Simplifying Healthcare: UHC's Hub Strategy for Vendors and Members

Speaker A: Foreign. Hi Karen, nice to chat, uh, with you again. Thanks so much for taking the time today to join Architect Health's the Fronter newsletter.

Speaker B: Thank you for having me here. I look forward to discussing healthcare with you.

Speaker A: Fantastic. So, for a bit of context for our podcast audience, let me, uh, introduce myself and the company. My name is Soam Shah and I'm the founder and CEO of Architect Health. As an AI powered digital health vendor management system, Architect Health simplifies vendor evaluation, accelerates procurement and ensures measurable ROI and spend reduction for payers and health systems. As the front door for digital health, we cut through the noise of point solutions so healthcare institutions know which ones truly add value. In our newsletter series, we interview healthcare executives and founders on their experiences with healthcare innovation, digital health and preventative care. Our goal is to identify pain points in these spaces and paint visions on how to address them, hopefully inspiring change makers in our industry. Today we are fortunate to have an incredible guest and health plan leader, Karen Nelson. Karen Nelson is the Vice President of Strategic Partnerships for United Healthcare's commercial business. In this role, she is pivotal in advancing innovation and vendor relationships within the commercial market. She champions groundbreaking initiatives including the well known UHC Store and UHC Hub that help create more choice and flexibility in health and wellness offerings for consumers and employers. Prior to this role, Karen led the telehealth evolution at UnitedHealthcare, significantly enhancing the company's digital health partnerships. She also had leadership positions at Optum, where she developed programs to help consumers with complex health conditions, including end stage renal disease. Karen Her Bachelor's degree and MBA from the University of St. Thomas, Karen is also a Certified Executive Coach of the International Coaching Federation and she is deeply committed to developing leaders and giving back through volunteer work with multiple nonprofit organizations. Thanks again for being here, Karen. Are you ready to get started?

Speaker B: I am. Um, thank you.

Speaker A: Cool. So first up, let's talk about the evolution of consumer solutions over 20 plus years at UnitedHealth and Optum. Um, your view of what members need has likely shifted dramatically from early appointment scheduling work to today's complex ecosystem. What's changed most in how you think about consumer experience?

Speaker B: There are two key areas that UnitedHealthcare is focused for helping members navigate the healthcare system simplification and affordability. I'll talk a little bit more about both of those and then share an example of how we bring both of those to life. First, simplification. We know that it can be difficult for consumers to navigate the complexities of the healthcare system. That's why we believe in Making the healthcare experience simpler and more accessible for everyone. At UH UnitedHealthcare, we prioritize creating solutions that are personalized, simple and affordable. When it comes to using one's health benefits, the experience ideally should be anything else. It should be like everything else that you shop for services or that you schedule. And most of the time, today's consumers are making decisions based on information from a device that they hold in their hand. Often they expect the options to be personalized and simple and data driven. Our goal is to transform the health system in response to these consumer expectations and needs. Second, affordability is also a key issue for employers and consumers. When prices for medications and healthcare products and services increase year over year, it results in employers, governments, insurers having to make difficult decisions about how to balance both affordability and access. We're seeing employers um, have healthcare cost increases of 6 to 10% and greater in 2026, driven by factors like catastrophic claims, specialty drugs and even chronic conditions. And we're bringing a laser focus on ongoing investments to this issue. For our members and clients, we're seeing some positive results. Let me give one example on how, how we bring simplification and affordability together. With solutions like Surest, we can help shrink the total cost of care while simplifying and improving the experience overall. Our Surest health plan flips the traditional health plan approach of insurance on its head. No more waiting for the bill to show up and to figure out how much you owe for that doctor or hospital visit. People know in advance using a simple app that shows them their actual costs upfront. Surest members do not have a deductible, so the price that that member sees is the price that the member pays. And then Sures members can also use the app to identify providers that have a track record of delivering effective and cost efficient care and they pay a lower copay when they choose those particular providers. Our employers are rapidly adopting um, surest. We're one and two and counting and that's up from one to nine in 2023. And these are some of the most sophisticated healthcare buyers, um, across the, across the company.

