- UnitedHealthcare is expanding its bundled payment offerings to providers in its Medicare Advantage plans in more than 30 states, the insurer announced Wednesday. The new program will let providers participate in bundled payments for eight specific procedures, including hip and knee replacements, coronary bypasses and spinal fusions, starting Jan. 1, 2020.
- The expansion builds on UnitedHealthcare's participation in CMS' Bundled Payments for Care Improvement - Advanced program in traditional fee-for-service Medicare. It will include care management and patient engagement tools, performance analytics and consulting and payment administration services for providers, according to a press release.
- Of the payer's roughly 5 million enrollees in MA plans, more than 3 million are treated by providers in value-based models. UnitedHealthcare, which contracts directly with more than 1.2 million physicians and 6,500 provider facilities, estimates it will have $75 billion in annual provider reimbursements tied to value-based arrangements by the end of next year.
Many industry players see bundled payments as a key driver in the shift toward value-based care. In bundled payment programs like BPCI-A, providers are rewarded for exceeding set price and quality standards meant to encourage low-cost coordinated care in lieu of fee-for-service.
The Minnetonka, Minnesota-based insurer is marketing the new Care Bundles Program as a way for providers to leverage its payer data and analytics to lower cost, potentially alleviating common provider concerns about risk assumption in value-based care models.
A June USC-Brookings white paper found Medicare's bundled payment programs are in a strong position to provide savings and create a cost-effective public payer program. However, though bundled payments have been en vogue lately, that doesn't mean providers are getting over all the humps to participation.
Of BCPI-A's initial 1,300 entrants at the model's October rollout, enrollment dropped 16% in the first five months as providers dropped to avoid financial risk, in line with a January report from the Government Accountability Office finding hospitals terminate their bundled care model participation when downside risk looms.
But marrying bundled payment models and MA may be a good play for UnitedHealthcare, given the stability of the privately-run Medicare plans — especially as greater numbers of the population age into Medicare. MA enrollment grew 8% from 2016 to 2017 according to congressional advisory group MedPAC, and almost 35% of beneficiaries choose MA over traditional Medicare now — a sharp jump from a decade ago when 10% enrolled.
And CMS finalized a rule last month enabling MA plans to provide chronic disease sufferers a suite of supplementary benefits addressing social determinants of health in 2020, including fresh produce and carpet cleaning, in addition to the slew of nontraditional benefits approved nearly a year ago.
That flexibility, in addition to a Congress likely to continue upping rates and approving more plan choices, has created a fecund environment for payers interested in experimenting with value-based care. An October report from Avalere found that at least 40% of MA plans are offering new types of population health benefits at no additional cost to beneficiaries this year.
The eight services covered by UnitedHealth's new program are single and double hip joint replacement, single and double knee joint replacement, non-servical spinal fusion, cardiac valve replacement, coronary bypass and percutaneous coronary intervention.
The payer, which brought in roughly $184 billion in revenue in fiscal year 2018, will add the new 2020 MA bundled payment benefits to those currently being provided in traditional Medicare: eight cardiac bundles, four spinal bundles and six orthopedic in 2019.