Tag Archives: UnitedHealth

Aetna, UnitedHealth show increasing appetite for value-based care contracts

The biggest health insurers are moving quickly towards value-based care arrangements, their recent earnings reports show.

While Aetna has long-held a goal to reach 75 to 80 percent of its medical spend in value-based relationships by 2020, Aetna’s medical spend is now 45 percent tied to value, CEO Mark Bertolini said during last week’s fourth quarter earnings call.

“One way we measure our success is by how well we are able to keep our members out of the hospital and in their homes and communities,” Bertolini said. “For example, in 2016, we reduced total acute admissions by approximately 4 percent, and we deployed predictive modeling to target members at the greatest risk of readmission.”

Aetna has achieved a 27 percent reduction in readmission rates using multidisciplinary care teams that engage facilities to develop effective discharge plans, he said.

“Collectively, these clinical programs have driven a best-in-class Stars readmission rate among national competitors,” he said.

Aetna sees more opportunities for reducing utilization over the long-term in readmission rates, and in a reduction in inpatient days. Unit price is still the driver in value-based purchasing, Bertolini said.

“I think value-based contracting is going to continue to be encouraged by even the current administration as a way of getting a handle on healthcare costs,” he said. “We have a healthy pipeline of opportunities. They will not all be joint ventures. I think there are other models emerging.”

UnitedHealthcare is increasingly helping states manage care for their complex, vulnerable and most costly populations, as well as assisting employers with programs to support the needs of retirees and employees with chronic conditions, according to CEO Stephen Hemsley in the insurer’s earnings report.

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary

UnitedHealth Buys Cataman Corp.

The nation’s largest health insurer, UnitedHealth, will muscle up for its fight against rising prescription drug costs by spending more than $12 billion to buy pharmacy benefits manager Catamaran Corp.

Pharmacy benefits managers, or PBMs, help negotiate the prices that customers pay for prescription drugs. They are seen as a key component in the push to contain soaring costs from specialty drugs, complex medicines that can represent treatment breakthroughs but often at a much higher price than other drugs.

Rising costs from these drugs are expected to affect more patients as use of the treatments grows and coverage for them shrinks.

UnitedHealth and Catamaran said Monday that their deal will combine businesses that have “distinctive, rapidly growing specialty pharmacy services” for a segment of the market that is expected to quadruple from an estimated $100 billion in revenues last year to possibly $400 billion by 2020.

Specialty drugs treat certain forms of cancer, multiple sclerosis and hepatitis C, among other conditions. They have always been pricey but confined to relatively small patient populations. That’s changing, due in part to some newer hepatitis C treatments that could be used by millions of patients.

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary