In 2022, UnitedHealthcare’s total cost of care — based on commercial large group PPO health plan claim costs — was 13.9% lower than the MarketScan benchmark, according to a March Milliman report commissioned by the insurer.
Nationwide, the total cost of care per member per month was $402.11 with UnitedHealthcare versus the $466.80 benchmark. There was variability across the country: The Southwest featured the largest gap, with UnitedHealthcare 17.2% below benchmark.
Becker’s spoke with Rhonda Randall, DO, chief medical officer for UnitedHealthcare’s commercial business, and Katy Curry-Lorusso, UnitedHealthcare’s chief actuary for national accounts, about the white paper.
“Often in healthcare, we have a tendency to focus on unit cost or one specific measure, whereas the total cost of care is the important thing to measure,” Dr. Randall said.
The report also reviewed Naviguard, an out-of-network cost management program within UnitedHealthcare that employer groups can participate in. Looking at only these participants, the total cost of care is 16.1% lower than the benchmark.
Inpatient costs were 13.8% lower for UnitedHealthcare, and outpatient was 9.3% lower.
The research offers a few caveats: The MarketScan benchmark may include UnitedHealthcare members, the paper does not address employers’ cost to engage in Naviguard and the cost analysis excluded prescription drugs covered under the pharmacy benefit.
“For an employer, pharmacy … could be 20% to 30% of their spend, so definitely a critical part of this,” Ms. Curry-Lorusso told Becker’s. “But this was focused on medical claims … which is the vast majority of spend for an employer.”
In conversations with employers, Dr. Randall said she focuses on “proof points” and then differentiating offerings.
“I think this externally validated study supports those conversations,” she said.
Beyond the data, she sees a broader movement “toward defragmentation and simplification” in the market.
“A few years ago, there were maybe more employers who were piecemealing activities and offerings with their employees,” Dr. Randall said. “We see now a move towards unification and simplification, combining benefits together.”
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