Speaker A: That's super exciting. Karen. I actually had no idea about Shurist and um, I realized there are a couple of things and themes that you brought out. One being the simplicity of um, the consumer experience that needs to be met. And the second is that focus on access. Um, how did kind of the Surest, um, um, kind of initiative come, come into light? You know what really drove that from the uh, UHC perspective?

Speaker B: Sures came about by listening to our members and employers and helping to address those two UM elements, the simplicity and affordability. Now we allow this across our book of business for our self insured employers where they can shop for healthcare insurance the same way we do for non healthcare services they buy. And results are showing that they're paying up to 44% less on out of pocket on average for those enrolled insurance compared to traditional employer sponsored health plans. We're seeing overall that SURES is lowering that total cost of care. It's improving access for members across demographics and those for a range across chronic conditions which we know are some of the top drivers of employer spend like type 2 diabetes. And I can give a concrete example from one of our large UM multinational employers. Through price transparency and aligned incentives, the Surest plan is showing a reduction in their cost both for the employer and their employees as well. When you're comparing the Surest plan against a high deductible plan for the 12 month period ending the middle of last year, the surest offering had 47% lower cost to the employer.

Speaker A: Wow.

Speaker B: For employees enrolled insurance during this same time period also experienced 42% lower out of pocket spend. So we know that Surest is driving a more optimal utilization pattern and behavior through this transparent copay structure. And um is help delivering that simplicity and affordability of care that that is important to um, the industry.

Speaker A: That's huge. That's fantastic. Um, transitioning to our next topic, let's discuss the UHC Hub. Um, um everyone talks about vendor fatigue. Um payers and their members are overwhelmed by too many disconnected tools. Walk us through the thinking behind the UHC Hub to tackle vendor fatigue. What problem were you solving for self insured employers? And how do you decide which vendors make the cut? And what's the difference between the Hub and the store?

Speaker B: Sure. Well first of all start a little bit about the UHC Hub where we know that 80% of employers currently offer or are interested in offering third party health solutions. And around half of employers are already working with four up to nine digital health solutions. So as the number of vendors serving the employee benefits market continues to rapidly expand, the UHC Hub can help reduce this administrative burden that employers face when evaluating, choosing and engaging in solutions that are right for their work workforce. At UH UnitedHealthcare, we're partnering closely with our clients on this population health, wellness prevention benefits and even health education. And in other areas we get to know their challenges and concerns before we design our strategies and solutions to meet those needs. So the UHC huh Hub is one such solution that aims to help our employers offer more dynamic benefit options that align with the interests of their employee populations. So given that vendor solutions can be confusing and overwhelming, the UHC Hub simplifies that process of selecting and purchasing and managing vendor programs for employers from everything from healthy living all the way to complex care. So the UHC Hub is a uh curated network of vendors that enables a simpler and more connected experience. And since the UHC hub's inception in 2024, over 60% of our uh, commercial self insured customers have purchased more than one vendor from m the UHC Hub. And almost half of our target customers do have a relationship with a UHC Hub vendor. So in contrast with the UHC Store, the UHC Store is a direct to consumer digital shopping experience and an important part to drive improvements to the the consumer experience through these tech enabled solutions. So through the UHC Store, employees and members can buy um, these particular vendors that save money and help shop for services to support their individual and family needs outside that open enrollment period. So the UHC Store is available to members through the United Healthcare app and on myuhc.com and helps people customize their healthcare experience with offerings that complement their employer sponsored benefits and includes popular vendors like Dario, Weight Watchers, Safe Trip and others. And so the UHC Store is available, um, we're making it available to 18 million of our commercial members.

Speaker A: Wow.

Speaker B: Where members can save up to 15% on average on certain health, wellness and lifestyle offerings.

Speaker A: That's super exciting. Um, it seems like United is really focused on being the centralized marketplace or building the centralized marketplace. So both employers and members know exactly, uh, what types of solutions are available to them? Um, and that's something that many other payers are trying to tackle. Do you need advice for payers that are looking to kind of build in this direction or even buy in this direction?

