We keep hearing about accountable care models and they all differ a bit but the one thing everyone says which is the same is that they all require software and IT to track everything so this is no different except United has their own or via a subsidiary such as Optum to come with their plan.   Where I’m at in the OC the company is real tight with Memorial Care and ownsimage all the big physician's groups or owns the company either directly or via a subsidiary that managed them, i.e.. Nautilus that even manages the doctors group at Cedar Sinai as well as the Greater Newport Doctor’s Group.  In the OC area the doctors tell me that to be in the ACO they get paid at rates less than Medicare pays. 

From the website, you can read between the lines and figure out the software models for an ACO is ready for the organization to select to use.  It’s what Optum, the old former Ingenix division of the company does.  You can also read where it says it’s been around for 30 years in part (this is just software building on itself as it does everywhere) so guess where CMS and HHS might get all their models and ideas…and this makes it a bit uneasy to have the #2 person at CMS being a former Ingenix/Optum CEO who’s been around there for a long time and we have a too big to fail insurer going here, the scary part. 

“UnitedHealthcare’s accountable care platform is not a pilot – it is a foundation built from over 30 years of developing and refining payment reform strategies. UnitedHealthcare can demonstrate with real experience the meaningful value that its programs can deliver.

Rather than focusing on just one model, such as an ACO, UnitedHealthcare has implemented a suite of innovative value-based contracting models that reward care providers for improvements in quality and cost-efficiency. UnitedHealthcare recognizes that care providers are at various stages of readiness to move toward a risk-based contract where they are accountable for cost and quality outcomes. One size doesn’t fit all, so UnitedHealthcare developed a flexible suite of value-based incentive programs that can be customized to meet care providers where they are at in terms of readiness to take on greater risk.”

Long and short of its is that folks crank out code day and night and are just about everywhere in healthcare as I believe I remember Cerner even licensed their Revenue Cycling so every time a system gets sold there’s royalty money coming in there too.  Like I have said, too big to fail and here you have for profit hospice services as well.  I can’ say for sure of course as I’m not there but I do see developing patterns and the hospice ruling on drugs and access this week looked like what comes out of United or Optum.  A former CMS employee told me that when CMS gets stuck that Optum/Ingenix has been around building models and helping them with their math for a number of years. 

Optum/United Healthcare Opening New Hospice Care Facilities In Birmingham & Macon, Hospice For Profit-Evercare Subsidiary to Gets Rebranded To Optum Palliative and Hospice Care

Doctors of course are all into better patient care but again you do have to watch insurers with double edge swords at time and that’s what happened with Sebelius as they do code and numbers well and can adjust and raise risk as needed for profits with sophisticated algorithmic formulas.  I’m just being smart as I would be anywhere but when you have a company with history like this one, you can’t trust everything that comes out as the gospel as they are in business to make money.  We are starting to see some of the United models fail here and there as they were exaggerated to begin with but they know how to market well too. 

It does get interesting to see the company being an ACO partner on one end and then fire Medicare Advantage doctors on the other side not to mention where they might be operating with other subsidiaries too.  They don’t have their act together 100% either as they wouldn’t be bidding and winning contracts where they cut the networks down to where there were no doctors.

Pre-Existing Conditions With Health Insurance May Be Gone But Narrow Networks Are Providing The Same End Result For Many Ill Patients With Not Being Able To Get Care - Extreme Cases Of New Killer Algorithms Popping Up With Insurance Business Models…

So again more money for the ACO software of course and the analytics for performance and who knows, maybe firing more doctors as it’s all an algorithmic business formula for this company.  Ethics are always second to money.  BD


Health Network and UnitedHealthcare are launching an accountable care organization (ACO) initiative to provide improved care coordination and enhanced health services to nearly 50,000 UnitedHealthcare plan participants in the region.

Banner Health Network's (BHN) partnership with UnitedHealthcare will help shift Arizona's health care system from one based on volume of care to one that rewards quality and value. Banner Health Network and its affiliated physicians will manage all aspects of patients' care, providing the right care in the right place at the right time. Primary care physicians in the ACO will receive regular patient updates, enabling them to monitor all of the care each patient is receiving, and to maintain all clinical information about each patient in a secure patient registry.

UnitedHealthcare employer-sponsored plan participants who are currently served by BHN's care providers will not have to do anything differently to receive the benefits of this new model, which include enhanced care coordination and follow-up.

http://online.wsj.com/article/PR-CO-20140721-907435.htmlBanner

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