- 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.
Programs Show Promising Results UnitedHealthcare’s accountable care strategy is showing promising trends in improving evidence-based care and quality outcomes while reducing costs.For example:
- Performance-based programs have demonstrated improved quality and cost-efficiency outcomes, such as a 14 percent reduction in the use of non-Tier 1 prescriptions and a 25 percent reduction in the use of out-of-network laboratory services.
- The transplant Centers of Excellence program has demonstrated a 25 percent reduction in average length of hospital stays for transplant patients, a 16 percent reduction in transplants due to applying evidence-based care approaches and improved transplant survival rates at Centers of Excellence.
- Accountable care programs have proven results that demonstrate improved health outcomes, such as a 4 to 4.5 percentage point reduction in medical cost trend, a 16 percent reduction in emergency room visits and a 17 percent reduction in inpatient days, in addition to clinical quality results trending above program targets on 95 percent of all measures.
- Accountable care programs focused on Medicare Advantage plan members achieved at least a 4 Star HEDIS level on screenings for diabetes, cardiovascular care, colorectal cancer and rheumatoid arthritis.