CRC Benefits Podcast

Innovative Solutions for the Small Group Market with Tiffany Stiller and UnitedHealthcare's commercial CEO Dan Kueter

• Michelle McCaw and Amanda Knight

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We sit down with Dan Kueter, CEO of UnitedHealthcare’s commercial business, to unpack small-group cost pressures and explore how employers can counter trend with level funding and more transparent, tech-enabled benefits plan design. UnitedHealthcare’s Surest health plan offers a clear path to lower costs and a better consumer experience. In this episode, Dan gives a deep dive on how Surest is built around more than 1 million variable value-based copays that vary based on a provider’s historical performance, upfront pricing, and smart digital nudges.

We also cover today’s top trend drivers, including specialty drugs, GLP-1s, cell and gene therapy, and behavioral health. Dan breaks down how to choose between level funding and adjusted community rating and more detail about how Surest can help lower costs for employers and members alike.

You’ll also hear why digital engagement is key to real results, plus insights on broker education, rollout best practices, and how to partner with UnitedHealthcare for ongoing feedback and product refinement. Be sure to subscribe so you don’t miss upcoming episodes of the CRC BeneFit Check Podcast, where CRC Benefits delivers real insight, practical strategies, and smarter solutions to help you lead your clients with confidence.

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Michelle McCaw:

Welcome back to the CRC Benefit Check Podcast. I'm Michelle McCaw.

Amanda Knight:

And I'm Amanda Knight. Thanks for joining us for another conversation where we explore strategies, insights, and innovations shaping the employee benefit space.

Michelle McCaw:

I'm really looking forward to this today because we're diving into a topic that matters deeply to brokers and employers alike. And that's how to bring real innovation to the small group market.

Amanda Knight:

And we're excited because this episode features a special conversation with United Healthcare CEO Dan Keuter, led by our very own Tiffany Stiller, CRC's Senior Vice President of Carrier Relations and ISD.

Michelle McCaw:

And Tiffany really has been at the center, um, actually, I'd even say the forefront of bringing fresh carrier solutions to our brokers. So it makes perfect sense for her to guide this discussion with Dan.

Amanda Knight:

So without further ado, we're handing the mic over today. We're going to hand it to Tiffany for her interview with Dan Kueter on Innovative Solutions for the Small Group Market with the spotlight on Sureest. This is the CRC Benefits Podcast from CRC Group. This podcast features news and insights from those working with our vast network of 20,000 brokers to deliver employee benefits to more than 200,000 small and medium-sized businesses. Plus, we give you the latest information on what is happening at CRC. This is the CRC Benefits Podcast. And now the hosts of the podcast, Michelle McCaw and Amanda Knight.

Tiffany Stiller:

Tiffany, take it away. Well, thank you, ladies. And Dan, thank you so much for taking the time to join us today. Um, I will share with the audience that we were talking to UHC's Sure's team about doing this interview, and then Dan ran up to me and said, I want to do it. And I thought, well, who better? So thank you again for your time. We we appreciate it.

Dan Kueter:

And well, thanks, thanks, Tiffany and Michelle and Amanda, all of you for making this happen today. Delighted to be with you. And uh yeah, I am proud of what we're doing to innovate in the small employer space, and I really find it fortunate to have the interest from CRC benefits and all of you individually and and your brokers to really seek out solutions that do bring affordability to the small employer market space.

Tiffany Stiller:

Jumping in, I mean, we are in the news every day. Um you can't avoid conversations around what's going on in healthcare. And uh, you know, on that topic, I want to talk a little bit about you know what's happening in small group, and I see United Healthcare continue to innovate in this space. And uh, you know, what what's new for you? What are you thinking about?

