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Value-Based Care Accounts for Half of UnitedHealth, Aetna, Anthem Reimbursements

February 07, 2017

UnitedHealth Group, Aetna, and Anthem—the nation’s largest insurers—have recently announced that they are paying nearly 50% of their reimbursements through value-based care models, according to recent reports.

In order to improve quality and rein in costs, value-based reimbursement combines health outcomes, performance, and quality of care for providers who contract insurers through accountable care organizations (ACOs), In a value-based pay model, doctors and hospitals often take on more risk so they can streamline care, improve quality, and eliminate bureaucratic inefficiencies.

“We made solid progress in 2016 with over 45% of Aetna's medical spend currently running through some form of value-based care model, positioning us to achieve our 2020 goal of 75%,” Mark Bertolini, CEO of Aetna, said during an earnings call. “We formed multiple collaborations with healthcare providers that span a wide spectrum of value-based care models including two new joint venture relationships.”

Among the three insurers, UnitedHealth and Aetna have made the most progress at moving away from the traditional fee-for-service models. Often times, a fee-for-service approach can lead to overtreatment and unnecessary medical tests and procedures. Similarly, Anthem, which operates Blue Cross and Blue Shield plans in 14 states, is also close to moving away from fee-for-service plans.

Current estimates show UnitedHealth spends $52 billion of its $115 billion—an estimated 45% of spending—in total annual medical spending through value-based care contracts with doctors and hospitals. Additionally, Anthem has said it currently has more than 43% of its payments linked to shared savings programs. Through a shared savings program, doctors and hospitals are contracted to improve quality while lowering costs which will allow them to keep any money saved on a year to year basis depending on the health plan. 

Additionally, Anthem recently released data from its Enhanced Personal Health Care program, a value based care model. Results from the program showed that it reduced per-member per-month savings of $9.51 for members enrolled in the program. Furthermore, Anthem reduced outpatient surgery costs by 5.1%. The results also showed that value-based care reduced admissions of high-risk patients with chronic conditions by 7.5%—while PCP visits increased by 22.9%.

“Our goal by 2018 is to hit 50% in shared savings programs,” Jill Becher, an Anthem spokesperson, said in a statement. “When you combine this with our pay for performance programs we will have well over half our spend in collaborative arrangements over the next few years.”

Julie Gould (Mazurkiewicz)

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