UnitedHealthcare will significantly expand its already substantial base of accountable care contracts over the next five years across its employer-sponsored, Medicare and Medicaid health benefit businesses, helping transform how health care is delivered, paid for and rewarded.
UnitedHealthcare is placing much greater emphasis on rewarding care providers for better care and lower costs as it dramatically reduces the use of exclusively fee-for-service contracts.
Already more than $20 billion of UnitedHealthcare’s reimbursements to hospitals, physicians and ancillary care providers are paid through contracts that link a portion of the reimbursement to quality and cost-efficiency measures. UnitedHealthcare expects that number to increase to $50 billion by 2017 as more care providers join the transition to accountable care contracts that reward quality and value-based health care.
UnitedHealthcare offers the largest care provider network in the United States and has accountable care relationships with more than 575 hospitals, 1,100 medical groups and 75,000 physicians across the country.
“We are improving health outcomes for patients at lower costs by moving even more broadly to value-based payment models and integrating those with our care provider network, product and clinical strategies,” said Austin Pittman, president, UnitedHealthcare Networks. “Our unparalleled experience with accountable care models – and there are many – demonstrates that they can work better for everyone in health care, from patients to payers to care providers.”
Accountable Care Strategy
UnitedHealthcare’s accountable care strategy includes three categories of programs that offer varying levels of integration with care providers depending on their ability to assume financial risk and affect health outcomes. By creating a flexible approach, UnitedHealthcare is able to align its programs with all types of care providers across its employer-sponsored, Medicare and Medicaid benefit plans.
The level of shared accountability and financial risk between UnitedHealthcare and care providers increases with each of the three programs:
- Performance-based programs – may include bonus-based incentives for primary care practices, or performance-based contracts with hospitals, physicians and ancillary care providers that reward them for successfully improving patient health outcomes and lowering costs.
- Centers of Excellence programs – reimbursements are bundled for specific treatments and/or procedures (e.g., organ transplants) rather than charging for each visit or drug administered.
- Accountable care programs – ACOs and Patient-Centered Medical Homes are among the most common. In these programs, both the health plan and care provider share in the risk and savings associated with managing patients’ health.
“Physicians have increasingly decided that the current fee-for-service model is not sustainable in the long term, but they want payment models that are more customized to meet their specific needs,” said Ruth Benton, CEO of Denver-based New West Physicians. “One size certainly doesn’t fit all, and UnitedHealthcare has worked with us closely to create a model that provides financial incentives and infrastructure support for delivering evidence-based high-quality care.”