Paying a fee for a service is typically how we
pay. Many of us pay to have our hair cut
and colored, our cars washed or repaired, and even when our time is crunched, we pay for our bi-weekly “mani-pedi.” And it makes sense to pay a fee for each of
these services.
But it doesn’t make sense in health care.
Most medical care is currently paid for using the
fee-for-service model: each time someone visits a physician or undergoes a
test, the insurance company or individual is billed. But the flaw in fee-for-service payments for
health care is that medical professionals are not paid for the best outcome – a
healthy patient – but for individual services performed.
“Physicians have increasingly decided that the
current fee-for-service model is not sustainable in the long term, but they
want payment models that are more customized to meet their specific needs,”
said Ruth Benton, CEO of Denver-based New West Physicians. “One size certainly
doesn’t fit all, and UnitedHealthcare has worked with us closely to create a
model that provides financial incentives and infrastructure support for
delivering evidence-based high-quality care.”
Yes, UnitedHealthcare is moving away from contracts
that reward the volume of care and replacing them with contracts that reward the
value of care.
Currently, more than $20 billion of our
reimbursements to hospitals, physicians and ancillary care providers are paid
through contracts that link a portion of the reimbursement to quality and
cost-efficiency measures. But as you may
have heard in the news recently, we are planning to more than double that
number to $50 billion by 2017 as more care providers join the transition to
accountable care contracts that reward quality and value-based health care.
UnitedHealthcare’s accountable care strategy,
which includes three categories of programs, focuses on achieving the triple
aim to improve population health outcomes, patient experience, and reduce
medical costs. Early results show promising trends in improving evidence-based
care and quality outcomes while reducing costs.
All programs are showing promising results:
Performance-based Programs have demonstrated improved quality and cost-efficiency outcomes such
as a 14% reduction in the use of non-Tier 1 prescriptions and a 25% reduction
in the use of out-of-network laboratory services.
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.
Accountable
Care Programs have proven results that
demonstrate improved health outcomes, such as a 4 to 4.5% reduction in medical
cost trend, a 16% reduction in emergency room visits and a 17% reduction in
inpatient days, in addition to clinical quality results trending above program
targets on 95 percent of all measures
Changing the way we pay our physicians and health
centers doesn’t mean we value them any less,
it just means we want to pay them more for the value of care they
provide.
For more information about how UnitedHealthcare
is modernizing our health care system by helping to transform the way health
care is delivered, paid for and rewarded, visit www.AccountableCareAnswers.com.
