Robert C. Falkenberg of UnitedHealthcare: “Our collective health and wellbeing will impact who we become as a society”

We have to make being healthy cool, and it needs to be a top priority for our society. Healthcare tends to be a political lightning rod, too often focused on how the system fails people. I think we need to get back to viewing patients as humans — as family members — mothers, daughters, sons and fathers. What happens […]

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We have to make being healthy cool, and it needs to be a top priority for our society. Healthcare tends to be a political lightning rod, too often focused on how the system fails people. I think we need to get back to viewing patients as humans — as family members — mothers, daughters, sons and fathers. What happens in society is that we have systematic problems and behaviors that lead to our poor health. Obesity is a huge problem in the United States, and it is getting worse, in part, as a result of the pandemic.

As a part of my interview series with leaders in healthcare, I had the pleasure to interview Robert C. Falkenberg, CEO of UnitedHealthcare of California. For the past thirty years, Rob has dedicated his career to the improvement of the health care system in the United States. With leadership experiences at Aetna, MassMutual, WellPoint and Sloans Lake Managed Care, Rob joined UnitedHealthcare in 2001, becoming CEO of UnitedHealthcare of Ohio in 2005, and then in 2016 he was named CEO of UnitedHealthcare of California. Rob brings decades of healthcare industry leadership with deep knowledge and experience working within the managed care sector. He earned a BS in Business Administration from Towson University where he graduated Magna Cum Laude, and he received an MBA from Loyola College.

Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

Early in my career, I had the privilege of working with Dr. Henry Cleveland, a prominent cardiac surgeon and one of the founders of Sloans Lake Managed Care, based in Denver. It was Dr. Cleveland who taught me the importance of taking a holistic view of patients’ needs and working to help treat people’s physical, behavioral and mental health. Dr. Cleveland understood the importance of approaching each of his patients holistically — by assessing mind, body and spirit.

In 1999, Sloans Lake Managed Care created the first alternative medicine insured benefit in the country. It was very progressive, including coverage for acupuncture, homeopathic remedies, chiropractic and more. We credentialed the providers, set up coding systems, etc. It was well ahead of its time. Even today, you don’t often see alternative medicine incorporated into traditional health insurance. Sloans Lake was a fledgling HMO, and we had to be different.

To this day, it is still embedded in my thinking about how we treat people, and I believe it is often a missing ingredient in our healthcare system. We need to fully connect with people, but not many insurance providers will cover Eastern or alternative medicine modalities. As an industry, it is essential that we breakdown the silos of care delivery. Both providers and payers must connect patients’ care and their coverage and treat patients as whole beings.

Can you share the most interesting story that happened to you since you began leading your company?

We had a program at UnitedHealthcare (UHC) that was called the Diabetes Prevention & Control Alliance (DPCA) — and you can tell just from the name that we were probably going to be in trouble. The program was derived from a CDC study which demonstrated that group therapy provided to pre-diabetic patients, including a clinical diet, exercise and social participation, would significantly help patients change behavior, lose weight and prevent diabetes. The study showed that no matter what your starting weight was, if you are able to reduce your body weight by 5%, there is a greater than 50% reduction in diabetes prevalence.

There was one sticking point: the program required that members had to attend regular class meetings at a YMCA. There were great intentions for the DPCA, but we took a clinical approach that did not work. So, we brought on Seth Tuckerman, the former COO of Beach Bodies, to help us make this a consumer initiative. He rebranded the program “Real Appeal” and prioritized it to address what consumers want most in their lives: (1) To Look Good (which usually translates to Lose Weight), (2) To Connect Socially, and (3) To Be Financially Secure.