Speaker B: You know, uh, both the UHC Hub and the UHC Store are solutions that we've created to simplify the healthcare experience and promote accessibility and ensure employers and employees can help um, more easily navigate coverage options. And so as I think about, you know, um, more broadly, you know, ensuring that we and other payers continue to listen to consumer demand, employer demand and some of the pain points and areas where we could help um, fulfill that. Navigation and simplicity and the cost of care are going to be critical for the industry going forward.

Speaker A: Got it. And you kind of hinted at personalization. Um, I want to move into transition to that question. Um, how do you serve the right solution to the right member without requiring them to navigate dozens of other platforms. And what role does data and AI play in that matching

Speaker B: AI is playing a large role and UnitedHealthcare is designing AI uh solutions across critical areas where members have historically faced friction. And there are some solutions yielding large results. And let me give a couple of examples of where we've incorporated AI. The first is in reducing administrative burdens with engineering capabilities. We have a UH AI claims assistant tool that is simplifying the process for out of network claim claim submissions by automatically populating medical field values making the process even faster and easier for members. Completion rate for these claims have nearly doubled while cutting time spent from 12 to 15 minutes down to 3 minutes. Another example is our new Smart Choice provider search capability which is leveraging AI and delivers that more personalized experience across four key standards to help match members with a provider. Um the four quality benefits, convenience and personal fit. And so specific to quality factors that may impact quality of care like provider credentialing qualifications and whether physicians meet UnitedHealth premium and efficient quality care criteria. UM benefits uh incorporates how the members health plan benefits and how you can get the most from UM one's particular plan. Third it was convenience where providers have appointments available um, and make sure that they are accepting new patients and their proximity to the member's location. And then lastly personal fit on how a provider matches one's personal preferences. The last example I'll talk about is advocate AI tools. So when a member reaches out with a healthcare question they're connected to an advocate where we've added AI tools to support these experiences so that the advocate can focus more on the member. Some of the examples of how it's incorporated into advocacy include the welcome experience where it provides key member insights based on claims activity or even previous calls to the advocate before the call to help streamline authentication and personalize that support. UM in call assist where AI is using voice analytics to better understand the members needs and provides benefits coverage and cost answers from the member's plan. And then lastly in call summarization where it summarizes the conversation so that advocates can add the summary to the member's file so that if the member calls back the advocate doesn't have to spend a long time um understanding in the members repeating their call history.

Speaker A: That's super exciting. There seems like a number of projects and UAT making bigger investments on AI UM across the board. UM which perfectly transitioned into the following which is over the next five to ten years where do you think AI will be the most promising in healthcare and in those areas, how do you decide what to build versus what to buy or partner for? Coming in with your strategic partnership side, I feel like this is a great question for you.

Speaker B: Yeah, uh, you are correct in that UHC is leaning heavily into AI driven solutions. And like shs, where I mentioned our Smart Smart Choice, Provider search and those advocacy tools and others are great examples of how we're investing um in the AI. Uh, overall, UnitedHealth Group spends 9 billion billion invested annually in technology and innovation. And that includes UM, AI as well. And we have the largest healthcare data set in the United States. So we can bring a tremendous experience to this particular space here. We use AI to produce insights for our employer clients. And let me give you an example from our Chief Data Officer and some of the work that he had done where, um, we were able to recently inform one large employer with over 77,000 members that 42% of their employees had complex conditions, including cancer. As a result of this analysis, the employer deployed a cancer specific care management team to better support these members, which resulted in over $250,000 in savings by closing over 100 gaps in care. So we've been using AI for years to build these innovations and continue to use the applications that are informed by our teams internally. Consumer demand, um, the billions of consumer transactions that we have every year to continue to refine that year over year.

Speaker A: That's super exciting. I feel like you're marrying the use cases of administrative and operations, but also um, care journey, care delivery and patient, um, experience in those categories or those types of categories. Uh, where do you think buying or partnering with other platforms and solutions, um, might be most relevant? And where do you think, um, the building capabilities, um, are ready and present?

