UnitedHealth takes aim at health records

UnitedHealth Group has entered a race involving some of the nation's biggest technology companies to make it easier for patients to use their health information.

At a New York investor conference last week, UnitedHealth Chief Executive David Wichmann offered his most detailed description thus far of a project called the "individual health record," a technology that the company says is being used on a test basis with three health care groups across the country.

The idea is to get consumers more engaged with improving health and managing costs through access to health information that traditionally hasn't been well integrated.

There's a real need to give patients and caregivers access to health data across distinct record systems, analysts said, but it's also not clear exactly how UnitedHealth Group will deliver on an idea that others have been pursuing for years.

"It is not an easy task," said Julie Dooling, a director with the American Health Information Management Association. But she said of UnitedHealth's ambition: "I do think, overall, it's very positive for the industry."

Minnetonka-based UnitedHealth Group runs the nation's largest health insurer, UnitedHealthcare, as well as a fast-growing division for health care services called Optum.

UnitedHealth's overall revenue is expected to grow 7 to 8 percent next year to as much as $245 billion, with Optum revenue again growing faster than the legacy health benefits business. The company projects global medical insurance enrollment will increase by as many as 1.175 million people in 2019, which would bring the total to 50 million enrollees.

Wichmann said during the investor conference that the IHR was released in November in beta form to three "accountable care organization" partners. That's a term sometimes used to describe health care providers that accept financial risk via contracts with insurance companies, on the theory that doctors and hospitals will have more incentive to provide quality and efficient care.

In the first week of use, one physician using the IHR "positively altered the course of treatment for, if not saved the lives of, two patients," Wichmann told investors. Another physician significantly altered a patient's treatment plan, Wichmann said, after confirming a new diagnosis that was identified by artificial intelligence within the individual health record system. One practice benefited from the efficiency in the system's "prepopulated history of a new patient," Wichmann said.

To develop the IHR, UnitedHealth acquired in September 2017 a company called CentriHealth. The firm developed IHR technology over 10 years and with more than 3 million lines of code, said Eric Murphy, the chief executive of UnitedHealth's OptumInsight division, in an interview. The system curates patient health information across a variety of data sources, Murphy said, to provide a summary of a patient's health record including types of care received, medications prescribed and a list of conditions and diagnoses.

"Our goal of reaching the 50 million people we serve with the IHR is no longer a question of if; it's when," Wichmann said at the conference.

"We provide each individual and their doctor or caregiver with a fully integrated, fully portable, real-time and dynamic medical record, powered by a proprietary medical ontology and best-known science, not dependent on any one system or network," he said. "The IHR not only shows doctors and patients where they have been and where they are, but can suggest a path forward in their journey to better health."

"The one thing that is different is their position in the marketplace," Bermudez said. "They're not just a random firm and company that got together and said: 'Hey, let's try to solve this big problem.' "

UnitedHealth's investor conference took place as the Wall Street Journal was reporting on a new effort at Seattle-based Amazon to sell software that mines patient records so that doctors and hospitals can improve care and lower costs. That's not precisely an individual health record, but it contributes to a growing debate about whether insiders like UnitedHealth or outsiders like the nation's technology giants are best positioned to transform health care.

In early 2018, Amazon Chief Executive Jeff Bezos announced a high-profile push for fundamental change in health care along with celebrity CEOs Warren Buffett of Berkshire Hathaway and Jamie Dimon of JPMorgan. In January, California-based Apple announced a revamp for the existing health app on iPhones that would make it easier for consumers to see medical data from participating health care providers. In March, California-based Google launched a software intermediary for health care that's meant to let doctors and hospitals better share data to improve care while promoting discoveries via artificial intelligence and machine learning.

As the big technology companies have unveiled health care strategies over the past year, established players have emphasized "the regulatory complexities, contractual relationships and fragmented nature of the health care system as barriers to entry," analysts with Morgan Stanley wrote in a note to investors last week.

"UnitedHealth, in its investor conference, discussed its use of semantic technology to develop its IHR product and showcased several new technologies it's been developing," the analysts wrote. They noted UnitedHealth's potential advantage with testing technology innovations across its growing OptumCare network of clinics — a network that's on the verge of including two large physician practices in the Seattle area, near Amazon's headquarters.

As for the individual health record, it's not clear exactly how much data the UnitedHealth system will present to patients and their doctors, said Dr. Richard Milani, the chief clinical transformation officer at the New Orleans-based Ochsner Health System. Health care providers typically provide claims information to health insurers so medical bills get paid, Milani said, but that's far short of the physician notes that often provide key clinical details.

"The goal is certainly a noble one," Milani said. "I'll be anxious to find out more details."

Other big companies have taken a stab at individual health records over the years, Milani said, pointing to an effort about 10 years ago by the computer giant Microsoft. Ochsner Health System, he added, is one of dozens of health care systems that has pledged to cooperate with Apple's health record project.

Individual health record projects must overcome significant barriers since not all health information is electronic, not all data is in a shareable format and not all patients and institutions have agreed to data transfers. Another challenge is presenting data in a way that doesn't overwhelm people with detail or raise false alarms, said Drew Harris, an assistant professor for population health at Thomas Jefferson University in Philadelphia.

"Delivering on the promise is the hard part," Harris said via e-mail. "Presenting actionable and understandable insights is a huge challenge."