UnitedHealthcare, Seeing Success, Increases Commitment to Value-Based Care Programs

UnitedHealthcare, the nation’s largest private payer, is increasing its commitment to value-based care models.

In the last three years, the amount of UnitedHealthcare’s care-provider reimbursements tied to value-based care programs has nearly tripled to $64 billion annually. By the close of 2020, that number is expected to reach $75 billion. Nearly one in every three people that are enrolled in a UnitedHealthcare benefit plan (that’s more than 15 million people) get their care from providers in value-based care relationships.

In fact, UnitedHealthcare just announced that it is expanding its bundled payment program for spinal surgeries and knee and hip replacements to 46 participating healthcare facilities across 37 markets. Now, more than 115 employers and three million employees are eligible to be part of this program.

UnitedHealthcare started its Spine and Joint Solution program in 2016 with only 28 participating markets. Since that time, it has seen a 22 percent reduction in hospital readmissions and 17 percent fewer complications for joint replacement surgeries when compared to facilities that did not take part in the program. There were also 10 percent fewer hospital readmissions for spine surgeries and 3.4 percent fewer complications compared to nonparticipating facilities, according to a report on the savings and outcomes of the program.

In addition to the improved care, users of this bundled payment program experienced significant cost savings. Participating employers achieved an average savings of $18,000 per operation (when compared to median costs in the same metropolitan area), and employees saved more than $3,000 in out-of-pocket expenses per procedure (through incentives such as cash, gift cards, additional vacation days for recovery, and health savings account contributions).

“The feedback we have gotten is that the majority of the payers today are talking to providers about bundles and similar value based contracts,” said Saqib Akhter, CEO of Post Acute Analytics, a company that helps health systems and providers monitor their patients in real time outside their four walls.

“Bundles are a very attractive proposition for providers and health systems to generate outside revenue and simultaneously impact patient outcomes from beginning of care to the end of care.”

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The announcement of UnitedHealthcare’s bundled payment expansion comes on the heels of the Centers for Medicare & Medicaid Services’ (CMS) recently launched voluntary bundled payment model, the Bundled Payments for Care Improvement (BPCI) Advanced.

BPCI-Advanced includes 32 inpatient clinical episodes, with 29 in the inpatient setting and three in the outpatient setting (many of which focus on orthopedic and cardiac conditions). BPCI-Advanced qualifies as an advanced alternative payment model (APM) under the Medicare Access and Chip Reauthorization Act (MACRA). This allows participants to avoid many of the hassles associated with the Merit-Based Incentive Payment System (MIPS).

“I think that by introducing these bundles and making them qualify for APM, CMS is signaling that it is going to be introducing even more payment models that allow providers to manage patient care throughout the continuum of care and benefit from the impact they make on total cost of care. I would expect there to be other value-based care models that qualify for APM in the near future,” said Akhter.

Many payers and providers see value-based care models as essential to the future of healthcare. 10,000 men and women reach retirement age each day, according to Pew Research and the Social Security Administration. This means that the number of people eligible for Medicare will increase to 20 percent of the U.S. population by 2029, while the number of people who will be paying into Medicare will drop from 63 percent to just 57 percent by 2029. As this huge population switches from commercial plans, the costs for Medicare and Medicaid will more than double. CMS and payers like UnitedHealthcare are trying to offset these rising costs with value-based plans.

“This program is one example of the ways we are reshaping how healthcare is delivered, helping enhance care coordination, improve outcomes and deliver greater value,” Dr. Sam Ho, UnitedHealthcare chief medical officer, said in a statement that accompanied the report. “The initial results and nationwide expansion demonstrate the value of this program to healthcare providers, employers, and their employees, helping to improve health outcomes and make care more affordable for more people.”

Value-based care models require a great deal of effective communication between organizations. However, many health systems do not have the necessary foundation in place to make a value-based arrangement work. Fortunately, some of this burden can be alleviated by a proven solution.

“Health systems and physician groups have had to focus on a number of priorities as the healthcare landscape has evolved pretty dramatically in the last few years,” said Akhter. “There are a number of providers who have not had the time and resources to focus on putting in the infrastructure to succeed in bundles. We think an analytics solution that makes it efficient and effective to manage bundles, having real-time visibility to what’s going on with patients and where interventions are required, is going to be critical in succeeding in bundles or any risk-based contract.

“Without this data, it is difficult for providers to determine where to focus their attention. With Post Acute Analytics, we help them pinpoint where their post-acute providers are doing a good job and not doing a good job taking care of their patients, we help them determine against market and national benchmarks where post-acute utilization can be further optimized, and we help ensure that their patients, once outside a health system’s four walls, have the best outcomes at the most appropriate costs by real-time monitoring.”

To learn more about Post-Acute Analytics and how its proven solution can help healthcare systems improve patient outcomes and lower costs, click here.


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