On Dec. 9, Salil Deshpande, M.D., chief medical officer of United Healthcare Community Plan of Texas, a division of United Healthcare of Texas, was interviewed by HCI Editor-in-Chief Mark Hagland, in the concluding session of the Health IT Summit in Houston, sponsored by the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics under the Vendome Group LLC corporate umbrella).
On Wednesday’s final session, held at the Omni Houston Westside, Dr. Deshpande, an internal medicine physician by training, who has practiced clinically, has worked in hospital administration, and has been a senior executive at United Healthcare of Texas for eight-and-a-half years, focuses in his medical administration work on United Healthcare’s Medicaid and dual-eligible populations in Texas.
Below are excerpts from Hagland’s interview with Dr. Deshpande, as conducted in front of the iHT2 audience.
Just now, in introducing yourself, you described a current focus at United Healthcare of Texas on dual-eligible plan members. That is particularly interesting to me, given that dual-eligibles are among the health plan members with the most complex situations, including poverty, sometimes homelessness, and other complications that aren’t purely medical. I continue to say that what we learn about the care management of dual-eligibles will point the way to successful care management across healthcare populations.
Yes, absolutely. And to step back for a moment, that emphasis on dual-eligibles, it is something that is a priority for the health plans. I think the focus and the eye on healthcare will continue for the country as a whole. It is obviously an issue that the payer industry is also very focused on. There’s been increased access to healthcare for the past several years. We expect that additional people will continue to move into the insured category. There are still continued pressures around healthcare costs in general, of course, but of those reasons will underlie why we are continuing to focus on healthcare as a society.
Salil Deshpande, M.D.
In terms of the cost pressure, that issue is particularly relevant among the dual-eligible population. They are among the sicker people, and are either elderly or have qualified for SSI by virtue of some other disability, and also are likely to be living below the poverty line. And they likely have a history of lack of access to care, that has caused their chronic conditions to be under-diagnosed. And for all those reasons, that patient population tends to be an expensive one, but with opportunities for healthcare improvement.
That is the reality for any population, but more dramatically in the elderly population and among relatively poor populations; in both cases, a relatively small percentage of members are driving the expenses. So to the extent that we can drive care management, we will both improve outcomes and lower costs, and thus, the focus on dual-eligible members makes eminent sense.
Have you and your colleagues been plunging into health risk assessment for that population?
Yes, the social determinants of care really do drive a patient’s clinical condition and overall well-being. So certainly, that patient with diabetes or congestive heart failure, or a congenital anomaly, will have conditions that will drive care management. But also, homelessness is an issue. Historically, healthcare has not focused on non-clinical issues, and yet those people who lack shelter, who do not have a steady job, or the income to buy groceries regularly—they are not paying attention to their prescriptions, because frankly they have other priorities; and so they are ripe for care management.
So those are significant opportunities. And where this dovetails with the data analytics issue that I know we wanted to discuss, is related to Optum, the United HealthGroup division (United Healthcare is the other) through which we provide population health management to providers. Optum’s services are broad, of course, and extend all the way through to fraud, waste and abuse detection solutions.
What are you doing here in Texas, around data analytics for population health?
I’ll start out with something that was originally deployed for our commercially insured population, but which we’re rolling out everywhere. Our AdvocateForMe program is essentially, a customer service program. For instance, let’s say you’ve lost your insurance ID card and need a replacement. Here’s the thing: if you call in, what will show on the customer service representative’s screen will be all sorts of clinical data, which will be generated by your claims history, or may emerge out of pharmacy or laboratory data, or out of information we’ve gathered around any clinical care quality gaps.
And if that customer service rep is actually a nurse who can make sense of a lot of that clinical data, when he or she answers the phone to get you a replacement ID card, maybe you’re a diabetic and haven’t had your hemoglobin a1c measured in six months, for example. So we might be able to make a connection for you and help you to access an endocrinologist, or connect you to one.
When you partner with providers around accountable care or population health development, are you increasingly able to provide them with analytics, in the context of risk-based contracting?