Care management and clinical programs

Almost half of all U.S. adults have at least one chronic condition, which may make it harder for them to get healthier.¹ Our care management and clinical programs are designed to step in and help these employees and their covered family members with a combination of timely outreach, clinical support and personal guidance.

Delivering extra support for those who need it most

Identifying and reaching out to at-risk employees sooner

Data and analytics help us identify at-risk employees for targeted support across multiple conditions, including proactive outreach and guidance from nurses, care advisors and case managers.

Streamlining the entire experience

Having a single point of contact connected to all aspects of the health care system can help those with significant health challenges find specialty providers, manage claims and preauthorization issues and more.

Lowering costs

The right support not only helps simplify the health care system for employees with complex conditions, it may also help lower costs by as much as $14.05 per member per month.²

Programs built to help ease complex health journeys

Using data from medical claims, health assessments, network usage and more, Standard Care Coordination identifies and addresses 50+ conditions among your employees for potential gaps in care. For those identified as at risk, resources include:

A nurse team to answer questions and offer guidance
Admission counselors to help with hospital length-of-stay and discharge planning
Access to condition-specific programs and more

Personal Health Support screens up to 100% of your employees for 100+ acute and chronic conditions. Personalized support for at-risk employees includes:

Earlier identification of opportunities for better health
Access to digital tools that include messaging, education, care plans and goal tracking
Guidance from an enhanced clinical team and enrollment in condition-specific clinical programs

Lowering medical costs

$5.05 – $11.05 per member per month savings for mid-size employers with best-in-class configuration³

$5.55 – $14.05 per member per month savings for large employers with best-in-class configuration⁴

People with complex health needs pay 7 times more out-of-pocket than the average patient, to say nothing of the emotional challenges they may face.⁴ With UnitedHealthcare, these patients — who often have 5 times more claims and see 3 times as many specialists⁵ than the rest of your employees — can access extra support through the Complex Care Concierge. Complex Care Concierge matches members with a dedicated Care Advisor, who:

Acts as a single point of contact connected to all aspects of the health care system
Helps manage claims, find specialty providers, streamline preauthorization and much more
Is supported by a specialized team with clinical, pharmacy, behavioral and social/emotional expertise

Simplifying complex journeys

23% reduction in appeals⁶

16% reduction in inpatient visits⁶

Flier: Complex Care Concierge (pdf)

Using personalized care plans and support, our clinical programs are designed to help employees navigate complex or chronic conditions like asthma, cancer, diabetes, heart disease, kidney disease and more.

Supporting healthier outcomes

Over 24% reduction in inpatient admissions for kidney conditions⁷

3.1 program ROI⁸

96% employee satisfaction with oncology nurse resources⁹

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Footnotes

UnitedHealthcare Health Activation Index®, 2017.
Average medical cost savings across UnitedHealthcare National Accounts BoB, 2020. Actual results will vary.
Average medical cost savings across UnitedHealthcare Key Accounts BoB, 2020. Actual results will vary.
UnitedHealthcare National Accounts 2019 BoB.
UnitedHealthcare commercial BoB 10/2019-09/2020 comparing non-eligible families vs. eligible families.
Pre/post study conducted on families engaged from Jan. 2019 – Dec. 2019, analysis completed Oct. 2020. Results not guaranteed.
Comparison between 2018 UnitedHealthcare Book of Business and 2018 United States Renal Data System national averages, usrds.org/adr.aspx
2019 Optum book-of-business data for kidney solution.
UnitedHealthcare book of business, Consumer Health Survey, Average FY 2020.

Disclaimers

Disease Management programs and services may vary on a location-by-location basis and are subject to change with written notice. UnitedHealthcare does not guarantee availability of programs in all service areas and provider participation may vary. Certain items may be excluded from coverage and other requirements or restrictions may apply. If you select a new provider or are assigned to a provider who does not participate in the Disease Management program, your participation in the program will be terminated. Self-Funded or Self-Insured Plans (ASO) covered persons may have an additional premium cost. Please check with your employer.