From bytes to insights and beyond: How data helps power health care innovation

Increasingly, payers and employers are leveraging the latest trends in data analytics and cutting-edge technologies to help better address challenges in health care. In fact, 67% of employers said they already have a strategy in place to collect, store and analyze data that can lead to meaningful improvements in employee health and well-being.
In the past, an imperfect and often complicated health care system, along with rising costs, impacted consumers' ability to easily access care. Nearly 11% of U.S. adults avoided health care due to costs in the previous year, in fact, according to a new report from America's Health Rankings.
The use of data and analytics in health benefits has expanded in recent years from helping provide actionable insights to powering the development of innovative products and capabilities that create simpler, more personalized health care experiences.
'We made over 400 enhancements to our digital experience last year and plan to deliver a similar number through 2025,' said Amy Jordan, vice president of product with UnitedHealthcare's commercial business. 'UnitedHealthcare's newest innovation, our Smart Choice provider search capability, empowers members to more easily find and connect with quality network providers from the palm of their hand.'
expand
Available to eligible UnitedHealthcare commercial members in the member app and website, Smart Choice provides results that meet member preferences and maximize member benefits, which may result in easier access and lower costs.
When members use the UnitedHealthcare app or myuhc.com to search for providers, they will see Smart Choice results based on multiple factors, including a member's personal preferences and health plan benefits as well as nationally recognized standards* for safe and effective quality care, according to Jordan.
'This is just one way we are putting data and innovation to work as part of a broader goal aimed at reducing heath care expenditures, improving outcomes and creating better member experiences,' Jordan said.
A data revolution: From PDFs to artificial intelligence
In recent years, the ability to access, analyze and use data to shape the future of health care innovations and insights has changed significantly.
'My first couple weeks on the job, I was literally taking printed PDF reports and typing numbers into Excel files to bring the story of data to life. That was two decades ago,' says Craig Kurtzweil, chief data and analytics officer for UnitedHealthcare's commercial business. 'Back then, it was a challenge to even access the data, let alone to translate it and visualize it in a way that an employer could understand.'
Data is now foundational to the health care industry and a cornerstone of its innovation:
Members are using data-driven tools like UnitedHealthcare's Smart Choice capability to more easily connect with quality network providers and make more informed care decisions
Employers are using population data to build employee engagement strategies to help better address certain health needs for specific groups of employees
Physicians and other health care professionals are using nearly real-time data to help improve the care delivery experience with members
'In the past, you had data, but it could take months to get your hands on it.' Kurtzweil says. 'Now there is a flood of data — insightful and valuable data — but it's become increasingly apparent that responsible AI and ML strategies can help translate that ocean of data into actionable insights.'
Turning insight into action for employers and employees
When Kurtzweil and his team meet with employer groups about their health plan performance today, the conversation goes well beyond volume-based discussions and top-line results.
Kurtzweil and team once informed a particular employer with an over 77,000-member population that 42% of their employees had complex conditions, including cancer. As a result of this analysis, the employer deployed a cancer-specific care management team to better support those members, resulting in over $267,000 in savings to those employees by closing 105 gaps in care. [1].
'We can now collect that data, integrate that data and apply those responsible and fair algorithms and machine learning to it in order to uncover trends within employer populations and gain actionable insights for them,' Kurtzweil says.
AI and ML: balancing innovation with responsibility
As more data is captured via overall engagement with the health system, artificial intelligence and machine learning can help sort that data.
In fact, the global health care AI market is predicted to reach $614 billion by 2034, up from $27 billion in 2024, and 92% of surveyed employers said they believe that artificial intelligence (AI) holds promise in health care.
These technologies assist in innovation at UnitedHealth Group — within Optum and UnitedHealthcare — helping make sense of 2 trillion health transactions annually. [2]
While safety, privacy, transparency and responsible use are at the forefront of using AI and ML, timeliness, simplicity and efficiency are also key drivers. Yet no matter how fast or efficient the data is captured, reliable human analysis remains critical and necessary.
'While AI and ML may be important tools in health care as we move forward, developing and implementing it responsibly — and ensuring that the privacy and security of member health data is protected — is essential,' Kurtzweil said.
Footnotes
[1] UnitedHealthcare National Accounts ASO client 2022–2024 analysis, Health Plan Performance Review Oct. 2024. This case study is true. Savings calculated on book-of-business case rate savings for these programs. Savings for enrolled members are case specific. Results will vary based on client-specific demographics and plan design. Results will vary depending on the state where the insured policy is issued and the amount of engagement by employees.
[2] UnitedHealth Group internal data collection and reporting, 2024.
Disclaimers
* Standards utilized by UnitedHealth Premium®. UnitedHealth Premium® is proprietary to UnitedHealthcare. UnitedHealth Premium evaluates physicians based on safe, timely, effective and efficient quality care criteria to help members make more informed choices for their health care. It's intended only as a guide and should not be the sole factor considered when selecting a physician. Designations have a risk of error and members should discuss designations with a physician before choosing one. If a member already has a physician, they should also consult with them for advice on selecting other physicians. The fact that a physician does not have a Premium Care Physician designation does not mean that the physician does not provide quality health care services. All physicians in the UnitedHealthcare network have met certain minimum credentialing requirements (separate from the UnitedHealth Premium criteria). Please visit the medical care directory specific to the member's benefit plan for physician designations and detailed information about UnitedHealth Premium and the evaluation methodology.
Advocate services should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through Advocate services is for informational purposes only and provided as part of your health plan. Wellness nurses, coaches and other representatives cannot diagnose problems or recommend treatment and are not a substitute for your doctor's care. Your health information is kept confidential in accordance with the law. Advocate services are not an insurance program and may be discontinued at any time.
Employee benefits including group health plan benefits may be taxable benefits unless they fit into specific exception categories. Please consult with your tax specialist to determine taxability of these offerings.

