This document discusses strategies for bending the healthcare cost curve by addressing modifiable risk factors and improving diagnosis. It notes that health behaviors contribute significantly to chronic disease and that current health IT does not strongly engage consumers. To increase value, the document advocates using technology to more actively involve patients in their care through virtual interactions with experts and care teams. This approach could boost patient trust in treatment plans and support for virtual care models while leveraging self-determination theory to encourage behavioral changes.

1. Bending the Healthcare Cost Curve
Anupam Goel
Chief Health Information Officer, UnitedHealthcare Clinical Services
October 10, 2019

2. Total National Health Expenditures, 1970-2017
Billions,2017dollars
https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/. Accessed 2019.9.5

3. 0
3
6
9
12
15
18
1 2 3 4 5 6 7 8 9 101112131415161718192021222324252627282930313233343536373839404142434445464748
Health Consumption Expenditures as a Percent of GDP, 1970-2017
https://www.healthsystemtracker.org/indicator/spending/health-expenditure-gdp/. Accessed 2019.9.6
USPercentofGDP

4. 0
3
6
9
12
15
18
1 2 3 4 5 6 7 8 9 101112131415161718192021222324252627282930313233343536373839404142434445464748
Health Consumption Expenditures as a Percent of GDP, 1970-2017
https://www.healthsystemtracker.org/indicator/spending/health-expenditure-gdp/. Accessed 2019.9.6
Canada
England
France
Germany
Japan
Sweden
Switzerland
USPercentofGDP

5. Age standardized disability adjusted life year rate per 100,000 people,
1990-2017
0
1
2
3
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Incrementsof10,000
https://www.healthsystemtracker.org/indicator/health-well-being/disability-adjusted-life-years/. Accessed 2019.9.6
Canada
England
France
Germany
Japan
Sweden
Switzerland
US

6. Age standardized disability adjusted life year rate per 100,000 people,
1990-2017
0
1
2
3
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Incrementsof10,000
https://www.healthsystemtracker.org/indicator/health-well-being/disability-adjusted-life-years/. Accessed 2019.9.6
Comparable
country
average
US

7. Age standardized years of life lost rate per 100,000 people, 2017
http://www.healthdata.org/united-states. Accessed 2019.9.5

8. Age standardized years of life lost rate per 100,000 people, 2017
http://www.healthdata.org/united-states. Accessed 2019.9.5

10. Population-attributablefraction(%)
Metabolic risk factors
• Hypertension
• Diabetes
• Non-HDL cholesterol
• Waist-to-hip ratio
Behavioral risk factors
• Tobacco use
• Alcohol use
• Diet quality
• Physical activity
Yusuf S. Lancet http://dx.doi.org/10.1016/S0140-6736(19)32008-2 Published online 2019.9.3.
Modifiable Risk Factors for Cardiovascular
Disease in High-Income Countries

11. Population-attributablefraction(%)
Metabolic risk factors
• Hypertension
• Diabetes
• Non-HDL cholesterol
• Waist-to-hip ratio
Behavioral risk factors
• Tobacco use
• Alcohol use
• Diet quality
• Physical activity
Yusuf S. Lancet http://dx.doi.org/10.1016/S0140-6736(19)32008-2 Published online 2019.9.3.
Modifiable Risk Factors for Cardiovascular
Disease and Overall Mortality in High-Income
Countries

12. Veinot TC.
Medical Care
2019;57:S108.

13. Veinot TC.
Medical Care
2019;57:S108.

14. Key Information and Communication
Technology Capabilities
• Collection and Display of
Information
• Customization of
Information
• Education
• Mediation of
Communication
• Support of Workflows and
Activities
• Framing and Support of
Decisions
• Social Coordination
• Optimization of Resource
Allocation
• Identification of Patterns
and Anomalies
• Prediction of Outcomes
Veinot TC. Medical Care 2019;57:S108.

15. Key Information and Communication
Technology Capabilities
• Collection and Display of
Information
• Customization of
Information
• Education
• Mediation of
Communication
• Support of Workflows and
Activities
• Framing and Support of
Decisions
• Social Coordination
• Optimization of Resource
Allocation
• Identification of Patterns
and Anomalies
• Prediction of Outcomes
Veinot TC. Medical Care 2019;57:S108.

16. I Sim. N Engl J Med 2019;381:956-968.

19. Institute of Medicine,
Improving Diagnosis in Health
Care. September 2015.

20. Berger ZD BMJ 2017;359:j4218.

21. Guidelines for the Management of Prostate Cancer: West Midlands Expert Advisory Group for Urologic Cancer. NHS England.
Published December 2016.

22. Singh S Adolesc Health Med Ther 2011;2:123.

24. Jain T JAMA doi:10.1001/jama.2019.9889. Published online 2019.7.26.

25. Diagnostic/treatment plan confidence/commitment
Willingnesstoreceive
carevirtually

26. Playing to our strengths
• Interactions with experts to increase trust in
diagnostic/treatment plan
• Interactions with other members of the team
to implement the diagnostic/treatment plan

27. Playing to our strengths
• Interactions with experts virtually (after initial
face-to-face evaluation) to increase trust in
diagnostic/treatment plan
• Interactions with other members of the team
(or a bot or an algorithm) to implement the
diagnostic/treatment plan

29. Deci EL Psychological Inquiry 2000;11:227.

30. Key Information and Communication
Technology Capabilities
• Collection and Display of
Information
• Customization of
Information
• Education
• Mediation of
Communication
• Support of Workflows and
Activities
• Framing and Support of
Decisions
• Social Coordination
• Optimization of Resource
Allocation
• Identification of Patterns
and Anomalies
• Prediction of Outcomes
Veinot TC. Medical Care 2019;57:S108.

31. Key Information and Communication
Technology Capabilities
• Collection and Display of
Information
• Customization of
Information
• Education
• Mediation of
Communication
• Support of Workflows and
Activities
• Framing and Support of
Decisions
• Social Coordination
• Optimization of Resource
Allocation
• Identification of Patterns
and Anomalies
• Prediction of Outcomes
Veinot TC. Medical Care 2019;57:S108.

32. What were we talking about again? (1)
• We are not getting the best value for our
healthcare dollar (lives, quality-of-life)
• Health behaviors are a big part of chronic disease
• Current Health IT offerings aren’t strongly
engaging consumers
• Patient confidence/trust in medical plan may
support virtual care

33. What were we talking about again? (2)
• Doing more to increase patient adoption
– Direct-to-consumer is not enough
– Self-determination theory >> Transtheoretical
model
– Expand our current deployments of information
and communication technology capabilities

34. Thank you
linkedin.com/in/goelanupam
anupam.goel@uhc.com