The doctor with the healthiest patients may actually get paid the least amount of money.
That’s because the current “fee–for-service” payment model means that physicians and health care centers get paid each time someone visits a physician or undergoes a test or procedure regardless of the outcome.
Seems backward, doesn’t it? Many physicians think so.
Ruth Benton, CEO of Denver-based New West Physicians, put it this way: “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. 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.”
That’s why 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.
UnitedHealthcare’s accountable care strategy includes three categories of programs that offer varying levels of integration with care providers depending on their ability to assume financial risk and affect health outcomes. The level of shared accountability and financial risk between UnitedHealthcare and care providers increases with each of the three programs and the results so far are promising:
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.
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.