Speaker B: Yeah, the use of AI holds tremendous promise to simplify and improve the health care system. And we've been using AI for years across our organizations. We're at the cutting edge of innovation in this space. While AI technologies are important and can positively impact healthcare, but we also believe they must be safe and explainable, trustworthy and used responsibly and ensure patient privacy and security, but also be informed by human oversight and input from clinicians, industry experts and academic partners. And within UnitedHealthcare, we're working with our partners at Optum to improve the healthcare experience with AI. UnitedHealth Group has 1000 AI use cases in production and counting, with half leveraging generative AI. So at UnitedHealth Group, the scale and the breadth of AI implementation are unmatched within the industry.

Speaker A: Got it. Uh, awesome. Let's move on to the following question. Karen, um, you led the telehealth evolution during COVID across millions of providers. What surprised you most about how virtual care has evolved since then? Where's the real opportunity now?

Speaker B: Yeah. Virtual care utilization exploded in 2020 with COVID and has since evolved to continue to meet the consumer needs from mental health to acute care, all the way to primary and specialty care. And this evolution spurred a broader telehealth adoption. Um, as now most providers offer virtual care options for a variety of services. Uh, UnitedHealthcare's virtual care solutions are designed to expand access and make it more convenient, lowering cost and achieving that whole person health even easier. And so leveraging what we just talked about, those data driven insights and advanced technology that they're being used in new ways to better meet the needs of employers and consumers for transparency and affordability and simplicity. So you'll see a theme that I've been sharing today. Uh, payers are also rolling out new AI powered digital solutions. Cutting edge consumer our customer service platforms, provider search tools and solutions is consumers overall are demanding that simple affordable healthcare experience. And so we must continue to evolve and respond in a mindset shift that leans into the potential of digital health, including telehealth, to build that better and more resilient healthcare system.

Speaker A: And specifically in these um, different telehealth categories, especially dealing with chronic care management and chronic disease management, what have been, what are some of the top four or five priorities that UHC has had um, recently, um, and has that shifted at all?

Speaker B: Ah, specific to telehealth and all the different categories is that we enable a broad provider network use for telehealth and it's integrated within our member benefit plan designs. So the use cases are you know, specific to a lot of the different provider types from primary care to specialty care and incorporating it into their uh, day to day practice where members then have that optionality to see their own provider, whether in person or uh, virtually as well.

Speaker A: Got it. So it's an enablement of the existing provider network to be able to function digitally as much as possible.

Speaker B: Yeah, we support the provider network, uh, overall, um, to provide our members those various access points based on what makes sense for the member and the provider.

Speaker A: Double clicking that into that a little bit more. How do you know when to um, bring in a vendor that you partner with through the UHC hub, um, as a complement or supplement to the strategy that you just laid out regarding uh, enabling virtual care for your provider network?

Speaker B: Yeah, the UHC hub and the UHC Store are intended to complement and supplement the members employer offered plan designs, which is their covered benefits, where they have access to our broad network of care providers and physicians. So as we think about the vendor, um, procurement management process and how we go about um, complementing the benefit plan design is we first start to listen deeply to our employers, our members, our customers and other types of um, stakeholders that we have. And alongside our customer needs, we perform a market scan and assess various solutions, vendors, capabilities, um, outcomes, et cetera. And then we ultimately narrow the selection down and do deeper reviews with stakeholders across the company to determine which of these vendors may be the best fit for the UHC Hub or UHC Store. And our goal ultimately is to bring, you know, vendors and partners who can integrate into this broader ecosystem and help offer administrative simplicity, discounted pricing. So we're bringing value to our members, um, and employers and demonstrate the value and outcomes to our customers as well.

Speaker A: Got it. Yeah, uh, Akira, I think you're definitely uh, reading my mind on uh, some of the following questions. So this is a great transition then into talking a little bit more about the better procurement management process. Uh, I want to get really detailed here as much as we can so you know, what teams are involved, who's um, driving some of these processes, what criteria matters the most? Um, and do you have any idea of any tools or systems that support the workflow for the vendor evaluation onboarding process? Um, and then lastly, you know, in an ideal world, what's broken about how payers manage vendors today that you would fix?

