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Friday Dec 14, 2012

United Healthcare Acknowledges Payment Shortcomings

A little more than a year ago, AAFP leaders and staff members met with representatives of UnitedHealthcare at our headquarters in Leawood, Kan. During that meeting, the Academy spelled out for the large private payer that its policy of paying fee-for-service rates that are below Medicare rates creates distressed practice environments and jeopardizes patients' access to care.

At the time, United's leaders expressed surprise that the insurer was paying less -- in some cases far less -- than Medicare in some markets.

We recently met with United again at its Minneapolis headquarters. At that meeting, the company's representatives said they had looked into the information we presented at our previous meeting, and they acknowledged that we were right.

Now, they say, they plan to do something about it.

Unfortunately, United didn't offer specifics about what it plans to do in the affected markets. What we do know is that the company says it recognizes the value of effective primary care, and it is working to identify markets where it pays below Medicare. It also is developing solutions to address the problem.

So where does that leave America's family physicians? Those of us who contract with UnitedHealthcare should be aware that when our contracts are up for renewal, there is an opportunity for re-negotiation, especially for those who practice in areas where the company has been paying less than Medicare rates.

When negotiating a new contract, ask your United representative about opportunities for enhanced payment for primary care. The company's representatives told us United is willing to offer increased payments to primary care practices that meet certain criteria, such as offering electronic prescribing.

United has said that it ultimately intends to move away from a strict fee-for-service system to a "value-based contracting model(consultant.uhc.com)" that will offer physicians rewards based on quality of care. The health plan hopes to have up to 70 percent of the patients it covers affected by this approach within the next three years.

United's representatives said they have seen the value of primary care in pilot projects in which the company is participating. The payer shared with us preliminary data from patient-centered medical home projects that showed it has reaped a 2-to-1 return on its investment in offering primary care physicians a blended payment that included care management fees, shared savings and enhanced fee-for-service.

Working with health plans -- and waiting for them to act on the information we provide -- can be a frustrating task. But we have an important message that needs to be heard: a strong primary care system results in better care for patients and lower overall health care costs.

Monday's four-hour meeting was just the first of many similar efforts for me. Every year, the Academy meets with some of the nation's largest private payers -- including Aetna, Cigna, Humana and WellPoint -- to discuss the value of primary care and the importance of fair payment for primary care physicians. I will keep you updated along the way.

Jeff Cain, M.D., is the President of the AAFP.

Posted at 12:58PM Dec 14, 2012 by Jeffrey Cain, M.D.

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