Dan Kueter:

Yeah, the small employer space is certainly uh you know important to us and um important to the entire marketplace. The the number of offerings available to small employers continues to grow. Um, but also the challenges of healthcare trend are very real and sometimes most impactful on small employers across all employers. And you know, so what's on my mind are the drivers of that trend. And we've spoken publicly about trend this year and trend forecast in the next year is really at a at a record high in terms of the near-term past. And uh that's challenging for all of us. And and uh the drivers of that trend, I think are well known by many, but just to hit a couple of them are X costs and those pharmacy costs in a number of ways, the rise of specialty medications. Everyone knows about GLP1s, of course, and substituting really low-cost drugs for very expensive drugs. Cell and gene therapy, the claims are rare, but when they emerge, they're multiple millions of dollars. So that's really been the biggest single driver of trend. And then behavioral health utilization, another, right? COVID brought in a whole new era of need in that space, and and we all want to meet that need, but it continues to be a driver of trend. And I think the industry is getting better at matching up the right resources with the right consumers, patients, if you will, in behavioral health, and that is having some dampening effect on behavioral health trend, but it's it's higher than than it has been historically. Uh, and then there's some other smaller contributing factors, uh, you know, the AI-driven coding and the No Surprises Act and the in the dispute resolution process that's wrapped around it. You've heard us, or actually some of my competitors, talk a little bit more about this than we have, and all of those things have contributed to it. And then another factor that we talked a little bit about, but the price increase demands from the providers are up. They're probably 100 basis points higher in the last couple of years and expected to be next year again than they have been pre-COVID or through the COVID era as well. So when you combine all that together, yeah, healthcare trend and therefore the cost demands on small employers are above what they've been uh in the last decade or so. And and that's a challenge for all of us to confront, and the best solutions to that, I think, is is innovation. So I appreciate the topic of the podcast, and that's what we were trying to bring is innovation to the small employer space.

Tiffany Stiller:

Yep. Uh and I am proud to see at uh the National Association meeting some of the great innovation that you're doing. I think you're you're really on the forefront. Um, some of the things I saw around behavioral health and how you're attacking it through virtual is wonderful. But what are some of the other things and other strategies that brokers can incorporate to help groups combat all of this added cost?

Dan Kueter:

Yeah, for sure. So I I think first, and I think this is quite well done in the in the in the marketplace, but there's always room for probably a little bit of improvement. And that's balancing between the cases, the groups that are right for level funding versus the groups that are right for an adjusted community rating product. Uh and level funding has really uh provided opportunities for groups to match their rate to their risk, give them some financial incentive toward employee and employer engagement where they have an opportunity to earn part of that cost back for a rollover into cost reduction in the subsequent year or or even a refund of sorts in a level funded environment. So I think making best use of level-funded offerings is a is a great first place to start. And then beyond that, really thinking about what the constructs of that benefit plan looks like. And Shurist was mentioned at the at the top, so of course I'll touch on that and I'll hope to go into some greater depth with Shurist and what it's done for us in the large group market and what it's now doing for us in the small group market in a level funded environment. So Shurist enables uh us to provide transparency to a consumer and engage them in the decision-making process about the care they seek at the time they need care. Do that in a very friendly, digitally engaged way that provides transparency to consumers and helps them make choices that leads to lower out-of-pocket costs for them for sure, and savings for the employer. So uh I think getting the first choice right of adjusted community rating versus level funded, and then inside level funding, evaluating whether Shurist is the right approach for that group or not, or at least a slice of that group. And typically uh I think brokers and employers alike find the answer to that to be yes. So that's what I would say is a top-of-mind recent innovation by us that has great promise.

Tiffany Stiller:

Yeah, and I I think we're gonna make Shurist a little bit of a uh the star of this show. And one of the uh aspects of Shurist that uh has stood out to me is the technology. And so do you want to talk a little bit about the app and how that's driving um the product and some of the outcomes?

Dan Kueter:

