UnitedHealthcare's provider search tool hinges on consumerism

Using provider data to populate a search tool

Shopping for healthcare is extremely unique, Jordan noted.

"People don't consume healthcare in the same way they consume their Amazon shopping purchases or their Target shopping purchases," she stated.

People might search for a product online or in-store, compare different products that do the same thing and examine the different price points for the various features they might access.

"Healthcare is completely different. You may or may not shop to a degree for your healthcare," Jordan countered. "We, as the payer, get really excited when people come in and then compare their providers and look at the cost transparency tools that we've put out there so they can understand," but that doesn't always happen, she acknowledged.

There's not much recent data about how many people actually use healthcare price transparency tools, and some research indicates that the format of price estimates can be complex. With financial health literacy somewhat low nationwide, this renders the tools of little utility for members and patients.

"We know everyone is on their own healthcare journey and has their own interest -- or lack thereof -- in how much research they want to do when they go see providers," Jordan stated. "Some people take the first recommendation they get from another provider or from a neighbor or friend or family member. Other people really want to dig in and understand more information about this provider or their specialty and subspecialty experience."

Understanding there'd be variation in consumer needs, Jordan and her team set out to create a provider search function that was simple, usable and provided options for people depending on how much they wanted to research provider options.

Smart Choice uses the following four data categories to score providers on a 100-point scale and inform users:

• Quality data. UnitedHealthcare leverages quality metrics set out by leading professional societies in relevant specialty areas to define the care quality of a certain provider.
• Cost efficiency data. The app looks at providers in a given zip code and rates them from a cost efficiency standpoint.
• Claims history. This is intended to help personalize the care for the user. For instance, a member experiencing knee pain likely wants to ensure the orthopedist they select specializes in knees, not shoulders. This is determinable by claims history.
• Convenience factors. Members often have personal preferences about their providers, such as travel distance, telehealth access, language or gender preferences, or they want to know if that provider is board-certified.

Not all data categories are weighted equally, Jordan stressed. The quality and cost efficiency categories are the most important as Smart Choice feeds options to users. When a provider scores well in both of those categories, they get a premium designation.

Conversely, the convenience factors are weighted the least.

"We're not going to elevate a provider that's a great personal fit for you but does not meet the quality standards," Jordan pointed out. "We're not going to give a higher score just because they're a strong personal fit; they are weighted appropriately. But when all things are equal, we want to make sure that we are at least taking into account those convenience factors and those personal fit components."

These data categories are important because they represent information that UnitedHealthcare generally already knows about its provider partners, which lets the payer verify that the information users get is accurate.

"It's no surprise to anyone in the industry that provider data accuracy is a challenge -- it's an industry-wide challenge," Jordan noted. "Every provider group uses different systems and at varying degrees keeps their information up to date."

Indeed, a 2023 JAMA Network Open study revealed that the provider directories of five of the biggest payers are 81% inaccurate.

"For us, we really wanted to make sure we at least had a breadth of information across these provider groups, so we could offer some sort of meaningful, personalized approach to creating this search capability."

Creating an accurate profile of contracted providers is essential as UnitedHealthcare continues to zero in on consumer-centric care.

Healthcare consumerism key priority for UnitedHealthcare

Like much of the healthcare industry, UnitedHealthcare has been confronted with the force of healthcare consumerism for more than a decade. People are increasingly expecting their healthcare experiences to reflect those of other retail spaces, but those expectations are complicated by the fact that healthcare as a "product" is highly unique.

Jordan said Smart Choice's data-driven approach was designed to borrow what they could from traditional retail spaces.

"How do we look at the rest of this retail landscape that's out there and start bringing some of those principles forward into our experience from a healthcare perspective?" she queried.

Part of that means serving members a baseline of information and creating options to dig deeper.

Like Russian nesting dolls, Smart Choice embeds provider data to let consumers choose whether they'd like to learn more. Someone looking for a covered urgent care clinic for a stubbed toe won't need to do that research, but someone planning the birth of their first child might want to dig deep.

Jordan and her team wanted to make a streamlined experience for both users.

"We're really trying to balance not overwhelming members with too much information but also giving them the avenue and the option to research further and ask more questions and arm them with information to make that decision," she said.

United Healthcare only unveiled Smart Choice to members in June, but the payer said it has its sights set on some key performance metrics. Specifically, Jordan and her team will be looking at the net promoter score for the tool, whether members could complete their desired tasks, how many more members are selecting a provider with premium designation and whether patients actually end up seeing the providers Smart Choice sorted for them.

Ultimately, these KPIs will help UnitedHealthcare continue its journey toward healthcare consumerism. Smart Choice is part one of those efforts, Jordan said, but the payer is also looking into how it can digitally streamline patient access and intake between the payer and the provider's office, as well as prior authorization forms and real-time benefits checks.

"We have technology that can do that, and so building those pipes to really unlock key member experiences is a big part of our long-term strategy," Jordan concluded. "Smart Choice is the first part of that. It is part of a broader, bigger agenda and story and vision that we have for transforming healthcare."

Sara Heath has reported news related to patient engagement and health equity since 2015.