United Healthcare Case Study

Introduction

United Healthcare is a managed health care company that was created in 1977 to provide health insurance to individuals and businesses. The company is the largest carrier of health insurance in the United States. United Healthcare has consistently received rewards and has a strong record for delivering optimal health care coverage. However, the company has struggled in dealing with hospital administrations and has also come into scrutiny for various legal troubles. These issues coupled with the problem of American healthcare and the passing of health care reform in the form of Obamacare means that the company will need to make changes to prepare for the increased number of individuals who will need healthcare coverage. The company will also need to adjust to competing with other insurance providers for these individuals. United Healthcare will need to evolve with the changes in healthcare legislation to accommodate for the healthcare needs of these individuals. 

Readiness of United Healthcare

Despite the company’s standing as the largest health insurance provider in the nation, United Healthcare is not prepared to address the needs of citizens in the next decade. As Obamacare begins to be enforced every American citizen will need to have healthcare. All businesses will also be required to provide coverage to their employees. As health insurance companies begin to market themselves to gain these new clients, they will have to compete with each other. United Healthcare can no longer assure that they will be the largest insurance provider. The insurance company will not only have to deal with an increased number of individuals who need coverage, but they will also have to provide coverage to individuals with pre-existing conditions who they may have previously denied. They will also need to address a number of issues that are beginning to be seen as conditions that should be covered more by health insurance such as mental illnesses. Diehr (1984), identified how very insurance providers adequately covered mental health and this is still an issue that is occurring to the present day. This will require United Healthcare to change their approach to providing coverage and also how they interact with healthcare providers.

Providing coverage to individuals who have pre-existing conditions will require United Healthcare to deal with more medical providers especially those in specialty fields that threat certain pre-existing conditions. According to a case study completed by PPMR (2011), United Healthcare ranks the lowest among hospital executives in terms of interactions with providers. The low rankings that United Health care has received from hospitals demonstrates that the company does not have the best reputation with providers. This could be due to the difficulty’s hospital administrators face in attempting to get the company to pay for procedures. As a result of this United Healthcare has begun to make changes as Goozner (2011) found. “The nation's largest health insurer recently launched an experimental cancer care payment program that disconnects physician reimbursement from drug sales and encourages oncologists to follow standardized regimens.” (Goozner, 2011 8). This is an important first step however the relationship between insurance providers and hospitals will become an issue for individuals who have pre-existing conditions who require additional medical services and procedures to treat their conditions. The company would have to resolve these issues in order to prepare for the changes in healthcare that will be occurring within the next decade. 

Network growth

In order to achieve adequate network growth in the next decade United Healthcare will need to be able to compete with other insurance providers who will be competing for the same clients. The company will need to reduce their rates so that they are competitive with other insurance providers. Draper (2002) has identified how insurance companies have begun to adjust to this need to be competitive with others. “Plans are moving to offer less restrictive managed care products and product features that respond to consumers’ and purchasers’ demands for more choice and flexibility” (Draper, 2002 11). United Healthcare will need to adapt to these demands for choice and flexibility through developing insurance plans that will meet the needs of a diverse groups of clients. They will also need to embark on a marketing plan that would target both individuals and businesses that will now need to obtain health coverage. United Healthcare will also need to train their insurance representatives to be able to explain the changes that have accompanied Obamacare and what is required of their clients. Through these strategies United Healthcare can hope to acquire the burgeoning clientele that healthcare reform has produced, and the company can expect to expand.

Nurse staffing

United Healthcare is unique among the health insurance carriers in that they have a program devoted to nurse staffing. The Center for Nursing Advancement within United Healthcare serves to train and mentor registered nurses. This is a valuable service as it not only prepares new nurses, but it also demonstrates that the company is devoted to ensuring individuals receive quality healthcare. As a strategic plan United Healthcare can expand their center by including a division that focuses on nurse staffing. As a result of a nursing shortage patients are not receiving the care that they need. The center can work towards addressing this issue through working with nurses before they become registered nurses. The center could provide assistance to newly graduated nurses to help them through the process to become registered. United Healthcare can play a key role in the staffing of nurses in hospital settings.

Resource Management

Increased number of clients will require United Healthcare to adjust their resource management strategies. Rather than devoting resources towards denying claims the company would need to focus on ensuring that each client is receiving the services they need. With an increased budget for marketing and reducing their rates United Healthcare would need to adjust their budget to accommodate these changes. A strategy for the budget could revolve around reducing the pay for top level executives within the company. This would demonstrate to clients, hospital providers and other insurance companies that United Healthcare is focused on optimal healthcare rather than profit. 

Patient satisfaction

Due to the increased competition between insurance providers United Healthcare will need to strive to provide patient satisfaction to all of their clients. The plan to increase the patient satisfaction would need to focus on determining areas of improvement. This could be completed through patient surveys that would identify areas of need. United Healthcare can then develop a plan to address concerns. The company would also need to focus on not only training customer services representatives in healthcare policy but also on how to provide customer service to individuals who may be upset about their coverage. As these representatives are the first individuals who clients encounter United Healthcare would need to focus on improving the service they provide. 

Conclusion

Healthcare reform has resulted in sweeping changes to the healthcare system that will require United Healthcare to evolve if the company wants to continue to hold the mantle of the largest provider in the United States. Through the use of a strategic plan that will accommodate for the increased number of patients they will serve the company can prepare itself for these changes. As the nation begins to focus on quality healthcare the insurance providers will also need to shift their focus from profit to optimal healthcare. The policies that United Healthcare implements will demonstrate whether they are focused on profit or care. Through being the company that is focused on quality care United Healthcare can prepare itself for the upcoming changes as well as being competitive with other providers. Through these steps United Healthcare can become the manage care provider of the future. 

References

Diehr, P., Williams, S. J., Martin, D. P., & Price, K. (1984). Ambulatory mental health services utilization in three provider plans. Medical Care, 22(1), 1-13.

Draper, D. A., Hurley, R. E., Lesser, C. S., & Strunk, B. C. (2002). The changing face of managed care. Health Affairs, 21(1), 11-23.

Goozner, M. (2011). United healthcare, five oncology practices try bundled payments. Journal of the National Cancer Institute, 103(1), 8-10.

PPMR (2011). United Healthcare’s Premium Designation Program for Physician Performance Measurement and Reporting Value Based Purchasing Guide, 1-7.