Speaker B: Yeah, I can speak to our process on, you know, how we evaluate the vendors and we closely align it to our um, enterprise sourcing and procurement processes where we do bring in stakeholders from across the company that are focused on clinical, legal, um, types of reviews. In addition, we also focus on security reviews and ensuring that the vendors are meeting our rigorous um, technology and security requirements that we bring forward. And so it is a broad team of teams that we assemble and ultimately we look at the vendors and their performance, their outcomes as I spoke about earlier, um, how they simplify the healthcare experience, how the vendor helps drive that affordability and um, treat each vendor uniquely, um, evaluate them and again incorporate the voice of our employer members to bring those particular vendors forward.

Speaker A: That's amazing. Um, a lot of help plans today that I've spoken to have been trying to re strategize on the exact vendor evaluation process and how that can connect to their global business services teams or other teams that are involved in strategic sourcing and executing, um, one thing that we often find is that the evaluation criteria is rapidly changing from condition to condition, um, timeline to timeline and patient population to patient population. Um, are there any consistent elements that are required, uh, or um, are definitely talking points. For example, we think about security and compliance, um, very deeply. So the concept of being compliant on HIPAA, uh, SOC2 high trust. Um, are there any things that come to mind in this kind of realm?

Speaker B: Yeah, I think those are great examples that you shared. Multi factor authentication is important as well, but um, each condition state is unique, uh, that we bring. Some of these particular vendors focus on health and wellness as opposed to chronic conditions. And so we incorporate the latest and greatest, um, you know, from our teams across the company. I am not a clinician by training, but certainly rely on them and their clinical expertise and review of the latest literature to help inform, you know, some of that decision making.

Speaker A: Awesome.

Speaker B: Great.

Speaker A: And kind of flipping the script a little bit. Um, I would love to kind of hear about your perspective, um, and advice to startups and other innovative solutions that are partnering with payers, uh, for digital health and virtual care startups trying to sell into uh, a payer like UnitedHealthcare. What do they consistently misunderstand about your priorities or processes? What did the best partners do differently from the first conversation to the last, and what would you say best to steer them towards a path of success?

Speaker B: We look for partners who are on the forefront of innovation that align with our mission of making the healthcare system work better for everyone. And we're particularly interested in partners in the health technology space who responsibly use AI features and make it easier for consumers to interact with healthcare and improve that access to care. Um, in addition, you know, given the rise in healthcare costs, we also offer partners that offer advanced solutions that are aimed at improving affordability and simplifying that healthcare experience. And then lastly, we take into consideration the imminent needs of our consumers and what they may be needing, um, or lacking in terms of their healthcare access. So for an example, um, given rising mental health needs, UnitedHealthcare expanded its suite of mental health offerings by adding Calm Health, an evidence based mental health app from Calm that offers on demand personalized support at no added cost to millions of our eligible members. So um, you'll hear the theme that, you know, listening to our members, our employers, our stakeholders is critically important to us as we evaluate our partners, um, and um, that we want to bring forward to our, to our book of business.

Speaker A: If there are any, you know, um, digital health innovative innovation startups in our podcast audience, are there any care areas or opportunities where you could clearly say that there is a certain gap at UnitedHealthcare or certain opportunity for partnership? For example, if there is a need for um, you know, diabetes management, if there is a need for uh, behavioral health? M. Is there anything that is top of mind for you right now as you kind of continue to uh, source strategically?

Speaker B: I will stay with our general categories. Any if there's anybody in our audience that help um, simplify or help drive affordability in the cost of care, those are the ones that we're most interested in connecting.

