Reprinted from ACO BUSINESS NEWS, a hard-hitting monthly newsletter on the latest industry actions to design and create ACOs, for hospitals, physicians, health plans and their advisers.
By Jane Anderson, Editor
August 2013 Volume 4 Issue 8
Accountable care currently accounts for more than $20 billion of UnitedHealth Group subsidiary UnitedHealthcare’s reimbursements to providers, and the insurer says it expects that number to more than double to $50 billion by 2017 as it contracts with additional ACOs.
UnitedHealth now has accountable care relationships with more than 575 hospitals, 1,100 medical groups and 75,000 physicians in the U.S., the insurer said last month in a statement. The programs are starting to show results, the insurer added.
“United is being very aggressive — both through its Optum subsidiary and through the health plan,” says Andrew Croshaw, managing director at Leavitt Partners. “They’re clearly investing more in the ACO movement.” Optum provides analytics and health information technology solutions for ACOs.
According to UnitedHealth, its ACO strategy includes three categories of programs that offer varying levels of integration with care providers, depending on those providers’ ability to assume financial risk and affect health outcomes. These categories include:
· Performance-based programs, which might include bonus-based incentives for primary care practices or performance-based contracts with hospitals, physicians and ancillary care providers;
· Centers of Excellence programs, in which reimbursements are bundled for specific treatments and/or procedures, such as organ transplants; and
· Accountable care and patient-centered medical home programs, where both the health plan and providers share risk and savings.
Of these three, ACO and medical home programs are the most common, UnitedHealth said.
Early results from the programs are promising, the insurer said. For example, ACOs have led to a 4.0 to 4.5-percentage-point reduction in medical cost trend, a 16% reduction in emergency room visits and a 17% reduction in inpatient days, according to the insurer.
Clinical quality results have trended above program targets on 95% of all measures for ACOs, UnitedHealth said, adding that ACOs within Medicare Advantage plans achieved at least a four-star HEDIS level on screenings for diabetes, cardiovascular care, colorectal cancer and rheumatoid arthritis.
Meanwhile, performance-based programs led to a 14% reduction in the use of non-Tier 1 prescriptions and a 25% reduction in the use of out-of-network laboratory services, UnitedHealth said. The transplant Centers of Excellence program has demonstrated a 25% reduction in average length of hospital stays for transplant patients, a 16% reduction in transplants due to applying evidence-based care approaches, and improved transplant survival rates at Centers of Excellence, the company said.
UnitedHealth’s plans to dramatically ramp up its accountable care business place the insurer in firm competition with Aetna Inc. and Cigna Corp., both of which also are betting heavily on ACOs within their own networks to control the cost of care, while offering services to ACOs in an effort to generate new revenue.
Aetna, for example, has said it anticipates significant growth in its ACO business this year, both with its ACO partnerships and in its data analytics services (ABN 1/13, p. 4). Revenues from accountable care should ramp up to $2.5 billion in 2014, when Aetna expects to have some 60 partnerships with 750,000 total members in place.
Cigna, meanwhile, expects to reach 100 collaborative accountable care (CAC) pacts with 1 million members by sometime in 2014. Cigna now has 66 CAC initiatives in 26 states, with more than 700,000 commercial customers and more than 27,000 physicians (see briefs, p. 12).
No comments:
Post a Comment