UnitedHealthcare on the Forefront of Changing the Paradigm

“Do you have the guts to break through where others don’t or won’t?” These are the words of UnitedHealthcare’s CEO on their mission to improve healthcare delivery in the United States. As this blog continuously chronicles, the system is fraught with deficiencies and opportunities for substantive improvement. Medical care has become too expensive. Delivery is fragmented and difficult to navigate. Plan designs are becoming more complex by the day. Members struggle with advocacy and problem resolution.

UnitedHealthcare (UHC) is spending extensive human and monetary capital in changing their organization from a claims payor and provider contractor to a sophisticated technology organization that is directly involved in care delivery. By amassing terabytes of data on providers, treatments, chronic disease states, human demographics among others, we are seeing a convergence of big data and medical delivery. In my opinion, their success, especially at their Optum subsidiary, spurred the recent transactions between CVS and Aetna and Cigna and Express Scripts. Both Aetna and Cigna have realized that they need to keep up with UHC’s trajectory.

Organizations such as UnitedHealthcare are going to usher in the end of the fee-for-service model as we know it. By either entering into bundled payment arrangements (i.e. capitation) with large medical groups or health systems, or through direct provider ownership (e.g. the acquisition of DaVita Medical Group, which focuses on kidney disease and dialysis treatment), they are looking to force change. 

The amount of data being collected is staggering. This data is being used to direct members to best-in-class providers, educate physicians on treatment solutions, help manage chronic conditions and potentially aid in solving misdiagnosed ailments. Kaiser Permanente has long been held up as healthcare’s most efficient and cost-effective model. The others are borrowing from their playbook in remaking themselves into a tighter delivery system. Stay tuned, it’s going to be interesting…

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