payers
and employers, technology leaders, government researchers,
academic institutions and consumer organizations. Our database
includes 128 linkable claims, 33 million unlinkable claims,
clinical data for 31 million patients and behavioral data for 35
million consumers. Research constellations come together to
use this real-world data and diverse research methods, tackling
big problems in health care; heart failure and Alzheimers are
examples of recent research projects. Organizations can partner
with Optum Labs as a constellation leader, sponsor or member,
and research partners have access to Optum Labs data and virtual
sandbox. Optum Labs is hosting an event on June 23 that allows
attendees to see firsthand how life science companies can benefit
and contribute to this endeavor.

Session 2. PRO and HRA: How they are converging into

the same thing
Presented by Gus Gardner, Group President, Patient Insights and
Epidemiology, Optum
Patient-reported outcomes and health risk assessments contribute
greatly to our understanding of how well health care is being
delivered. However, HRAs offer little in the way of real-time
health status, as well as lacking standardization and comparability
among individuals and across populations. Optum takes a hybrid
approach. While HRAs try to measure the risk of future health

issues, SF health surveys measure present health status, which

can help prove drug efficacy, for instance. SF health surveys
are the most reliable, rigorously validated and widely used
health status measures in the world, measuring eight health
domains and offering summary scores for physical and mental
health, which are standardized so outcomes can be compared.
The Smart Measurement System provides measurements for
any population, correlating SF scores with utilization, job loss,
hospitalization and many other risks and outcomes. Dashboards
can evaluate treatments, understand future risk and track trends.

Session 3. Translating to the language of payers: Actuarial

analyses of new drug therapies
Presented by Greg Warren, Vice President of Actuarial Consulting,
Payer Consulting, Optum
The major steps in the formulary design process include
evaluation of last years formulary, modeling decision
scenarios and creating an implementation plan for updating
the formularies. As one of many stakeholders in the process,
actuarial services focus on managing financial risk. Accurately
predicting the uptake and cost of new products is among
the most important issues facing risk-bearing entities such as
insurers. Actuaries measure risk in terms of money, assuming
that clinical benefits will be reflected in the financial impact.
Actuaries differentiate products based on the probability and size
of the products financial risks or opportunities, often asking,
Can a product bend the trend curve? At Optum, our unique
knowledge of actuarial services for health care helps life sciences
companies translate their message to the language of payer
in a variety of ways: an educational workshop series called
The evolving health care ecosystem; the health technology
pipeline for gaining early insights into payer budge expectations
for pipeline products; actuarial modeling; and risk/gain-share
agreements.

2015 Optum Day: An overview

Session 4. Real-time insights from advanced

analytical tools
Presented by David Dore, PharmD, PhD, Vice President and
Principal Epidemiologist, Optum; and Meg Good, PhD, Vice
President, Health Economics and Outcomes Research, Optum
Real-world data and analytics provide a deeper understanding
of patients unmet needs, enable more personalized care and
engagement, identify and close gaps in care, and demonstrate
the value of interventions on population health. However, there
are challenges in dealing with large, disparate data sets, which
have made the process slow, siloed and expensive. Dr. Good
said, Thats why the Optum data geeks are so excited about our
partnership with SAS Technologies to create the new SAS RWD
Analytics Platform. Using live, online examples, Dr. Dore and
Dr. Good demonstrated how several analyses that used to take
days or weeks could now be done in seconds or minutes. This
will help pharmaceutical companies, providers, payers and others
accelerate data-driven insights for better decision-making across
the clinical and commercial continuum. The platform and tools
will be available to a broad range of users beyond the traditional
expert, power users who were able to use them in the past.
Track 2: Value and payment models
Evolving value and payment models to reflect new
channels for life sciences companies
Session 1. Closing gaps in care and driving adherence
Presenter: Tom Murray, Senior Vice President, Optum
The health care landscape is rapidly changing, with the basis of
payment shifting from volume to outcomes, risk shifting from
payers and employers to providers and states, and a larger
burden shifting to consumers. In response to these dynamics,
health services companies need to change as well. Optum
takes an integrated, holistic approach to population health
management. Building on its integrated core clinical solution,
Optum incorporates specialty networks, pharmacy and local care
delivery systems to maximize economic and health outcomes by
addressing gaps in care and lowering costs. The eSync clinical
platform serves as the foundation, continuously monitoring
population data across medical, pharmacy and behavioral
health. Large UnitedHealthcare ASO groups with integrated
OptumRx PBM are able to address gaps in care and reduce
costs with proven results, including a 57 percent increase in
care management enrollment through PBM and a 63 percent
increase in health and savings opportunities. Integrated medical
and pharmacy data identifies gaps in care and prioritizes those
members to receive interactions with pharmacists and other
resources for closing those gaps.

