UnitedHealthcare Finds Value-Based Care Closed 50M Gaps in Care

March 13, 2018 - Value-based care helped close 50 million gaps in care between 2013 and 2017 while reducing care costs, lowering ED utilization, and increasing provider care quality, according to a new report from UnitedHealthcare (UHC).

UHC examined data from more than 110,000 physicians and 1100 hospitals that treat people enrolled in UnitedHealthcare employer-sponsored, individual, Medicare, and Medicaid health plans. The payer found that adoption of value-based care programs in all their business segments consistently benefited payers, providers, and patients.

UHC currently allocates $64 billion of the total annual payments to providers through value-based arrangements and expects that number to reach $75 billion by the end of 2020.

Sam Ho, MD, Chief Medical Officer of UnitedHealthcare said that value-based care programs with effective data sharing and collaborative development between payers and providers can generate the highest possible value within the healthcare industry.

“Value-based care is creating a platform for positive change throughout the health care system,” Ho said.

“Patients get more consistent, quality care that is better coordinated and easier to navigate; health plans and care providers are working together on behalf of patients in new ways; and physicians are being rewarded for placing value and quality over volume.”

NexusACO, a specialized UHC ACO group for employer-sponsored beneficiaries in 12 states, led to lower utilization rates in hospitals and the ED.

NexusACO participants experienced 11 percent fewer hospital admissions, a 9 percent decrease in inpatient length of stay, and 8 percent decrease in ED visits per 1000 patients compared to non-ACO providers. UHC expects the NexusACO initiative to reach 250,000 members.

UHC ACOs operating across both employer-sponsored and individual care networks generated quality performance improvements and cost reductions compared to their fee-for-service counterparts.

Eighty-seven percent of ACOs in employer-sponsored and individual care networks outperformed fee-for-service organizations in top performance categories. The ACOs serving commercial and individual members experienced 17 percent fewer hospital admissions, 14 percent fewer ED admissions, and 12 percent better financial results than non-ACOs.

ACOs have also driven positive clinical and financial results within UHC’s Medicare and Medicare Advantage populations.

Medicare ACOs earned higher quality ratings within 67 percent more performance categories than non-ACOs. Medicare ACOs had 13 percent lower ED utilization than non-ACOs. Physicians in Medicare ACOs earned a total of $90 million in bonuses for quality and addressing gaps in senior care.

Value-based care programs are growing within UnitedHealthcare’s Medicaid networks to address the social and environmental challenges that impact beneficiaries.

One in six Medicaid members sought care from a physician participating in a value-based care arrangement, UHC said. Medicaid ACOs have a five percent higher rate of well-child visits in the first 15 months of life, 9 percent fewer ED admissions, and 2 percent lower rates of ED visits compared to non-ACOs

UHC highlighted the provider benefits of VBC through a case study involving Arizona Care Network (ACN).

In 2014, UnitedHealthcare and ACN developed an ACO network of more than 5000 physicians to help drive reductions in ED admissions, hospital admissions, and costs.

ACN’s ACO helped decrease hospital length of stay by 25 percent and acute hospital admissions by 22 percent. ACN also was part of UnitedHealthcare’s premium designation program which helped members understand their most cost-effective healthcare choices. UnitedHealthcare coordinated the program by providing cost and quality criteria to ACN providers for patient education purposes.

UHC suggested that there is momentum for future adoption of ACOs and other VBC programs. UHC believes that payers can help address major industry challenges to VBC such as data sharing and coordinating quality measurement with providers.

Payers are in a strong position to share clinical data to help establish VBC guidelines for providers, UHC said. Providers and payers also need to engage in bilateral data sharing through easy-to-use tools like data visualization dashboards to keep up to date on quality performance.

“We’ll work to improve the payer-provider relationship and quality of care,” UHC concluded. “Executive leadership is needed to drive change within provider organizations while physician champions are critical to clinical success.”