Monday, July 22, 2013

One way to modernize our health care system…change how we pay

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

Monday, July 1, 2013

Don’t forget about your eye health this summer

Slather on sunscreen. Drink lots of water. Spray on bug repellent. Wear a wide brim hat.

There’s a lot we can do to protect our health before heading out for Fourth of July picnics or other fun summer activities.  But, according to our summer savvy regional medical director, Dr. Phil Benditt, one area of health many of us neglect to protect in the summer is our eye health.

So, I asked Dr. Phil to tell me more…

According to Dr. Phil, the same ultraviolet radiation that causes sun burns can also cause serious eye damage.  Both long-wave UVA rays and short-wave UVB rays are known to contribute to the development of cataracts and macular degeneration, which can result in blindness.

Many people may not be aware that intense short-term exposure to ultraviolet light can cause “eye sunburn,” a painful condition associated with long hours of outdoor recreational activity.  Long-term exposure to ultraviolet radiation can also lead to skin cancer around the eyes.

Sunglasses and a wide-brim had can protect your eyes from the sun.  Ideally, sunglasses should block out 99 percent or more of both UVA and UVB radiation.

For those who prefer a cool indoor movie theater to the heat outside, Dr. Phil says 3-D movies are also an opportunity to check up on your eye health.  The American Optometry Association’s (AOA) report, “3D in the Classroom” states that 3-D movies have the potential to help identify vision problems that may otherwise go unnoticed.  After watching a 3-D movie, if you or a family member experience blurred vision, dizziness, discomfort, double vision, or eye fatigue, schedule a visit with your eye doctor.  According to the AOA report, about one in four children might have vision problems that may be detected with 3-D viewing.

So, whatever eye wear you are sporting this weekend – sunglasses or 3-D – have a safe and happy Fourth of July holiday!

Dr. Health E. Hound sporting his favorite eye wear