UnitedHealthcare is launching a new program allowing providers in more than 30 states to participate in bundled payment models for patients enrolled in its Medicare Advantage plans.
UnitedHealthcare Bundles, set to roll out in January 2020, will be a voluntary value-based care payment program for eight medical procedures: single and double hip joint replacement, single and double knee joint replacement, non-cervical spinal fusion, cardiac valve replacement, coronary bypass and percutaneous coronary intervention.
The Medicare Advantage-focused bundles program will be offered along with United's existing work with the Centers for Medicare and Medicaid Services' Bundled Payments for Care Improvement Advanced for fee-for-service Medicare.
BPCI Advanced has bundled payments for 32 clinical episodes of care and qualifies as an advanced alternative payment model under MACRA.
WHY THIS MATTERS
As in the BPCI Advanced model, physicians and hospitals in UnitedHealth's bundled program will be rewarded for exceeding standards in cost and quality for the eight procedures and follow-up treatments.
Bundled payments are seen by many as a way to get various healthcare providers to work together closely to improve health outcomes.
UnitedHealthcare's bundles program aims to drive coordinated services over an episode of care, at a lower cost. The program will provide resources such as care management solutions for Medicare Advantage patients to receive pre-operative education to post-acute care, along with patient engagement tools and performance analytics.
The move by the insurance giant to offer bundled payments in the Medicare Advantage space reflects two of the biggest intertwining trends impacting healthcare today: the shift to value-based care and the rapid growth of Medicare Advantage plans.
Every day, roughly 10,000 baby boomers turn 65, becoming eligible for Medicare. At least a third choose a Medicare Advantage plan over traditional Medicare. This Silver Tsunami is helping to drive healthcare away from fee-for-service toward value-based, managed care focused on better outcomes and cost.
The Centers for Medicare and Medicaid Services expects enrollment in Medicare Advantage this year to hit an all-time high of 22.6 million senior citizens – which would represent an 11.5 percent rise from 2018. A full 36.7 percent of Medicare beneficiaries will be enrolled in Medicare Advantage in 2019, based on CMS projections.
Seniors are flocking to MA because the plans make it easier to navigate the healthcare system and generally offer prescription drug coverage and additional benefits and services not available through original Medicare, such as dental and vision.
ON THE RECORD
"Our extensive data and technology experience positions UnitedHealthcare to collaborate with care providers to support better health and better care, at a lower cost," said Jeff Meyerhofer, president of bundled payment solutions, UnitedHealthcare Medicare & Retirement. "We are making it easier for care providers by managing both the fee-for-service and Medicare Advantage models … so they can focus on caring for their patients."
Mark Klimek is an independent writer and editor with 20 years' experience covering financial issues, healthcare and more.