In memoriam: Brian Thompson was a visionary leader lost too soon

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The tragic assassination of Brian Thompson, CEO of UnitedHealthcare and a prominent leader in the health insurance industry, has left an indelible void in both the professional community and in the lives of those who knew him personally. Brian was not just a figurehead in the health insurance world; he was a visionary whose work focused on ensuring access, equity and innovation in health care. His untimely death, under such tragic and violent circumstances, has shaken the industry to its core and ignited a collective call for justice and remembrance.

I got to know Brian personally in what would best be described as a wartime situation. I started working directly with him in March of 2020 just as the COVID-19 lockdown shut down the entire health care industry. I worked in the White House at the time as an economist advising the Trump administration. I was suddenly called on to recommend how to distribute the first $100 billion of CARE Act financial relief to health providers who were struggling financially and no longer able to complete elective procedures. To put it bluntly, federal government Medicare contractors failed to find easy ways to distribute the money through normal channels. That is where Brian responded through a personal connection to a federal official to map out a novel, unorthodox mechanism using resources of UnitedHealth Group and, in particular, using their Optum bank to move the first tranche of $30 billion to over 300,000 physicians and hospitals throughout the United States to keep them financially afloat during the first month of the pandemic.

Most people need to learn about this effort. When we think back on COVID, people focus on the success of Operation Warp Speed to get the economy fully reopened. In many ways, there was no template to rescue an entire health care economy. It’s a tribute to Brian and his courageous and ingenious way of getting all of the key components of UnitedHealth Group to come together to complete a mission that the Medicare contractors said would not be possible until July 2020 with two months of planning and another one month of execution.

Why did this relief matter? Many hospitals had seven to 10 days of cash on hand at the time because they were running very lean supply chains, as they had been trained to do for 20 years. During the lockdown, there were no elective procedures. These services keep many hospitals and physicians operational. Without revenue, providers could not pay their staff at the worst possible time during the COVID pandemic when some cities such as New York and Detroit were surging with hospitalizations. These hospitals needed to have money flowing into their health systems in order to stay operational.

UnitedHealth Group was in a unique position because they are not just an insurance company but have Optum Bank. This bank’s purpose is to hold health savings accounts and have people use them to pay for medical services. Because United had a bank, they could wire money directly to hospitals and physicians who did not know they would be getting assistance until it showed up on April 9, 2020. All of Minnesota’s major hospital systems received at least $20 million of relief that day. Several New York City hospitals quickly spent over $100 million to stay operational. While these sums may sound very large, they are only about two weeks of operating expenses for those large hospital systems.

At the time, those working on this project were encouraged by the notes we received back two weeks after the first tranche was deposited. Here are some examples:

Social media has now fixated on the pre-authorization of medical claims, a practice in force for 40 or more years. If the national claim denial rate is 5%, 95% of care is approved care that is often too expensive for a purely cash health economy to provide medical services to those in need. Remember that part of the 5% of rejected claims is to protect against medically unnecessary and perhaps fraudulent care.

As a positive step forward, I propose that federal and state regulators require quarterly transparency of claim denial and pre-authorization rates for all insurers, whether for-profit or nonprofit. In addition, the same transparency should apply to government-regulated health insurance, including Medicare, Medicare Advantage, Medicaid and employer-sponsored health plans. This would provide a full picture of the entire insurance industry instead of one isolated firm — full transparency of the entire industry at this time.

Regarding the social media posts surrounding Brian’s murder and justification for violence, Brian Thompson did not deserve an assassination for his leadership at UnitedHealth Group. Many things need to be reformed and improved in the health insurance and health care industry. Those improvements should not start with violence. If there is any silver lining to tragedy, I hope it starts a thoughtful and impactful national conversation about how we can improve the health care delivery system and health care finance. The saddest regret I have about writing this is that my friend, Brian Thompson, is one of the people I would most want to talk to about improving the health insurance system for the next generation.

Stephen T. Parente is a professor at the Carlson School of Management at the University of Minnesota and the former chief economist for health policy on the Council of Economic Advisers at the White House during the Trump administration.