Speaker A: Fantastic. Great. Hopefully we get some type of uh, business development progress and opportunity as uh, a result of this um, but transitioning into um, one of the last couple of questions, um, the next conversation topic that I usually have with payers that we work with is okay, well it's great that I'm finding these innovative solutions, but how do I know that they really work? Um, and defining that real ROI can be really muddy, uh, as there are a lot of different data points that can cloud uh, the truth. When you look at programs coming through UHC Hub or UHC Store, what actually counts as ROI for you? Medical cost savings, outcome improvement, retention, nps, operational efficiency. And how do you weigh those against each other and measure them?

Speaker B: Yeah, real ROI starts with adoption, uh, when members actively use the programs that complement those um, employer benefit plan designs rather than compete with it. And the ones that complement, we're seeing stronger engagement and that meaningful impact. Uh, the UHC Hub and the UHC Store are designed to meet members where they are and give them that choice of health and wellness programs that drive that engagement and utilization. So specifically for employers, ROI shows up as smarter benefit utilization, not just short term medical cost savings, where members are using the right solutions at the right time and that supports that simplicity and affordability. We measure success by how well these programs integrate into the everyday member experience. They improve access to care, they reduce friction, they um, have positive member satisfaction and again reinforces that value of the employer's overall benefit strategy. So when member adoption is high and those experiences are seamless, then outcomes follow with that better engagement satisfaction and a benefits ecosystem that is working as designed.

Speaker A: And is this information and data, um, something that UnitedHealthcare has to corroborate, corroborate and measure um, independently or is this something that uh, oftentimes you can rely on the results and feedback shared from the providers or vendors?

Speaker B: It's ultimately a mix of how we measure, but um, a lot of our Data and results we share with employers. Right. So that they can, you know, use information across the board to make better um, benefit plan decisions and what types of programs and services that they would incorporate that supplement, you know, their, their existing plan designs that they offer to their, to their members or to their employees.

Speaker A: Makes a ton of sense. Great. Um, going into a hot topic, value based care. UnitedHealth has been very vocal about doubling down on value based care and tying more members and providers into outcomes based arrange. Where do you see the most exciting intersection between value based care and digital virtual solutions over the next few years?

Speaker B: Yeah, uh, creating that true consumer experience in healthcare is the real opportunity. And to do that, to drive to value based care, you need the tremendous amount of data and using the AI driven tools and information, um, at scale like we are continuing to invest in. And so some of those insights um, is how we built out solutions like Surest, which we believe is the future of value based care. But there's also some new solutions that will be rolling out later this year and in the future that create a more personalized experience and give consumers the information they need to be actual consumers. So what that means is offering real choice and the economic sense of the terms, uh, choice based on insight into quality and the cost of what they're buying. And we know that choice and insight about which providers are best for members needs. And so we've seen, you know, through our innovations like Surest and offering the price transparency and value that their savings of, you know, 44 on average for members with 83% member engagement. So the Surest digital shopping experience does help improve access for people, um, and help them navigate the best care that makes sense for them.

Speaker A: Fantastic. All right, Karen, we're getting into our very last question. Are you ready?

Speaker B: I'm ready.

Speaker A: Okay. So what shift in healthcare business models, technology and partnerships excites you most for 2026 and beyond? What should leaders be preparing for now? Both on the digital health side and the health plan side,

Speaker B: we hear from employers every day and the number one need in healthcare is affordability and simplicity, in that order. And we're going to keep on innovating. We're leading that charge in the healthcare system transformation and uniquely positioned to do so where insurers are the primary party in the system to help incentivize and keep the costs low and keep people as healthy as possible. Um, just in conclusion, we believe that the challenges within the healthcare system are within our ability to solve and we're doing that with our scale innovation experience and technology in partnership with providers, employers, vendors, um, and other stakeholders. So driving to affordability and simplicity are going to continue to be important as we fulfill our company's mission.

Speaker A: Well, I'm personally really excited to continue seeing the progress here, and, uh, I'm going to continue to harp on the themes of, um, simplicity, affordability, um, this year. So thanks so much for that. Karen. This has been amazing and, uh, really, really appreciate your insights and words of wisdom, as I'm sure the rest of our audience will as well.

Speaker B: Thank you very much for having.

Speaker A: Sam.