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Careers in Healthcare Administration Veronica Aispuro , PhD veronica_aispuro@uhc.com February 22, 2014 SCASA Career Day

Careers in Healthcare Administration Veronica Aispuro , PhD veronica_aispuro@uhc.com 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)

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Careers in Healthcare Administration Veronica Aispuro , PhD veronica_aispuro@uhc.com February 22, 2014 SCASA Career Day

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  1. Careers in Healthcare AdministrationVeronica Aispuro, PhDveronica_aispuro@uhc.comFebruary 22, 2014SCASA Career Day

  2. 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 • Legal • Compliance • Customer Service • Resolution of Grievances • Quality Improvement • Provider Assessment • Underwriting • Business Planning & Development • Policy Advocacy Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

  3. 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 ofpay for performance programs? Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

  4. 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 UnitedHealthcareMilitary & Veterans UnitedHealthcareMedicare & Retirement Our mission is to help people live healthier lives. Our role is to help make health care work better for everyone. UnitedHealth Group Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

  5. 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. Medicare Star Ratings • 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 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

  6. Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

  7. 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) CMS – Administrative data, database of beneficiaries • 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 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 7

  8. 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 • Asessingeffectiveness of interventions aimed at improving clinical and operational outcomes Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

  9. My Experience Working as Statistician in Healthcare Administration • 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 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

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