After the CEO’s assassination, the uniethealth faces a defining moment

Last month, Andrew Witty led the first call for the profits of United Group since the tragic assassination of Brian Thompson, the Director General of its Insurance Division, United. The killing shocked the industry, drawing renewed attention to the country’s biggest health insurer at a time when public disappointment about health care costs and coverage denials has reached a boiling point.

In the call, Witty addressed the elephant in the room: why is the health America unbearable.

“Basically, health care costs more in the US because the price of a single procedure, visit or recipe is higher here than elsewhere.”

Witty is right. Americans pay twice as much as their global counterparts for the same medicines, hospital attitudes and clinical services. Worse, insurers have little price control: a broken patent system, restrictions on drug price negotiations, and consolidating without hospital control make it extremely difficult to restore on the annual healthcare bill of $ 5 trillion.

But does that mean nothing Can it be done? The United Group is not just any insurer, after all. It is the largest and most powerful healthcare company in the world, providing 50 million Americans, hiring 90,000 doctors and generating the fourth highest income among US corporations.

Part of the challenge is that the insurers have historically addressed the increase in costs by limiting the care: rejecting preliminary authorization requirements, denial of claims and restricting the patient’s access. This approach has made them an objective of reviewing the Congress, media criticism and public anger.

But the story does not have to end there. Witty has an opportunity to take advantage of this moment and relocate the strategy.

Next era for UHG: Health competition, not denials

For decades, UNITESHEALTHCARE has been ahead of its competition by consolidating market power, expanding into lucrative areas such as managing pharmacy benefits and maximizing profits within a dysfunctional system.

It is a strategy that reminds you of a classic story. Two climbers encounter a gold charging in the woods. One quickly brings the shoes. Others mock, “Why worry? You can’t overcome a bear!” The first climber responds, “I don’t have to overcome the bear. I just have to overcome you.”

Likewise, UHG has long focused on overcoming its competition by reducing costs, tightening prior authorization rules and limiting access to care.

Now, Witty has an opportunity to stop running and start leading. Instead of relying on preliminary authorization requirements and denial of requests, UHG can reduce costs by keeping people healthier in the first place.

This would mean shifting from short-term measures to reduce the cost of long-term investment in the prevention and effective management of chronic diseases: the biggest stimulants of medical spending and the reason that the Life expectancy of the US has stalled over the past 15 years.

Witty’s chance to fix the real problem

According to CDC, 6 in 10 US adults have at least one chronic illness. Conditions like diabetes, heart failure and hypertension are major contributors to serious medical complications, including heart attacks, strokes, cancers and kidney failure – right causes of death and disability that make up at least 70% of all costs of health care.

But these complications of chronic disease are not inevitable. CDC data suggests that the most effective prevention and control of chronic diseases would reduce these expensive and life-threatening medical problems by 30-50%. In other words, the problem is not just the spread of chronic illness. How well (or poor) health care system controls them.

Currently, the US does a poor job of managing chronic disease.

• Hypertension, which contributes to 40% of shocks, is only 60% of the time in the US but high performance health systems reach control levels that are 30% higher, according to HEDIS data.
• Diabetes, the main cause of heart disease, kidney failure and amputations, is successfully controlled in less than half of patients nationwide, despite the availability of proven interventions.

The problem is this: we know how to prevent these complications, but our health care system fails to evaluate and finance the solution. As a result, the US spends most of its health care dollars by treating costly, preventable conditions after becoming life threatening. This is where

Witty and United Group have an unprecedented opportunity to address our current failures and lead the transformation of American medicine.

UHG has resources, data and providers’ network to implement smarter strategy strategies. Leaving a system that expects life -threatening illness to develop, UHG can not only improve patients’ health, but also significantly lower costs of long -term health care.

Three ways of how UHG can lead the future of health care

Witty’s latest public comments suggest he understands the problem. The question is: Will he take the bold action required?

For more than a decade, policymakers and healthcare leaders have spoken about shifting America’s health care model from service fee (which rewards volume) in value -based care (rewarding better health results ). But despite the rhetoric, little has changed. Financial incentives for doctors and hospitals remain misinformed, technology is supported in managing chronic disease, and insurers continue to focus on restraining care than preventing the disease. Witty has an opportunity to redefine what can be a health insurer. Here are three bold movements to start the transformation process:

1. Pilot a model of care capable

Instead of paying provider for test, procedure or hospitalization, United have to pilot a system in numerous communities where doctors and hospitals receive a fixed, risk -regulated, patient payment. This model, called “capital”, stimulates early prevention, intervention and better management of diseases than unnecessary treatments.

• Make a five-year funding commitment to participants to allow enough time for better management of chronic illnesses to reduce hospitalization and urgent visits.
• Pay doctors participating at the level they would earn under service fee, but promise to share half of the cost savings with them as patients become healthier and require fewer visits, hospitalizations and complex procedures.

2. Invest in primary care and preventive health

SH.BA underestimates primary care, favoring expensive specialty care and hospital interventions. UHG should shift stimuli to prioritize prevention, ensuring that chronic diseases are managed before escalating.

• Increase the number of primary care doctors participating in pilot projects to ensure that they have time to focus on the prevention and effective management of chronic diseases when they arise.
• Opetum lever data to help clinics proactively manage patients’ health. Provide monthly reports that highlight the patient’s progress in managing chronic diseases, identifying those who are at risk of complications and individuals with flags in need of early intervention to prevent costly health crises.

3. Use it generating for excellent management of chronic illness

Instead of patients relying on rare visits of doctors for helping in managing their chronic diseases, monitoring health with it can track daily patient data-such as blood pressure, glucose levels and early signs of heart failure-allow for real-time intervention. By analyzing patterns and detecting warning signs early, he can warn doctors when a patient’s condition is deteriorating, thus preventing costly complications and hospitalizations.

• Use predictive analytics directed by him to personalize care plans and recommend medication changes quickly, long before they are planned to visit in the office.
• Use new, open -sourced models as a deepseek to create clinical remedies specific to diseases that empower patients to prevent and control their chronic conditions more effectively.

A defining moment for wise, united

This is Witty’s chance to redefine the role of health insurance in America. At the cost of coverage becoming unaffordable for tens of millions of Americans and assembling Congress control, UHG has a choice: Continue the status quo of cost reductions and use and face potentially high consequences or lead a transformation that reduces costs by improving health.

For the health of our nation, let’s hope that it chooses the latter.

United Group was contacted about this story on Friday, February 7th. The company did not respond by the time of publication of this article.