This contracting and bidding situation has been going on since 2009 and yes it’s taking forever, but in the north Healthnet kept their contract and in the south United contested twice and here’s the latest with Humana staying in place. It’s pretty gutsy when United said that Tri-Care misevaluated the proposals a second time. According to this article they still have not given up and are reported to be looking at some other methodologies, like maybe pulling some algorithmic reports? They own enough companies to do all the analytics that one could desire I think and even said they would not stop short of legal action. The Tri-Care contract for the south includes Alabama, Arkansas, Florida, Georgia, part of Kentucky, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee and most of Texas.
Humana Keeps Tricare In The South And Back in May of 2010 HealthNet Was Able to Keep the Northeast-Both Companies Filed Appeals
This makes for somewhat of an interesting story as Tri-Care went up for bid and Aetna and United were awarded new contracts; however, Humana and HealthNet filed appeals and both Aetna and United lost the bids and they reverted back to the incumbent insurance carriers. Back in May of 2010 it was announced that HealthNet would stay in place in the north as somehow it was determined that Aetna was considered to have “cheated” with a conflict of interest and now the appeal for Humana has been granted with United Healthcare having to give up their contract too. Here’s a flashback on HealthNet below.
Also in the West they won the opportunity to re-open the western states bid for the DOD bid for a $16.9 billion dollar contract for retired military and their families. Sounds like they want it all. In April the DOD agreed to re-open the case in the Western states award which was given to TriWest Healthcare Alliance Corporation who was the only other bidder. They have the big semi 64 foot trailers to move out there for telemedicine it appears and appears they want to get their telemedicine in action. In the south for other business areas they already have some pharmacists at Walgreens on pay for performance and I’m guessing rolling more patients into this program is a focus as well.
United Healthcare Expanding Diabetes Prevention & Predictive Algorithm Program With Walgreens And Pay for Performance Incentives In Atlanta
In addition they recently bought a big IPA in southern California that again I’m guessing they want to roll this all into their current business plans.
OptumHealth (Subsidiary of United Healthcare) Takes Over Memorial IPA in California-Subsidiary Watch
The United CEO is the highest paid public company CEO in the US and no wonder he wants everyone else on pay for performance but it’s nowhere near what his P4P is by any means. Pay for performance is not all that it has cracked up to be either.
Pay For Performance Is Not All That It Has Cracked Up to Be-Time to Rethink As Money Is Not Creating Better Health Outcomes
They will be busy working those algorithms to create analytic justifications it sounds like as the old Ingenix was infamous for doing, now under the Optum umbrella and name. BD
A division of UnitedHealth Group lost its protest of a $23.5 billion, five-year contract that was awarded to Humana to provide health insurance to military personnel and their families in the southern U.S.
The Minnetonka, Minn.,-based health insurer which employs thousands of people in Connecticut protested the TRICARE South Region contract given to Louisville, Ky.,-based Humana in late February. The U.S. Government Accountability Office denied the protest by UnitedHealth Military & Veterans Services, LLC.
"The protester argued that TRICARE misevaluated the proposals and made an unreasonable source selection decision," said Ralph O. White, managing associate general counsel for procurement law at the U.S. Government Accountability Office. "The GAO's decision reviewed UnitedHealth's challenges to TRICARE's evaluation and concluded that the agency's assessment of proposals, and selection decision, was reasonable