You know, Shurist really solves the three or four greatest points of frustration for employers and consumers. And and those long-standing frustrations have been deductibles, co-insurance, the lack of transparency, especially before care is sought, and then digital engagement. And and we think Sure solves all of those. Uh, it is a variable copay plan without deductibles, without co-insurance, that makes available on the app to get into your technology uh question uh of the the cost of the service that the consumer is going to pay prior to them seeking that service. So it enables shopping, right? The great hope of 25 years ago with HSAs was that we were going to turn consumers into healthcare shoppers, and it never really materialized because they didn't have the information available. Yeah, exactly. Now with Shurist, they do a super user-friendly app. I think of it personally as a cross, and I'm a Shurist member, have been for years, uh, and it works great for my family. And the Shurist app, I think of it as a cross because kind of between the Amazon app and that Marriott Bonvoy app in terms of the Marriott hotels and the mapping technology and choosing between them. So when one uses the app, they enter what they have, and it could be something like I need an MRI, or it could be something like I have a sore knee, to be honest with you. And it's sufficiently intuitive to prompt the consumer in a very logical way through making some choices and then evaluating different points of care on where you might get that MRI, or maybe even something as complex as where you might choose to have your baby, quite honestly. And my youngest is is uh approaching college, and so it's been a while, but I still remember the administrative process associated with that, with the claims and how they all come from all directions hospital, pediatrician, anesthesiologist, etc. Uh, and and the confusion and the consumer liability of that. Well, with the Surest app, all of that is known up front. You know that the price of having this baby at a given hospital is maybe as low as $550. And at another one, it could be $2,500. And that's what you're gonna pay. And it takes into account behind the scenes the bill from the pediatrician, the bill from the anesthesiologist, the hospital. Maybe there's a short NICU stay. Was this a 48-hour stay or a 96-hour stay? Was this a traditional delivery or a C-section? All of that is contemplated in the price that's set, and the consumer pays the price that's set, and that's made transparent on the app. So it's it's the technology, yes, but it's the integration of the technology with what's actually happening behind the scenes. Super complex. Years of development, lots of dollars behind the scenes to make this simple for the consumer up front and transparent. And it's more than way more, and again, some of the complexity happening behind the scenes, way more than just a tiered copay plan, because you can think of another care that someone's needing, and the app nudges the consumer toward the better decision. So, for example, I need a knee scope. Well, do you really need a knee scope? Maybe you need 10 or 15 visits at zero cost for physical therapy. And I think the clinical literature and orthopedic surgeons would tell us if a consumer could go through that, they may avoid a high percentage avoid surgery, and our experience validates that. So, this is the type of sophistication that's built into that technology of the SureST app that nudges consumers not only to make the best decision, but then gives them the transparency of the cost implications of that decision. And so it's it's pretty transformative for us, and it's super easy to use, which leads to digital engagement with consumers, unlike I think the industry has ever seen. We have upwards of 80% digital engagement very rapidly in the first couple of months of a group enrolling insurers. And that's really unprecedented. And if you can get carriers of any sort, uh, or even hospital systems to talk about the use of their Epic app or things like that, it this this kind of surest digital app engagement is really unprecedented. And that speaks to the value that consumers get from it and how easy it is to use it. Just like the apps they use in the rest of their life Amazon, Marriott, Delta Airlines, you kick your choice, Walmart Plus app, etc. Uh we tr we aim to be that easy, but the surest app.

Tiffany Stiller:

Yeah, I mean, uh to me, the the sh unsurety that you take away that gives people better confidence in their healthcare because you're giving them guidance is is worth everything. Um all the things I've seen to date point to a great success story here, really good feedback from groups. Um can can you talk about some success stories and some early um, you know, positive feedback you're getting from this product and and the employer groups that are on it and utilizing it?

Dan Kueter:

