Personal Health Support is a unique program for individuals who are living with a chronic condition or dealing with complex health care needs. We provide a high level of support, educational tools, and telephone access to a registered nurse who is assigned to employees and their families. They can tell employees more about the benefits available to them, offer information about a wide range of health issues and direct them to UnitedHealth Premium® and Centers of Excellence network physicians and facilities. The nurse may also discuss and refer to our disease management services. These resources can help individuals better manage chronic conditions such as diabetes and asthma, or other serious illnesses, including cancer.

UnitedHealth Premium^® Designation Program and Hospital
Comparison Program
We provide quality, efficiency and cost information for primary, specialty and hospital-based care to support individuals in making informed decisions throughout their continuum of care.

UnitedHealth Premium Designation Program
Physicians and facilities are evaluated for quality and cost efficiency based on externally developed, consensus-based national standards. Physicians and facilities must first meet the quality criteria before being reviewed for cost efficiency. Physicians receive a one star designation for meeting quality care criteria and two stars for meeting quality and cost efficiency criteria. Physicians are designated across 21 care specialties that include primary and specialty care. The program is currently available in 132 markets across the United States. The program also designates specialty centers for cardiac care, congenital heart disease, infertility, total joint replacement, surgical spine, and neonatology.

Hospital Comparison Program
Hospital comparisons are provided for 50 inpatient procedures in about 150 markets. Hospitals are assessed based on hospital- and condition-specific quality using a three-star scale. Cost information is assessed and categorized as below market average, average and above market average. A cost range for a procedure at a specific hospital is also included.

• Incentive tracking and management available with or without a custom program
• Basic incentives available to employers of any size
• Packages allow increasing flexibility
• Gift cards for employers with > 750 members
• Available for Health Assessments, Online and Telephonic Health Coaching and other activities
• Incentive report provides earned/redeemed values
• Personal reward total and fulfillment status is always in view

Online Health Assessment and Report
Our integrated Health Assessment survey helps UnitedHealthcare customers take a 360 degree look at their overall health. After completing the survey, they will receive a Personalized Report offering suggestions on how to make healthier lifestyle choices. They will also get personalized messages and tips based on the data they entered. High risk members will be referred to other clinical programs as necessary.

24/7 Nurse Line^sm
Our toll-free line provides 24/7 access to registered nurses for help with health related questions, and personal or family-related concerns. Callers meeting certain clinical criteria receive follow up calls from nurses for triage to other clinical programs.

Emergency Room (ER) Decision Support

ER costs are an issue for employers with high or increasing current use by their employees. The ER Decision Support program targets members before they become frequent ER users and addresses many underlying reasons members use the ER inappropriately, including lack of knowledge of appropriate resources including a Primary Care Physician (PCP). The program increases customer value through cost reduction and reduced utilization trend. It engages “at risk” employees, increases use of Premium^® and in-network providers and identifies appropriate referrals to case or disease management, complex medical condition, and behavioral solutions programs.

The program targets members with 1-4 ER visits within a 12-month period and uses escalated outreach strategies each time they use the ER. It starts with an automated call with a prompt for education, talking with an ER Decision Support nurse, or to request mailed information. 3-4 visits prompt a Decision Support nurse to engage (or re-engages) them with their PCP. The final step is a $20 incentive to the member to make, and keep, the appointment.

Treatment Decision Support

Our Treatment Decision Support program is core to Personal Health Support program. It is an expanded clinical offering, which in conjunction with Health and Wellness, Disease Management and Network resources, helps integrate multiple clinical products and technologies through this care management platform.

The program targets nine specific conditions in five clinical focus areas that have been identified based on their prevalence and cost per episode. Then helps consumers actively engage in treatment decisions of their conditions by providing them information about their medical conditions, possible treatment options that a consumer could discuss with their health care provider(s) and the clinical and cost ramifications of their treatment choices. We give them tools to avoid inappropriate treatments and to access appropriate care cost-effectively. The results are better health outcomes for employees and lower health care costs for employers. 

Consumer Activation Messaging

Activation messaging is a set of consumer-specific communications distributed through an employer’s portal, Health Statements and, for additional capacity; there is also a buy-up option for call centers via the Customer Care Professionals. The messages offer suggestions on how members may get more value from their healthcare dollars/benefits, more efficiently utilize their benefits or achieve better health outcomes.

Medical, pharmacy and lab claim streams are monitored for opportunities to communicate with the consumers about behavioral changes that can create a better health outcome.By monitoring the consumer behavior in the pharmacy space and medical network usage, we leverage the opportunity to help employers/employees get the most from their plan by offering suggestions on generic drugs, mail order, pill splitting and encouraging in-network provider usage. This information, combined with the plan design, creates powerful, personally-relevant activation messages.