Session 2. New approaches to formulary management

Presenter: Brian Solow, MD, FAAFP, Chief Medical Officer,
OptumRx
The pharmaceutical marketplace is like a teeter-totter with
pharmaceutical companies and manufacturers on one end,
and payers and PBMs on the other. Stakeholders also include
wholesalers, distributors, hospitals, prescribers, consumers,
regulators and legislators, among others. Specialty pharmacy
growth is the single greatest factor influencing pharmacy trend,
with 70 percent of total pharmacy drug expenses represented by
five condition classifications: inflammatory conditions, hepatitis,
multiple sclerosis, HIV and cancer. Patent expirations, direct-toconsumer (DTC) and drug price inflation are also strong trends
influencing the marketplace. The OptumRx approach is to stay
ahead of the curve, with pipeline forecasting of blockbuster
drugs. This comprehensive approach to determining a drugs
value considers all impacts to overall health care costs and
outcomes, reviewing therapeutic use, clinical profile, competitive
environment and regulatory status. Two interdependent
committees P&T and BIC operate with the foundational
philosophy of maximizing clinical quality with a focus on the
lowest net cost. Utilization management strategy is driven by
pipeline forecasting, along with pharmacy and medical data and
modeling plan benefit design. Once a drug is launched, clinical
outcomes and savings are monitored, along with continued
evaluation of clinical literature as part of the formulary review

2015 Optum Day: An overview

Session 4. New trends in the Brazilian health care system

Presenter: Rafael Vasconcellos, MD, Senior Vice President of
Medical Affairs, UnitedHealth Group
Dr. Vasconcellos began by showing that the 564 million people in
Latin America spend $338 billion in health care. Brazil represents
46 percent of those expenditures. Now part of UnitedHealth
Group, Amil is Brazils largest health care company. The company
operates 29 hospitals, 42 clinics and 221 satellite medical offices.
Dr. Vasconcellos provided an overview of Brazils regulatory
framework and then covered several examples of innovative Amil
programs.

Track 3: Patient and provider engagement

process. In order to stay ahead of the curve, OptumRx has an eye
on future advances, including medical necessity expansion, sites
of service, price and contract innovations, preferred products,
utilization management, and next-level physician and consumer
engagement.

Session 3. ACO and risk sharing: Approaches to risksharing analytics

Presenter: Jay Hazelrigs, Vice President of ACO Actuary
Consulting, Optum
As the value-based care market approaches its tipping point,
stakeholders in health care must look for ways to address
health care inefficiencies, thereby creating greater value. This
is accomplished through population health interventions and
value-based risk-sharing contracting. Avoidable expenses and
inefficiencies is health care amount to $765 billion annually,
representing an opportunity to save 30 percent in costs. Medicare
FFS patients use more resources and experience worse outcomes
than patients in value-based models. Medication adherence is
another area of opportunity. Value-based contracts are also an
important part of the equation. Organizations that have been
successful in this cite four areas of critical focus for success
in population health management: optimize their network,
manage care transitions, identify opportunities for high-acuity
interventions and expand disease management. Most payers
and providers are moving toward risk models that promote
quality and high performance through coordinated care. On
the continuum from FFS to ACO, most payers and providers
have implemented some form of pay for performance and are
beginning to consider or rollout PCMH, buddle payment and ACO
initiatives. Examples of risk-sharing analytics were shared and can
be reviewed in the PPT presentation.

