UnitedHealth Group, Minnetonka, MN, USA.
Health Aff (Millwood). 2013 Aug;32(8):1440-5. doi: 10.1377/hlthaff.2012.1082.
Patient engagement is crucial to better outcomes and a high-performing health system, but efforts to support it often focus narrowly on the role of physicians and other care providers. Such efforts miss payers' unique capabilities to help patients achieve better health. Using the experience of UnitedHealthcare, a large national payer, this article demonstrates how health plans can analyze and present information to both patients and providers to help close gaps in care; share detailed quality and cost information to inform patients' choice of providers; and offer treatment decision support and value-based benefit designs to help guide choices of diagnostic tests and therapies. As an employer, UnitedHealth Group has used these strategies along with an "earn-back" program that provides positive financial incentives through reduced premiums to employees who adopt healthful habits. UnitedHealth's experience provides lessons for other payers and for Medicare and Medicaid, which have had minimal involvement with demand-side strategies and could benefit from efforts to promote activated beneficiaries.
患者的参与对于改善治疗效果和建立高效的医疗体系至关重要,但支持患者参与的努力往往过于狭隘地集中在医生和其他医护人员的作用上。这些努力忽略了支付方在帮助患者改善健康方面的独特能力。本文以大型全国性支付方 UnitedHealthcare 的经验为例,展示了健康计划如何分析和向患者和医护人员提供信息,以帮助缩小护理差距;分享详细的质量和成本信息,为患者选择提供者提供参考;并提供治疗决策支持和基于价值的福利设计,以帮助指导诊断测试和治疗方法的选择。作为雇主,UnitedHealth Group 还使用了这些策略以及一项“赚取回补”计划,即通过降低保费为采取健康习惯的员工提供积极的经济激励。UnitedHealth 的经验为其他支付方以及医疗保险和医疗补助计划提供了借鉴,因为这些计划在需求方策略方面的参与度很低,可以从促进有活力的受益人的努力中受益。