Real Appeal was relaunched as a free program to lose weight and stay connected, and it was a great success! All the elements of the program were still based on the science in the CDC study, but were now promoted it in a positive, fun way. We ran the first pilot in Ohio in 2015. To kick off the program, I sent a personal letter to each of those identified as a target enrollee, speaking to each as an individual, expressing interest in their long-term health and wellbeing. We experienced over 60% enrollment in the pilot, and after launching the program nationally, hundreds of thousands of people have benefitted.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

My first job out of college was with Aetna as an Employee Benefits sales representative. I sold my first policy to an auto dealership in western Massachusetts, and I was so excited about making that sale. I drove across the street to my next appointment, and realized when returning to my car, I had left the engine running and locked my keys inside.

Fortunately, the auto dealership made a new key for me! I was an eager, absent-minded kid. I’ve learned to be a bit more focused and grounded, and I’m thankful for new technology that prevents locking keys in the car.

What do you think makes your company stand out? Can you share a story?

UnitedHealthcare’s performance-based networks are specifically designed to provide patient-centered care focused on the physician and patient relationship. We really try to concentrate on what makes a difference in people’s lives.

In Southern California, UHC has a sister division named Optum Care. Optum Care employees and manages the largest number of primary care providers under one umbrella. In an effort to provide a better consumer experience for UHC members utilizing Optum Care providers, we created a product called Harmony.

Harmony is one of the first tangible examples of a provider organization teaming up with an insurance carrier to work collaboratively to build a more integrated care and coverage experience for the patients we serve. Harmony has been the biggest product success in the history of UnitedHealthcare in California, with over 60,000 enrollees joining the program over the past eighteen months. Now UnitedHealthcare’s customer service is integrated with the physicians’ offices so it doesn’t matter where the patient goes to get information. Patients will receive the same information no matter where they turn for answers.

The Harmony concept of integrating care and coverage is intended to be available for any other carrier who wants to partner with Optum Care. It is not restricted to just UHC patients.

What advice would you give to other healthcare leaders to help their team to thrive?

Imagine yourself as a consumer and challenge yourself to go through the process of receiving care and trying to coordinate that with your insurance plan. Sometimes you have to break the status quo and start afresh.

The Covid-19 pandemic has created the need and demand to provide virtual healthcare. Now we’ve learned there are times to come into the doctor’s office, and times when it’s not optimal. I think a hybrid model will emerge; we are now able to remotely monitor so many conditions using sensors and our mobile devices, like blood sugar levels, for example. Think about using technology to make care easier and more effective.

Did you know that one-third of healthcare spending today is unnecessary — either non-optimal or repetitive because we lack an organized delivery system? There is so much opportunity in healthcare today. I encourage my colleagues to put themselves in their consumers’ shoes and be creative in addressing impactful change.

Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

In the U.S. we have a very fragmented care delivery system, which is less a system and more a large number of independently owned or managed providers or provider groups. This large number of independent providers is not well coordinated. There is too much supply in some specialties and not enough supply, particularly in primary care. We need to take a more community-based, holistic view of what is best for the community and do it in a more systematic, thoughtful and efficient manner. We must focus on the consumer experience, integrating care and coverage, be more accountable for affordability and adhere to evidence-based care protocols to optimize patients’ satisfaction and outcomes.

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

We have to make being healthy cool, and it needs to be a top priority for our society. Healthcare tends to be a political lightning rod, too often focused on how the system fails people. I think we need to get back to viewing patients as humans — as family members — mothers, daughters, sons and fathers. What happens in society is that we have systematic problems and behaviors that lead to our poor health. Obesity is a huge problem in the United States, and it is getting worse, in part, as a result of the pandemic.

Eighty percent of what influences a person’s health happens outside the doctor’s office. Recently I became involved with PEAR Sports, a quickly emerging digital fitness and wellness technology company. We can now provide innovative, low-cost digital exercise and training solutions for all levels of fitness, across all ages, and make it easily accessible via mobile devices and computers. We can also make it community based so it’s a more social, fun experience that people can enjoy doing together. I know I’m more likely to engage in exercise if I’m doing it with a friend.

