Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

UnitedHealthcare Sees Positive Impact of Accountable Care

By Jennifer Bresnick

Accountable care and other quality investments have produced significant improvements in complication rates and hospital admissions, the payer said last week.

UnitedHealthcare’s investments in accountable care organizations and pay-for-performance contracting is reaping rewards for the national insurer, Chief Executive Officer, President, and Executive Director Stephen J. Hemsley reported during an earnings call last week.   Measurable benefits from the shift away from volume-based payments included fewer repeated tests and procedures, a lower number of preventable complications, and a significant expansion of value-based contracting.

“Modern plan designs harness greater patient responsibility with online tools and consumer engagement services that help people make better choices and decisions to get the right care at the right facility for the right cost,” Hemsley said. “These consumers and those in similar consumer-centric programs are motivated to engage and make the best choices about their health and healthcare. Consumer engagement includes making quality and pricing transparency tools available right at people’s fingertips, right on their smartphones.”

Over the past six years, UnitedHealthcare has reduced inpatient usage by 26 percent per Medicare member, Hemsley added, and 16 percent per commercial plan member.  In Q3 of 2014, the medical-care ratio, which measures the portion of insurance premiums used for patient care, dropped from 80.6 percent to 78.7 percent as the utilization of services remains “restrained.”  Third quarter revenues increased by 6 percent, “even considering the growing mix toward lower margin public and senior sector customers,” Hemsley said.

“Our premium cardiac physicians have 28% fewer repeat procedures and a 29% lower complication rate for implantable cardiac device surgeries,” he continued. “Our premium orthopedic surgeons have 41% fewer repeat procedures and a 17% lower complication rate for knee surgeries. There are more examples like these, demonstrating that getting an engaged consumer to the right doctor makes a meaningful difference.”

UnitedHealthcare and a number of other major payers have poured a great deal of effort into expanding their accountable care contracts, partnering with ACOs to deliver more coordinated, patient-centered care that aims to lower costs, cut preventable readmissions, and improve care quality through pay-for-performance incentive plans.  In the past three years, UnitedHealthcare has increased its accountable care spending from $13 billion to $35 billion, and plans to hit $65 billion by the year 2018.

“The modern health system is being shaped around aligned incentives, supported by transparent information and consistently high-quality clinical services,” Hemsley said. “These changes are helping our nation in turn to achieve optimal evidence-based utilization and cost. As always, our goal is to perform in the upper end of our range. We remain focused on executing a deliberate quality and cost agenda because improving healthcare quality and affordability is core to delivering value.”


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