The shift toward increased collaboration, outcome-based payment and new benefit design is transforming how we pay for health care and how health care is delivered.
UnitedHealthcare is taking an industry leading approach to this transformation by
leveraging years of experience with value-based contracting models. Through the expansion of our existing programs and the creation of new innovative programs, we are rewarding care providers for delivering improvements in quality (as defined by evidence-based guidelines) and cost efficiency. Our accountable care platform charts the path to superior performance, making health care more affordable and helping people live healthier lives.
We are paying for value through outcome-based payment models.
} We have implemented a suite of innovative value-based contract models that reward care providers for improvements in quality and cost efficiency.
} We recognize that care providers are at various stages of readiness to move towards a risk-based contract where they are accountable for cost and quality outcomes. Therefore, we developed a modular suite of value-based incentive programs that can be leveraged across the accountable care continuum.
} Nearly $28 billion dollars of our network health care spend, across Commercial, Medicare and Medicaid lines of business, is currently tied to value-based contracts.
} We currently have value-based contracts in place with more than 600 hospitals, 1,150 medical groups & 80,000 physicians.
Accountable Care Platform/Accountability Continuum
Nearly $28 billion dollars of our total network health care spend flows through the programs in our Accountable Care Platform.
Level of Financial Risk
Performance- based Contracts (PBC)
Condition or Service Line Programs
Shared Savings
Shared Risk
Capitation + PBC Our modular set of value-based payment models are deployed across the continuum.
We are able to align our value-based payment models with a care provider’s risk readiness.
Bundles &
Accountable Care Programs
2
1 Estimated national network medical expenditures across all lines of business.
2 Deployment statistics for executed contracts as of July, 2013 net of program overlap.
Managing entire POPULATION HEALTH
Accountable Care Programs
Shared Savings, Shared Risk, Capitation
(including ACO, PCMH)
70,000+ Physicians 550+ Medical Groups
90+ Hospitals Managing a specific
CONDITION or SEVICE LINE
Condition or Service Line Programs
Bundle/episode payments Service Specific Programs
2,300+ physicians 25+ ancillary providers
160+ hospitals Achieving specific
METRICS
Performance-based Programs
Primary Care Incentives, Performance-based Contracts
32,000+ Physicians 900+ Medical Groups
575+ Hospitals
Nearly $28 Billion of Network Spend is Tied to our Accountable Care Platform.1
Increasing level of integration, financial risk and accountability
Value-based engagement with more than 600 hospitals, 1,150 medical groups and 80,000 physicians participating in our Accountable Care Platform.2
We are transforming the delivery system to be more accountable for cost, quality and experience outcomes.
} We are collaborating with care providers and delivery systems and supporting them with tools, actionable data and clinical consultation as they become more integrated and accountable for outcomes.
} Our Performance-based Programs reward care providers for improvements in quality and cost-efficiency.
} Our Centers of Excellence (COEs) leverage competition to drive enhanced quality and cost- efficiency in managing health conditions.
} Our Accountable Care Programs couple value-based payment models with proactive population health management strategies to drive increased quality, lower cost and improved consumer experience.
Our Goal:
Shared Value
Consumer
} Lower out-of-pocket costs } Improved quality of care } Increased satisfaction
with experience
} Entire system working for their best outcome
Employers/Plan Sponsor } Lower cost of care
} Improved quality outcomes } Increased satisfaction
with experience
Care Provider
} Financial benefit from incentives
} Infrastructure support for delivering evidence-based high-quality care
} Practice pattern transformation to improve accountability readiness
} Increased market share
We are aligning network, product and clinical innovations to maximize value.
} Our high-performance networks leverage a variety of aligned, flexible and targeted network, product and clinical strategies to drive optimal value.
} Our suite of value-based benefit designs incent consumers to select higher performing care providers, resulting in savings opportunities for consumers and employers.
} Our care management programs support better health outcomes for consumers and deliver value across the entire health system.
} Our innovative pharmacy programs promote transparency and synchronize with our medical and wellness programs to drive value through total cost management.
} Our performance measurement transparency programs activate and inform consumers, maximize affordability for employers and support care providers with actionable information.
We are leveraging transparency to improve quality and lower cost.
} Currently there are over 293,000 physicians in 148 markets across 41 states that are evaluated for the UnitedHealth Premium® Designation program. } UnitedHealth Premium® is evolving to an integrated system with consistent
measurement and reporting across multiple programs to reinforce performance improvement and shared accountability.
} The Health Care Cost Estimator (myHCE) tool provides cutting edge information to compare both cost and quality in order to assist consumers in choosing the best care for their specific health care need.
} Care provider portals, such as View360, provide network physicians and their practice staff with valuable information supporting proactive consumer outreach to drive increased consumer compliance.
Our Accountable Care Platform delivers meaningful value.
} Our Accountable Care Platform is not a pilot – it is our foundation.
4
Performance-based Programs
} $50M savings in last 12 months } 3.6% readmit reduction
} 9% reduction in inpatient length of stay
• Reduction in the use of non-participating laboratory services • Reduction in the use of non-Tier 1 prescriptions
Accountable Care Programs
1Patient Centered Medical Home
} 1.5%-3.5% lower medical cost trend than expected } 4:1 ROI
Westmed ACO
} 3% reduction in medical cost
} 5% reduction in acute hospital admissions • Improved 9 key quality metrics
Centers of Excellence
} 25% decrease in the average length of hospital stays for transplants } Improved transplant survival rates at Centers of Excellence
• 3% reduction in one-year mortality for liver transplants • 5% reduction in one-year mortality for heart transplants
} 1 6% reduction in the incidence of transplants through application of evidence-based appropriateness criteria
Accountable Care Platform Impact | Proven Results
1 Patient Centered Medical Home results based on 4 states and 1 Commercial ACO.
Our Value Agenda – The UnitedHealthcare Difference.
} Our modular suite of value-based programs enables us to customize our accountable care approach with care providers across all stages of the risk continuum and support them as they become more accountable for cost, quality and experience outcomes.
} Our broad national network of more than 676,000 doctors and health professionals, 64,000 pharmacies, 5,100 hospitals and 1,000 convenient care clinics enables us to implement our value- based programs in many different markets with a variety of different types of care providers.
} We are unique in the marketplace because we are an industry leader not only for private, commercial insurance but also for Medicare Advantage and Medicaid programs. We have the opportunity to partner with care providers in proactively managing the health of a variety of populations.
} We offer comprehensive data and reporting, innovative mechanisms to distribute funds based on performance and access to cutting edge health information technology. We are supporting care providers in this transformation by supplying them with the tools they need to be successful.
} We believe our strategy uniquely maximizes value by aligning incentives across consumers, care providers and payers to achieve the Triple Aim of better health, better care and lower costs.
} Our Accountable Care Platform delivers distinctive value through delivery system transformation.