Yeah, absolutely. And and you know, uh when I think about success stories, it really starts at the macro level. And the market is smart. Let's face it, employers are smart, brokers are smart, consumers are smart. So the best feedback that we get that Shurist is working is really the continued growth of Shurist. So more brokers are presenting it to more groups, more groups are choosing it to be the only or one of their selections. And then within the group, more consumers, employees members uh are choosing Shurist, and those that choose it stay with it. So the macro success comes out in those numbers. And then we also see it in the cost performance of Shurist, where the savings for out-of-pocket savings for a consumer upwards of 40% because they're making better choices. Uh and then the savings for employers on a full-year premium basis 8 to 12, 15%. There's some geographic variation to that, and there's some digital engagement variation to that. Without digital engagement, the savings kind of evaporates. So the higher the level of digital engagement with the employees, the greater the savings is going to be. So that's the macro extent. When I think about specific employers, and I can think about employers in the in the level funded small employer space where they have moved to this, they engage a little bit of employee education so that folks get registered for the app and get comfortable with it. Again, it's super quick because it's super easy, as I described. Uh, and then the healthcare changes, uh, the choices begin to change, and that produces the value. So we have rolled this out just in 2025 in the small employer space and had great success with it already. It's been in the large market for many years, and we've got employers all the way from some of America's largest employers in our national account segment, where we've got about 25% penetration already, actually, with folks choosing it. Our company's been offering it for years, as you would imagine. My family's been on it for years. So the successes are from the most sophisticated, complicated, uh, largest employers in the country down to through the middle market and down into small employers. And the experience is relatively consistent. Some of the numbers are different. Is the savings 6% or is it 12%? There's geographic variation to that. There's a there is a slope to it, and I don't want to get into a wonky actual conversation about benefit slope, but I think a lot of your listeners know what I'm talking about. So depending on where the benefit plan sits on the slope, there's sometimes more savings in certain places than others. But all of those are factors, and the success factor of this has been satisfaction from employees. So HR teams, uh, or sometimes in the smallest employers where there's not an HR team, even the business owner reports satisfaction from employees, fewer questions, fewer concerns about the math behind deductibles and co-insurance and so forth, because the variable copay makes it super simple and it just works. So there's satisfaction and point proof points really at so many places, it's kind of hard to capture it all. So uh, you know, I think hopefully that gives you uh a sense of the things that are really proving to be the satisfiers, and sometimes even in places where we didn't expect them, like I just described, fewer questions to the HR office or the CFO or even the business owner.

Tiffany Stiller:

Right, right. You've got happy employers, happy employees, people saving money, and better guidance around their health care, all a win. So love it. Um anything else you'd like to share with you know our brokers and partners listening?

Dan Kueter:

Well, I appreciate the question. And what I should really summarize with is just gratitude, right? This product only works because of the partnership between United Healthcare and our distribution channel. And so these products are really simple, and the digital app is intuitive, but there's always a level of education that's necessary for the employer, and then to some extent to the employees. And that would not happen without the partnership of our distribution channel. And so I know these are primary listeners to the podcast, and so I just want to say thank you. You're central to the success of this product, central to the success, really, of your employer customers getting access to this product and having it work for them. So uh that's the thank you. And then the offer is if we need to do more, we really think this is transformative, not only for our business, but really for the industry, and we think it's part of the long-term solution to America's healthcare cost problem. And so if there's more that we need to do, we're all ears to hear it. In in product refinements, in in ways to get the word out differently, uh, in some offerings or insights on how to package it best for certain employer categories. We're all ears because we're wholly committed to this. We continue to invest and innovate, and we're gonna bring it to other areas of our product offering as well, continue to as well, continue to integrate it more fully uh into our solutions. And uh so if there are things that that come to mind, we want to hear about it.

Tiffany Stiller:

Well, thank you. I can't thank you enough for your partnership and and for taking time to speak with us today. And uh now we're gonna move on to some fun.

Michelle McCaw:

We are, we are. That was a great conversation, Tiffany and Dan. Thank you. Uh so yeah, before we wrap up, we've got something a little special planned. Um, it's our Fast 3 QCA edition. So we do this at the end of every episode, but this one's special because Dan, I'm a Quad City girl. And uh I know you called this your stomping grounds for a while. So um just gonna give a quick round uh, or excuse me, a quick nod to the quad cities um and learn a little bit uh more about who you are. So if you like questions, all in good fun, no prep, no pressure, just the first thing that comes to your mind, okay?

Dan Kueter:

Awesome.

Michelle McCaw:

All right, all right, Dan, are you ready?

Dan Kueter:

I'm ready, Amanda.

Amanda Knight:

Here we go. Tiffany, you want to start with the first one?

Tiffany Stiller:

Oh, okay. Here I go. Which quad cities company is known for its green and yellow tractors?

Dan Kueter:

Well, boy, that's an easy one, right? Of course. And I did have the opportunity to live in the Quad Cities for a decade. Uh, I did have an opportunity to lead our health plan that was based in the Quad Cities that we acquired from the answer to your question of John Deere, right? So, John Deere, great American company. Uh, no question about it, I got a got a John Deere Zero Turn in my yard, in my garage rather than my moon yard, with most people don't expect that. So there's a little bit of tidbit in tidbit here for you. I'm one of just a few folks in my neighborhood that still do. But for me, it's fantastic, and it's thanks to uh thanks to a fantastic piece of John Deere equipment, by the way, uh that my friends from the Quad Cities helped me procure um uh just as as I live there.

