Isapre Banmédica Awarded for Improving Care Management in Latin America

Quality and cost-effective health care are goals of every major health care company, but it takes innovation and focused leadership to make a real impact. Isapre Banmédica, UnitedHealthcare Global’s insurance division in Chile, is an example of how these goals were effectively put into action. The health plan’s efforts are being recognized with the 2019 Richard L. Doyle Award, which acknowledges organizations that make innovative use of care guidelines to achieve optimal patient care. 

Isapre Banmédica is one of the largest health plans in Chile, serving more than 850,000 members. Recently, its advancements in clinical care management saw great success helping reduce unnecessary health care costs and improving the quality of care for its members, which led to MCG Health’s recognition. 

In order to achieve this, Isapre Banmédica incorporated the use of evidence-based care guidelines – using a novel approach that had not yet been done in this region. A team of nurses and medical directors was recruited and trained, embedded within hospitals to monitor patient care, and provided real-time feedback on individual cases and aggregated performance reports. 

As a result, hospital provider communication and practice patterns improved, and they were able to establish a baseline to compare hospital performance across the system. 

After conducting reviews on more than 14,500 hospital admissions over a six-month period, they were able to achieve the following results:

  • Reducing inappropriate admissions by 43%
  • Improving the right level of care for patients by 26%
  • Decreasing the difference between the actual length of stay and the expected length of stay from 1.92 days to 1.36 days

“Using evidence-based guidelines as a foundation, we focus on improving the quality of care for those we serve,” said Molly Joseph, CEO of UnitedHealthcare Global. “That reduces unnecessary health care costs and allows more people to get the care they need, when they need it.” 

This is the fourth time UnitedHealth Group has won the Richard L. Doyle Award. In 2010, UnitedHealthcare won for successfully collaborating with hospital surgeons to safely reduce patient readmissions related to gastrointestinal (GI) surgery. Later, in 2016, UnitedHealthcare Global Solutions was recognized for improving quality of care delivery for people traveling and living abroad, and in 2017, UnitedHealthcare’s Amil won the award for improving health outcomes in Brazil. 

UnitedHealthcare Global is the only international organization to ever win this prestigious award and the only payer organization to win two years in a row.