Try Our AI Features

Explore what Daily8 AI can do for you:

Learn with AIFact CheckingText to SpeechAI Summary

Related Articles

Axios

7 hours ago

• Axios

Exclusive: R&D startup Uncountable raises $27m Series A

Uncountable, a digital platform for industrial research and development, raised a $27 million Series A led by Sageview Capital, co-founder and CEO Noel Hollingsworth tells Axios Pro. Why it matters: Real-time events are making R&D teams' traditional reliance on Excel spreadsheets obsolete. How it works: The company's cloud-based R&D platform allows enterprises to unify experimental data and deploy AI-driven tools to accelerate development cycles. The software's AI tooling can offer experimental options to R&D teams as supply chain issues arise or environmental regulations change. Zoom in: SE Ventures, Teamworthy, 8VC and MK Capital participated in the round. Founded in 2016, the company — co-headquartered in San Francisco and New York — has raised approximately $32.5 million.

San Francisco Chronicle​

16 hours ago

• San Francisco Chronicle​

Have job-based health coverage at 65? Waiting to enroll in Medicare could cost you

When Alyne Diamond fell off a horse in August 2023 and broke her back, her employer-based health plan through UnitedHealthcare covered her emergency care in Aspen, Colo. It also covered related pain management and physical therapy after she returned home to New York City. The bills totaled more than $100,000. The real estate lawyer, now 67, was eligible for Medicare at the time but hadn't enrolled. Since she was still working, she thought her employer health insurance plan would cover her. More than a year after her riding accident, Diamond was back at the emergency room after she tripped on a step while entering a New York restaurant. Her face covered in blood, Diamond was examined by staff, who did multiple CT scans. The bill for that care: $12,000. This time, though, the insurance coverage wasn't routine. Nearly all her claims were denied. Diamond was caught in a fairly common coverage snag: People who have group health insurance when they become eligible for Medicare sometimes find themselves on the hook for their medical bills because their group plan stops paying. Diamond contacted several people at UnitedHealthcare before she found out why the insurer refused to pay her claims. When Diamond turned 65 in 2022, Medicare — unbeknownst to her — became the ' primary payer ' for her claims, meaning the federal health program for older or disabled people was supposed to take the lead in covering her medical bills, before other insurers paid anything. (As secondary payer, Diamond's employer policy picked up 20% of what Medicare would have paid.) Had she signed up for the government insurance plan when she turned 65, Diamond could have avoided a financially perilous situation that left her unexpectedly responsible for the medical costs she incurred during that time. She began to understand what had happened as she made inquiries about the denied claims. Diamond said she was told that UnitedHealthcare audited her claims last year and determined it had been improperly paying for her care, perhaps because her pricey medical claims after her fall from the horse raised a red flag. The insurer not only stopped paying current claims but also moved to claw back tens of thousands of dollars it had paid to providers in the two years since she turned 65. Some of those providers are now seeking payment from her. 'It's horrifying,' she said. 'For about two months I was devastated. I thought, 'Where am I going to get the money to pay all these people? There goes my retirement.'' The mistake has already cost her $25,000 and may cost her much more if providers continue to bill her for amounts that UnitedHealthcare has clawed back for care she received before signing up for Medicare in February. A UnitedHealthcare spokesperson declined to provide an on-the-record statement, citing safety concerns. Patient advocates say they frequently hear from people who, like Diamond, thought they didn't need to sign up for Medicare upon turning 65 because they had group health coverage. That assumption is generally correct if they or their spouse is working at a company with at least 20 employees. In that case, employer coverage is considered primary and they can delay signing up for Medicare as long as they or their spouse continues to be employed there. But, if someone has employer coverage through a company with fewer than 20 workers, Medicare generally becomes the primary payer when they turn 65. The real estate law firm at which Diamond is a partner has a handful of employees. Similarly, if someone is older than 65 and has retiree health coverage or has left their job and opted to continue their employer coverage under the Consolidated Omnibus Budget Reconciliation Act, also known as COBRA, Medicare pays first. The issue can also arise for people who are younger than 65 if they are eligible for Medicare because of a disability. In those instances, Medicare pays first if they or their family member works at a company with fewer than 100 employees. If people in these groups don't sign up for Medicare when they become eligible, they can find themselves responsible for all their medical bills for years. (They may also owe a penalty for late enrollment in the Medicare program.) 'It's very alarming and there's no current fix to the situation,' said Fred Riccardi, president of the New York-based Medicare Rights Center, a national patient advocacy organization. Mark Scherzer, a lawyer in Germantown, N.Y., who helps people with insurance problems, and who advised Diamond, said he gets calls a couple of times a month from people who face this issue. 'What I see constantly now is that insurers go back and they claw back the money from the doctor and the doctor then claws the money back from the patient,' he said. Costly claims may trigger an insurer to examine someone's coverage. Those big claims 'seem to get on the insurer's radar,' said Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center. UnitedHealthcare has recouped over $50,000 in medical bills from some of the providers who treated Diamond in New York after her riding accident. She's paid them about $25,000 so far. Some have agreed to let her pay the amount Medicare would have paid. But there may be more bills to come. Under New York law, health plans have two years after claims are paid to claw back payments from providers, and providers have three years to sue patients for medical debt. So, while there is still time for Diamond to be billed, the clock will eventually run out. Diamond plans to sue the broker who manages her company's health plan and other benefits for negligence. 'The Medicare secondary payment rules basically say that if you didn't sign up because you didn't know Medicare was supposed to be primary, that's on you,' said Melanie Lambert, senior Medicare advocate at the Center for Medicare Advocacy in Connecticut. Lambert said she has seen the issue 'many, many times.' In some instances, if a beneficiary can demonstrate they were misled by an employer or a federal employee, they may qualify for relief or a special enrollment period, she said. In a 2023 letter to the acting secretary of the Department of Labor, the National Association of Insurance Commissioners advocated applying a 'commonsense rule to COBRA plans, individual health insurance, and other coverage sources: those entitled to Medicare Part B but not enrolled in it should not lose benefits they pay for from a non-Medicare coverage source.' The Department of Labor didn't respond to a request for comment. In earlier times, people started collecting Social Security benefits then automatically got Medicare when they turned 65. Now, enrolling in Medicare is more complicated for many people, said Tricia Neuman, a senior vice president and the executive director of the Program on Medicare Policy at KFF, a health information nonprofit that includes KFF Health News. 'As more people are delaying going on Social Security and delaying going on Medicare, there's more opportunities for people to make mistakes, and those mistakes are costly,' Neuman said. Coverage experts say there are no clear requirements for insurers, employers or the federal government to notify people about how the payment rules governing coordination of benefits between health plans may change when they become eligible for Medicare. The information appears in a chart in the government's 'Medicare & You' handbook, if someone knows to look for it. But it is not easy to find. A straightforward fix could solve many of the problems people face in this area, Scherzer said. Since every health plan knows its enrollees' ages, why not require them to notify people approaching 65 of possible benefit coordination issues with Medicare? 'It's so simple and such a no-brainer.'

