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Coupon Book with Scissors

During the open enrollment period for 2014 healthcare insurance a few months ago, my wife and I chose the AARP Medicare Rx Preferred plan offered by United Healthcare, the largest health insurance provider in America. How could we go wrong? UnitedHealthcare is an operating division of UnitedHealth Group, the largest single health carrier in the United States. A United Healthcare unit had been chosen to fix the healthcare.gov website. They are reputed to be a company with the technical expertise to make the health care system run more efficiently. Efficiency is desperately needed in healthcare. How efficient is United Healthcare?

UnitedHealthcare delivers products and services to approximately 70 million Americans. Their network includes 751,609 physicians and health care professionals, 80,000 dentists and 5,629 hospitals, and access to drugs for 13 million people. The company claims that has made significant investments in research and development, technology and business process improvements – nearly $3 billion in the past five years. They say that the investments led to changes that are improving the way care is delivered and administered. I am not impressed with their business processes. After receiving a letter from AARP Member-Advantages (run by UnitedHealthcare), I noticed an error in my address. It was close, but not accurate. I contacted them with the correction. A few weeks later, I received a letter confirming the change. Here are a few observations about the letter:


bullet “Your records have been updated to reflect the address listed below.” Ok, that is good, but they sent the letter to the old address with the mistake in it.
bullet  Insured and addressee on the letter showed: Mr John Patrick. No period after Mr
bullet Membership# with no space after the p
bullet The membership # showed ten digits as in 0987654321. My membership card ends with -11, like 098765432-11. The website will not accept the membership # shown in the letter

The first error tells me there is a lack of common sense in their business process when they send an address correction confirmation to the old address. The period and space are nits, but show me their business process lacks attention to detail. In big systems like healthcare.gov, it is little things that can cause big problems. Printing an account # on the letter that is invalid on the web site is not a nit, it is a failure of data integrity.

Three months after enrolling in the United Healthcare AARP MedicareRx Preferred plan, I received their Coupon Payment Book. Yes, a physical paper payment book with printed coupons in it along with 12 envelopes in which to return checks for my monthly premium payment. The last coupon book I can recall was from a bank after I bought my first car in 1967. I cannot remember the last time I wrote a check. My wife also received the same set of coupons and envelopes. This is the digital 21st century, but our nation’s largest healthcare insurance company is using coupon books. They do offer the option of automated deductions of the monthly payments from either the social security payment or by a deduction directly from a checking account.

Many services provide for automatic deductions from your checking account and can be set up online and be activated in minutes if not instantly. Not so with our nation’s largest healthcare insurance company. They require that you fill out a paper form and send it with a check. Then they say, “If you choose a payment method such as deduction from your Social Security benefit check or EFT, it may take up to three months to begin. Continue to mail checks and coupons until you receive a letter from us”.

I do not like to make negative statements on patrickWeb about individual companies, but I must say that I find United Healthcare more than disappointing. As an American citizen and taxpayer, I am embarrassed to receive a coupon book and 12 envelopes in the mail. United Healthcare gave its top executive a compensation package valued at about $13.9 million last year. I am confident he doesn’t write checks and probably doesn’t even know his company is following antiquated practices. Bill Gates once called the major banks “dinosaurs”. I wonder what he would say about this healthcare behemoth. Many people say the government is incompetent and we should turn healthcare administration over to the private sector. If the healthcare insurance leader is using thirty-year old coupon and check technology, do we want to turn administration over to them?

This post is partly a rant, but mostly about a serious issue — the cost of American healthcare. We spend more  than two-and-a-half times as much as most developed countries in the world, including relatively rich European countries like France, Sweden and the United Kingdom. There are numerous reasons why our healthcare is so expensive, but, in part, higher costs arise because the U.S. has been slow to adopt progressive information and communications technology to improve the administration of healthcare and to reduce waste. In Sweden, all drug prescriptions are “written” electronically — a message is sent directly from the doctor’s office to the pharmacy. Not only does this cut down on medical errors, it also reduces pharmacist workload. E-prescribing is rolling out in the U.S. also, but adoption has a long way to go.

So much for the rant. What do I recommend? I will be writing much more about this, but, in a nutshell, I believe the best solution is for the government — yes, the government has a role — should mandate payment standards. Hospitals and doctors must adhere to uniform accounting standards to report their financial performance, but they can use whatever electronic medical record system they want, or chose to use none. There are 250+ EMR vendors and they are less than compatible. Germany has 300+ healthcare insurance companies, but they all must comply with certain standards. That is the first part of what we need. Second, healthcare administration should be done at the state level. New York, Ohio, Florida, and Texas are truly different, and they are all large enough (all are much larger than Sweden) to fund and develop efficient information technology systems.

There is obviously much more to this topic and I have other recommendations. Stay tuned.