Michelle McCaw:

Definitely. All right, we'll we'll keep it rolling. Hopefully, uh this one. I thought this one might be the complicated one, but but we'll see. Um, do you know what's unusual about the Mississippi River that's only right here in the Quad City area? It's not true anywhere else.

Dan Kueter:

Well, the Mississippi River, and this just if if this is where you're headed with this one, the Mississippi River uh doesn't really flow north to south through the quad cities, it it flows east to west through the quad cities, and that trips up a lot of people, and it's confusing to folks because when you cross the river, you're like, oh gee, I must have been going east because I was I knew I was in Iowa and I was crossing the river, so I must have been going east into Illinois. Well, actually, no, you might have been going south, right? It's like one of those geographic anomalies, like folks in certain parts of Michigan go south to Canada, and you're like, how can that possibly be? But it actually is, and the same thing exists there with the Mississippi River in the Quad Cities.

Michelle McCaw:

This one is not stumpable. He's not stumpable. I don't know. Amanda's got a good one. This one might stomp him.

Amanda Knight:

Okay, food question, which you were smart to give this one to me, Michelle. You know me well. Food question. If you had to pick just one, quad cities style pizza, an Iowa pork tenderloin sandwich, or Whitey's ice cream. You can pick one. What are you choosing?

Dan Kueter:

Boy, it's got to be Whitey's ice cream all the way. I do love that bad boy's pizza. And also, obviously, Happy Joe's taco pizza is a phenomenon in that area. And for all for taco pizza, wherever it exists, it all originated, I think, from the Quad Cities at Happy Joe's first. But you cannot deny Whitey's ice cream, the top of the heap there.

Michelle McCaw:

Good answer. Good answer.

Amanda Knight:

All right, Tiffany.

Tiffany Stiller:

Last question coming from you. And to finish, not a quad cities related question this time. But if you weren't doing what you do now, what would be your dream job?

Dan Kueter:

Boy, that's a heck of a question. That might be the toughest one of all. Um, you know, I love sports, uh, better watching than playing. Anybody that's seen me on a golf course or near one knows that. Uh, if I wasn't doing what I'm doing, and I love math, I love leadership, I love uh the connection of those things. I'd love to be a base a Major League Baseball general manager, right? I think about the Moneyball story and Billy Bean and one of those people, characters in that book and movie is just coming back uh into baseball to be the general manager of the Rockies. I think about that. Theo Epstein is one of those people I respect a great deal for what he did uh and how he went about it and did it. I'm a lifelong Cubs fan, so I'm grateful for what he did in the 2016 uh team and so forth. So I would love, I'll never have the chance, by the way, but I would love the opportunity to be a general manager in Major League Baseball.

Michelle McCaw:

I was just gonna say, I think uh I think you'd do very, very well at that. And I'm a Cubs fan as well, so uh so I agree, love to see that.

Tiffany Stiller:

Now, with that said, we are very lucky to have you where you are, so let's keep going. Well, thank you for that.

Michelle McCaw:

Absolutely. Dan, we really appreciate your time and perspective and everything United Healthcare is doing to bring the meaningful innovation to brokers and their clients.

Dan Kueter:

Thank you so much. It's been my pleasure to be with you today.

Amanda Knight:

And as we look toward 2026, you know, employers and brokers alike, we know, are searching for solutions that break that status quo. Um and it's exciting to see how carriers are starting to rethink what's possible in that small group space.

Michelle McCaw:

Yeah, definitely. That's that's what today was all about. Um, finding fresh, practical ways to deliver value and help our partners stay ahead of the curve. So thank you again, Dan. Thank you, Tiffany, and to all of you for tuning in to the CRC Benefit Check Podcast.

Amanda Knight:

Be sure to subscribe so you don't miss upcoming episodes packed with more information that you need.

Michelle McCaw:

Until next time, we'll keep bringing you the insight, intel, and innovation that help you serve your clients and grow your business.