UnitedHealthcare: Reducing Unnecessary Hospitalizations


UnitedHealthcare is an operating division of UnitedHealth Group, the largest single health carrier in the United States. UnitedHealthcare provides case management programs in order to coordinate more effective care delivery to its members. The primary goal of these programs is to treat members in their respective homes rather than in the hospital.

In order to improve the quality of care for its patients, UnitedHealthcare partnered with QualPro to improve its case management process and reduce the number of unnecessary hospitalizations.


QualPro consultants helped UnitedHealthcare form a team consisting of UnitedHealthcare’s medical directors, health service directors, nurse practitioners, field case managers, and telephonic case managers. Together, the team brainstormed over 800 improvement ideas designed to reduce the number of hospitalizations and improve case management. Our consultants helped the team narrow the list to 19 ideas that were practical, fast, and cost-free. Some of these ideas included follow-ups, new triggering programs, and call frequency.

Our consultants designed the experiments for UnitedHealthcare personnel to perform. After selecting a sample of various UnitedHealthcare care centers, the project team tested the 19 improvement ideas. A screening experiment revealed that eight of the ideas had a significant impact and were worthy of further exploration. A refining experiment confirmed the effects of the ideas and revealed the precise strength of their influence.

After analyzing the experiment results, QualPro’s consultants created recommendations to help UnitedHealthcare reduce hospitalizations among elderly and high-risk patients. In accordance with our commitment to driving continuous improvement, our consultants worked closely with operators to guide process changes and motivate project team members to exceed goals.


After implementing QualPro’s recommendations, UnitedHealthcare reduced its number of unnecessary hospitalizations by 12.7 percent.