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Robert Warn is a numbers guy. To be specific, he’s vice president of finance and controller for OptumRx, a diversified pharmacy care services company that provides service to more than 56 million people in the United States, and processes more than 1.3 billion prescriptions annually.
With its customers—benefit sponsors like health plans, employers, governments, unions, and trusts, as well as individual consumers—OptumRx plays the critical roles of simplifying the pharmacy experience and providing consumers easier access to more affordable medications.
But looking at the composition of individuals at OptumRx and their related teams, as he describes them, in his 175-person department, he’s really more focused on the delivery of pharmacy services than words like “finance” and “controller” suggest.
Those teams tell a story about pharmacy marketplace—which constitute the fourth most costly component of healthcare, according to industry observers, and the most frequent consumer touch point in healthcare. Warn has a department that addresses the cost side of pharmacy spend: billing, collection of discounts from drug manufacturers, and sharing of those discounts with clients to lower their pharmacy spend. He also oversees the group that manages the payment of processed scripts from retail pharmacy networks.
But Warn’s team also works with newer services such as home delivery pharmacies, specialty pharmacies for very high-cost illnesses (cancer and chronic diseases like diabetes), and behavioral health pharmacies that are in hundreds of community healthcare facilities across the country. All of these warrant a group of finance people at OptumRx under Warn’s direction that think about the impact they have on the pharmacy marketplace and consumers one at a time. The nature of these newer services means delivering pharmaceutical drugs in new ways and gleaning new, specialized financial insights.
“We feel like we can fundamentally fix the broken healthcare system and favorably impact society.”
But what Warn keeps at the top of his mind throughout is that spreadsheets, calculators, and algorithms shouldn’t be a barrier to what they ultimately make happen. “Typically, the pharmacy benefit is one of the most used benefits inside an individual’s health insurance plan, and that means those touch points are critical snapshots for interacting with people to understand their current health situation and what we can do to improve it,” he says.
“There is, of course, a lot of national discussion on the cost of drugs and how American consumers pay a disproportionately high amount compared to other countries,” Warn acknowledges. “But because we work at the point of delivery and because of our scale, we are in a position to lower costs for our clients. Other parts of the system don’t have that same incentive.”
Though not the only pharmacy care services company in America, the company holds significant market share. It is also part of a larger company, UnitedHealth Group, a healthcare products and insurances services company that had $175 billion in revenue in the most recent fiscal year. With the aging of the population and increased access to healthcare—thanks in part to the Affordable Care Act (ACA)—prescriptions to American patients in 2020 will have increased 11.8 percent since 2016.
But being able to afford medications and healthcare in general, even with employer-provided insurance, is an issue. “It’s a fair critique,” says Warn. “We focus on pricing every day. Manufacturers set the price, but we do what we can to lower it, particularly when we negotiate deeper discounts.” It’s a strong imperative given that large employers expect the total cost of healthcare benefits to rise 5 percent in 2020 alone. So how else might cost containment be accomplished?
Warn says the goals of managing costs and driving for better patient outcomes naturally coincide. He says that starts by designing and managing services so that individual consumers are taken care of, one at a time. That can be seen in various means and methods of delivery: “Give consumers drug delivery and communications the way they want it,” he says. This means that such things as home delivery and text messaging (or phone calls, or emails) that encourage more patient compliance with doctor’s orders.
OptumRx also employs technologies and data analytics that lower prices—and it furthers intelligent decision-making by healthcare providers. “It’s all about data,” says Warn, noting how patient privacy regulations have historically been a speed bump within the industry, but they’ve managed to work through some of the issues in productive ways.
But, of course, data would be meaningless without the team of people that Warn works with every day. Warn believes company culture is what enables all these numbers—data analytics paired with keen eyes on fiscal responsibility—to bring a human approach to human health.
“OptumRx has an awesome culture,” he says. “Everyone is aimed at the same mission. We feel like we can fundamentally fix the broken healthcare system and favorably impact society.”
