UnitedHealthcare cancels agreements with doctors servicing Medicare Advantage patients

As of February, more than 2,000 physicians will be dropped from UnitedHealthcare’s Medicare Advantage program in Connecticut. Although you’ll see this referred to as a profit-related move in the media, this is not about United being greedy.

President Obama said you could keep your physician and keep your health plan. He lied to you. Hidden in one paragraph of Matthew Sturdevant’s blog post at the Hartford Courant’s website is this…

The federal government, through its Centers for Medicare & Medicaid Services, has instituted a five-star quality rating system that provides incentives to insurers to reduce costs, [Mark] Thompson [Fairfield County Medical Association] said, citing it as a contributing factor in the UnitedHealthcare change.

That paragraph is referring to changes including those brought to us by President Obama’s Affordable Healthcare Act. New regulations implemented this year may certainly be the primary catalyst for this change by United. I don’t like referring to Wikipedia, but here’s a snippet.

The health reform legislation (the Patient Protection and Affordable Care Act of 2010) ties federal reimbursement rates for insurance carriers administering Medicare Advantage products to performance, as measured by the Stars rating system. Bonus payments are attached to stars ratings, and bonus revenue will be awarded, gradually increasing with maximum bonus opportunity in 2014. According to the Congressional Budget Office, payment reforms for Medicare Advantage plans based on Stars scores are projected to save billions of dollars in federal health care spending.

In short, these changes are being driven almost exclusively by the federal government, not a desire to increase profits at UnitedHealthcare. The Centers for Medicare and Medicaid Services (CMS) has at least 50 measurable objectives to determine how much UnitedHealthcare and health care professionals will be reimbursed. They have to meet these objectives to get good ratings or the CMS will pay them less money.

From Title 42 of the US government regulations

The quality rating for a plan shall be determined according to a 5-star rating system (based on the data collected under section 1395w-22(e) of this title).

From 1395w-22(e).

Each MA [Medicare Advantage] organization shall provide for the collection, analysis and reporting of data that permits the measurement of health outcomes and other indices of quality.

Don’t be fooled, the federal government is looking for the best outcomes at the lowest cost and the health care insurance industry is doing the same thing. If a physician is spending too much money and getting crappy results compared to a physician spending less and getting better outcomes, guess what’s going to happen? Since the federal government won’t pay a reasonable rate to a health insurance company for a physician who is not getting highly rated outcomes – as defined by the federal government – the health insurance companies will not be willing to have those physicians or physician groups as a contracted provider in network.

8 replies
  1. Lynn
    Lynn says:

    Thanks Steve, ?I now understand this. I’m at a loss as to what should be done, except to vote out the entrenched in 2014 and I know it’s useless in CT and MA.?

  2. Lasiklaser
    Lasiklaser says:

    “?physician spending less and getting better outcomes” , ?my questions is, how are they measuring outcomes?? ? Where are they getting the data on outcomes. ?It is disgusting that ?physicians who invest in the latest technology and education on “cutting edge” treatment and care are now being discriminated against. ? Furthermore, physicians are NOT ALLOWED to rally together…it is considered anti trust, they will be thrown in jail. ?Oh yes, and lets not forget the black cloud of malpractice that hangs over every head of every medical provider. ?
    Tort reform???? ??
    Thanks for posting the article. ?Much appreciated.?

    • Steve McGough
      Steve McGough says:

      As I understand it, UnitedHealthcare and all the other health care insurance companies have internal measurements. Lots of them. Think of an internal “Angies List” rating doctors and other health care providers. The entire HSA idea was to put more control of health care into our own hands. Of course, emergencies are emergencies but for many procedures, you have time to research cost, experience and outcomes (success). In general, doctors and health care providers don’t like to be graded, but patients – looking for services we are paying for – should have access to that data. (I don’t think) insurance companies share the bulk of information with subscribers, but they have TONS of internal data to determine if it is worthwhile to have a physician or other health care service providers in network, or leave them out of network.

  3. lpalshaw
    lpalshaw says:

    I wonder what AARP has to say about this, seeing as how they were a major supporter of Obamacare and United Healthis AARP’s partner in Medicare Advantage Plans.

    • Dimsdale
      Dimsdale says:

      They are keeping their heads lower than Hillary running across the airport tarmac in Bosnia to avoid “sniper fire”.? 😉

  4. Dimsdale
    Dimsdale says:

    Wouldn’t it just be more gratifying and effective if they went after the fraud instead of the doctors?

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