As part of the insurer’s priority to tie $75 billion of their provider reimbursements to value-based arrangements by the end of 2020, UnitedHealthcare is launching a bundled payment system in Medicare Advantage to shift payment structures in a few critical procedures.
The so-called UnitedHealthcare Care Bundles program will launch next year and offer providers across 30 states the option of participating in bundled payment arrangements for eight medical procedures, mainly orthopedic and cardiac treatments and surgeries.
These include hip and knee replacements, non-cervical spinal fusion, coronary bypass and cardiac valve replacement.
Through its participation in the CMS BPCI Advanced program, UnitedHealthcare offers bundled payment arrangements for a selection of beneficiaries in fee-for-service Medicare, but will now expand its efforts for the managed Medicare population.
The BPCI Advanced program, however, has already seen participation drop among providers since its launch last year partially due to the potential of downside risk from not meeting quality and cost benchmarks.
On the other hand, Medicare Advantage has been a major avenue for growth among health plans and has been advanced as a priority for the Trump Administration’s efforts to push towards value-based care through privately run payers. About 22.4 million people are enrolled in Medicare Advantage in 2019 and UnitedHealthcare is the single largest payer organization in the space.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
UnitedHealthcare has nearly 5 million members in its Medicare Advantage population, around 3 million of which are treated by care providers in value-based models.
Bundled payments essentially refer to an alternative payment model to fee-for-service where providers are rewarded for exceeding certain cost and quality standards across an entire episode of care, instead of being paid for individual treatments and appointments.
This kind of care coordination and associated administration can be difficult, especially among providers set up for traditional fee-for-service reimbursement. The country’s largest insurer is positioning its nationwide presence and sophisticated data infrastructure as a way to enable the shift to value-based care among willing participants.
UnitedHealthcare says its voluntary Care Bundles program will provide participants technology and support like care management programs, patient engagement tools, performance analytics and payment administration services.
“We are making it easier for care providers by managing both the fee-for-service and Medicare Advantage models, taking on the administrative burden and tailoring our services to their individual needs, so they can focus on caring for their patients,” Jeff Meyerhofer, president of bundled payment solutions for UnitedHealthcare’s Medicare & Retirement business said in a statement.
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