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UnitedHealthcare Partners with Accountable Care Organizations

UnitedHealthcare has invested in advancing their partnerships with accountable care organizations.

Value-Based Care Reimbursement

Source: Thinkstock

By Vera Gruessner

- In December, UnitedHealthcare announced in a company press release the release of NexusACO, a new health plan option for self-funded employers that is available in 15 markets. Tier 1 of NexusACO involves offering healthcare access to members from physicians affiliated with accountable care organizations (ACOs). spoke with Reed Bjergo, VP, Product, UnitedHealthcare, to learn more about NexusACO and UnitedHealthcare’s transition to value-based care reimbursement.

“We are committed to the value-based care arrangement and we really believe that it is the future of delivering healthcare more affordably and providing the highest quality of care to our members,” Bjergo said. “We believe that one of the most successful avenues for us to get there is to provide an incentive-based product for our members and providers to leverage the benefits that we can bring to the marketplace that is unlike anything our competitors offer.”

“This exemplifies our commitment to delivering value-based care and providing high-quality care to our members in a more coordinated fashion that we believe will ultimately deliver the best health outcomes for our members,” he added.

In recent years, UnitedHealth Group has worked to expand their work with accountable care organizations and invest in improving their provider relationships. With NexusACO and their work in accountable care, the health insurance company hopes to improve their population health management.

“We spent the last several years working with our partners in the provider space and we have expanded our footprint with ACOs across markets and regions,” Bjergo explained. “We’ve established a sizable national footprint in the ACO space.”

READ MORE: Key Steps for Payer Success in Accountable Care Organizations

“While we’ve been expanding our geographical reach, we are committed to investing in those relationships with our provider partners. We’ve reorganized ourselves and committed organizationally to deepening those relationships through an ACO activation approach.”

In order to manage population health, UnitedHealthcare and their partnering providers are committed to sharing patient data and strengthening their coordination.

“This is a commitment with our ACO partners to really leverage the strength of each of our organizations,” Bjergo continued. “Through UnitedHealthcare providing unparallel data to our provider partners and allowing them to more effectively manage total population health.”

“That is our motivation to develop a unique suite of products with NexusACO. It’s a combination of providing a product in the marketplace and deepening our relationship with providers to be able to enhance value for our members.”

NexusACO enables members to have access to treatment through accountable care organizations, which bring hospitals, primary care physicians, and other specialists to work on coordinating care for specific patient populations. More timely and accessible data sharing techniques are often implemented among ACOs, which includes tracking emergency room visits, hospital admissions, and other types of care outside of the primary doctor’s office.

READ MORE: Successful Accountable Care Organizations Use 3 Key Strategies

“We are seeing a significant improvement. We’re seeing a reduction in the total cost of care that is administered through our accountable care organization,” he said. “It does vary a bit by market and by business segment. The results have been significant. It is our objective to continue to focus on reducing that total cost of care through a product such as the NexusACO product.”

“Ultimately, we want to deliver a more affordable offering to our members from a premium price point perspective as well. This allows us to translate the reduction and the improvement that we see in the total cost of care into a more affordable product in the market from a premium perspective as well,” explained Bjergo.

Partnering with an accountable care organization and offering members the new health plan benefit allows UnitedHealthcare to more firmly move into value-based care reimbursement. Through accountable care, UnitedHealthcare members are able to receive better care coordination, improved health outcomes, and generally lower costs in terms of premium prices.

Bjergo also offered some advice for other healthcare payers to advance their work in value-based care reimbursement.

“The shift to value-based care is not an easy one. It’s not one that’s meant to be an immediate and swift shift. A true shift to value-based care does require some fundamental infrastructure adjustments on behalf of the provider partner,” commented Bjergo. “UnitedHealthcare has full appreciation for the magnitude of those shifts. We are committed both through UnitedHealthcare and through some of the services and capabilities that we offer through our Optum business as well.”

READ MORE: Will New Model of Accountable Care Organizations Cut Costs?

“We are committed to enabling providers with those capabilities and tools to allow them to be successful in this shift into a new healthcare delivery model,” he concluded. “My main piece of advice is that it’s a significant shift and it’s a model of healthcare delivery that UnitedHealthcare is fully committed to because we firmly believe that this will provide the most value to our members. It will also provide increased incentive and the best quality outcomes that our provider partners can offer for their patients.”


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