New avenues for engaging providers and patient

adherence, the future of insurance/specialty benefits and
how these programs are impacting clinical care today
Session 1. New channels for using real-world evidence
to directly change clinical care
Presenter: Allen Kamer, Chief Commercial Officer,
Optum Analytics
Lowering the cost trend and improving patient outcomes are
essential for creating a lasting impact on the health system.
Optum One is a dynamic, software-as-a-service solution providing
clinical intelligence analytics for providers to proactively manage
their patient population health. It intelligently organizes, identifies
and stratifies patients according to their care needs. As providers
are bearing more risk, the Optum One health analytics platform
allows providers to better understand their patients risks and
gaps in care; for example, enabling them to identify patients with
undiagnosed diabetes. The Optum One database now includes
60 million lives, 108,000+ active physicians, 500+ hospitals and
4,500+ clinics. With this data at their fingertips, providers are
able to address gaps in care, thereby lowering costs and achieving
better outcomes for their patients. This creates value for provider
systems as well as life sciences organizations. As providers are
better able to control costs and improve outcomes, life sciences
organizations are seeing opportunities to create a new channel to
directly influence outcomes, with deeper insights into real-world
data and the opportunity to test solutions in real-world practice.

2015 Optum Day: An overview

Session 2. Consumer engagement in the changing health

care market
Presenter: Seth Serxner, PhD, MPH, Chief Health Officer, Senior
Vice President of Population Health, Optum Care Solutions

Session 3. How CDHPs will change every decision made

in health care today
Presenter: Deborah Culhane, Senior Vice President of Financial
Services, Optum

Population health management has evolved from disease

management that targets the top 35 percent of high-risk
and high-cost conditions, to care and lifestyle management
programs customized to achieve specific population goals, to
where we are now: proactively engaging the entire population
wherever they are on the spectrum from well to high-risk. The
value proposition is evolving as well, from reducing health care
costs and improving employee health and productivity, to seeing
population health as a critical element to business strategy,
making the connection between a companys health and
employee wellness. This approach to well-being comprehends
employees physical, emotional, social, financial, community and
career needs. Rather than achieving health being the primary
focus of a given intervention, behavior change is the focus, with
personal satisfaction and happiness as motivators for taking
ownership of ones health. Optum bases its population health
on the ASM Model: awareness, skill building and maintenance.
Using consumer-focused guiding principles, we design programs
that are delivered by phone, online, in print and face to face
at home, at work, on the go and at the doctors office.
Our consumer segmentation research allows us to define the
dimensions that speak to and motivate different individuals
within a population. Analytics tools identify and engage with
high-value members. Creating a culture of health is the key to
employee engagement. And the value of doing so is quantifiable:
Companies that encourage a culture of health outperformed the
S&P 500 94 percent versus 1 percent return for the same period.

Employer-paid medical costs have increased by nearly one-third,

and large companies see CDHPs as the most effective way to
control costs. High-deductible plans typically have a $1,000
$2,000 deductible paired with a $3050 percent employer
contribution to an HSA or HRA. High-deductible plans drive lower
costs and better consumer decision-making. As health care costs
shift from employers to employees, my health, my money
becomes the mantra; however, in order to adopt this attitude,
employees need education, resources and ongoing support. As
of March 2015, Optum BankSM, member FDIC, has more than
$2 billion in assets and three million health accounts. Optum is
uniquely positioned to help consumers understand how to save
and pay for health care, with the proprietary 5 Stages of Health
Saving and Spending engagement program and multimedia
learning tools. Optum can also help self-insured employers
medical expense risk and catastrophic claims.

2015 Optum Day: An overview

Session 4. Exchanges: The future of health

benefits shopping
Presenter: Marc Salinas, Senior Vice President of Private
Exchanges, Optum
Companies are being cautious in their approach to private
exchanges, with strong growth not expected until 2016. In
addition to several factors holding them back, most employers
are looking for value beyond just cost-shifting, asking How do
we drive sustainable savings? Optum Market for employers is
a different kind of exchange. In addition to offering employees
choices and incentives, Optum Market also provides guidance
to help people use their benefits better, flexibility to retain an
existing benefits strategy, an openness to work with a clients
preferred partners, and integration with year-round health
management. Intelligent enrollment is based on what we

know about an employees historical utilization, providers,

prescriptions and current risks and programs, combined with
what we learn about recent changes to health status, interest
in new programs and incentives, and contact preferences. This
provides value to employees because they receive better advice
on plan selection, can easily compare their choices and receive
proactive guidance on programs and incentives. For employers,
the value is realized in faster insights into new health risks, higher
ongoing engagement levels, and more informed and empowered
employees. Launched in September 2015, Optum Market went
live for all 125,000 domestic employees of UnitedHealth Group.
This summer, were targeting enrollments for our first external
customer, and in 2016, Optum Market will partner with a major
industry association and begin actively selling for Jan. 1, 2016
effective dates.

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