Our collective health and wellbeing will impact who we become as a society. We have to make it something that people learn to incorporate as part of their daily lives and routines. We want to help people do this together. Sure, we each need to take some personal responsibility, but as an insurance provider and a society, we need to make fitness and healthy living easier, fun and a positive thing to achieve. A social element is essential so more people can learn to enjoy fitness and make it part of our culture. People want to look good and they want to feel good, but they don’t want to be told what to do. And that’s where the social element comes in: we can help people connect with others. Peer pressure can be a wonderful thing, and together we can make fitness a fun habit.

As a network and as a community, we need to give people the tools necessary to be active and to encourage everyone that it’s cool to be healthy.

Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

There is a book I read, The Blue Zones. The author studied geographically dispersed communities globally and found common dynamics and cultural elements where people are living longer and healthier. What was typically present in these societies is a communal environment inclusive of all ages, and socio-economic defining characteristics are blurred. There are also nourishing diets centered around fresh ingredients and healthier cooking.

This strong socialization aspect relates back to the Real Appeal program that we discussed earlier, trying to make people feel better about themselves, losing weight and being connected to social settings that help them invest in their health and avoid becoming diabetic. We can intentionally create the equivalent of Blue Zones where restaurants practice serving healthier foods, politicians promote the advantages of being part of a healthier community, and we all focus on the vitality of all people contributing to that community.

Throughout of the Covid pandemic, our senior population has been more isolated. Post pandemic, we need to ensure that our seniors are encouraged to reengage and to become active participants in their communities. To do this will require a community approach.

We ought to look at our communities as welcoming of all and do a better job of promoting a healthier lifestyle for all as well. Employers, restaurants, senior centers, and others need to work together to engage in more community-wide, healthier behavior. This has been done at the local level, and it can now be something that we prioritize and cherish as a country.

I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?

It is very well recognized that individuals who have serious physical health challenges almost always have corresponding emotional or behavioral comorbidities that need to be treated together. We have not done a good job at the primary care delivery level of integrating a patient’s clinical needs and recognizing when behavioral care and general care need to be performed in a more holistic fashion.

Bayless Integrated Healthcare in Phoenix, Arizona is a good example of this. They are housing care teams under an integrated structure to address both behavioral and physical needs. They are doing this across the full community, for commercial patients as well as Medicare and Medicaid. We need to do more of this.

How would you define an “excellent healthcare provider”?

An excellent healthcare provider is focused on me as an individual person before they treat me, after they treat me, and while they are treating me. I want them to see my healthcare experience with them as a complete journey — before, during and after whatever kind of treatment I receive. This will encourage a more trusting relationship between the provider and the patient.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

This favorite quote reflects back to the Blue Zones ideas and other life experiences where innovation has been a hallmark of success.

“The person who says it cannot be done should not interrupt the person who is doing it.”

— Chinese Proverb

Are you working on any exciting new projects now? How do you think that will help people?

I think the Harmony project bears repeating because it is not restricted to UHC members. Harmony is a very exciting chance to transform the way in which care delivery is provided between a carrier and a provider with the patient at the center of it all, integrating both the clinical and customer service experiences. I encourage other providers that we partner with to follow this model with other insurance carriers as well, so it becomes the norm of integrated service.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

When I have downtime to escape and read a book, I try to take an adventure to experience a life that I might have if I was fearless and didn’t have bills to pay, like Jack Reacher novels! I like movies and humor, and I enjoy reading unbiased, non-political journalism. I like to get the facts from multiple sources and stay educated on current issues.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

I would like to inspire a Blue Zones movement throughout America. It’s bigger than any one area of our society. There is an opportunity to prioritize health, especially for those who are less well-to-do financially. Seniors often need the most support in our healthcare system. They are frequently disenfranchised, disconnected, and more depressed because they are alone. My passion project would work on health, wellness and fitness across all socio-economic lines.

How can our readers follow you online?

Please connect with me on LinkedIn,

Thank you so much for these insights! This was so inspiring!

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