Transcript UnitedHealth Group

Careers in Healthcare Administration
Veronica Aispuro, PhD
[email protected]
February 22, 2014
SCASA Career Day
What is Healthcare Administration?
Healthcare administration is the field relating to leadership,
management, and administration of health care systems.
(Wikipedia)
Delivery of Care (Direct contact with members)
• Management of hospitals, physician groups, nursing homes
Operations (Indirect contact with members)
• Financial
• Provider Assessment
• Legal
• Underwriting
• Compliance
• Business Planning &
Development
• Customer Service
• Policy Advocacy
• Resolution of Grievances
• Quality Improvement
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Affordable Care Act Impact
• How can we reduce health care costs?
• How will Medicaid expansion affect other business
segments?
• How will mandated insurance impact health care costs?
• How can we improve health-care quality, efficiency, and
accountability?
• What is the impact of pay for performance programs?
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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
UnitedHealth Group
UnitedHealth Group is a leading health care
company, serving more than 80 million
individuals worldwide. Our family of companies
touches nearly every aspect of health care,
helping people live healthier lives.
Our health benefits businesses are:
• UnitedHealthcare Employer & Individual
• UnitedHealthcare Community & State
• UnitedHealthcare Military & Veterans
• UnitedHealthcare Medicare & Retirement
Our mission is to help people live healthier lives.
Our role is to help make health care work better for
everyone.
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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Medicare Star Ratings
• The Star Rating System was initially
designed by the federal government
agency CMS (Centers for Medicaid
and Medicare Services) to assist
beneficiaries in their health plan
selection.
• Health reform (Affordable Care Act legislation) introduced a
pay-for-performance program for Medicare Advantage plans
starting in 2012 using the CMS Star Rating system.
• Higher Stars  Higher Bonus Payment
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What measures make up Star Ratings?
HEDIS (Healthcare Effectiveness
Data and Information Set)
CAHPS (Consumer Assessment of
Healthcare Provider Systems)
PDE (Prescription Drug Event)
HOS (Health Outcomes Survey)
Call Center
IRE (Independent Review Entity)
CTM (Complaints Tracking Module)
MARx (Medicare Advantage
Prescription Drug System)
• Member Surveys: satisfactions
and health status over time
• Health care metrics for
preventative care and chronic
disease
• Operations related to call center,
complaints, appeals
• Drug safety monitoring
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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
CMS – Administrative data,
database of beneficiaries
Star Ratings Analytics
• Data preparation and integrity assessment
• Predictive modeling using leading indicators to project year
end performance
• Assessing impact of star rating methodology changes
• Advocating for or against proposed changes and current
method of implementing paid incentive program to
government
• Identifying factors that contribute to successful measure
perfromance
• Asessing effectiveness of interventions aimed at
improving clinical and operational outcomes
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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
My Experience Working as Statistician in
Healthcare Administration
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Lonely statistician
Focused consulting
Identifying appropriate modeling
Data is abundant but not analysis ready
Learning data platforms
Fast paced
Advocating data driven decisions
Tailoring results based on audience
Started lower and ended up here and happy
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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.