Yahoo

16 hours ago

• Yahoo

Israel resumes limited natural gas exports amid ongoing conflict

Israel has recommenced limited natural gas exports, prioritising domestic needs, according to the country's Energy Ministry. This move comes nearly one week after the shutdown of two significant offshore fields due to military activities in the region. The Ministry Spokesperson conveyed to Reuters that the resumed exports are derived from surplus supplies. While most of the limited exported gas is currently flowing to Jordan, only "tiny volumes" have reached Egypt this week, as per an Energy Ministry source. The halt in exports began on 13 June following military escalation, leading to the closure of the Leviathan and Karish fields, operated by Chevron and Energean, respectively. During this period, only the Tamar field remained operational, catering mainly to Israel's domestic demand. Israeli Energy Minister Eli Cohen stated that exports would only resume once military authorities deemed it safe. He told Reuters: 'I don't want to use our strategic storage, so therefore, I needed to cut exports.' Egyptian fertilizer producers, impacted by the supply disruption, have not yet received gas but are expecting flows to resume next week. Israeli gas is a crucial component of Egypt's energy mix, representing up to 60% of its gas imports and around a fifth of its total consumption, as reported by the Joint Organizations Data Initiative (JODI). Egypt has been hard-pressed to find alternatives to gas from Israel, which has become a significant importer due to a decline in domestic production in 2022. To bridge the supply gap, Egypt has increased fuel oil usage in power plants and secured deals to import more than $8bn (E£405.35bn) worth of liquefied natural gas. The country is also preparing additional floating regasification units. The Egyptian Petroleum Ministry has not provided comment on the matter. "Israel resumes limited natural gas exports amid ongoing conflict" was originally created and published by Offshore Technology, a GlobalData owned brand. The information on this site has been included in good faith for general informational purposes only. It is not intended to amount to advice on which you should rely, and we give no representation, warranty or guarantee, whether express or implied as to its accuracy or completeness. You must obtain professional or specialist advice before taking, or refraining from, any action on the basis of the content on our site.