UnitedHealth Group UNH +0.70%, the nation’s largest health insurer, will launch a nationally branded accountable care organization, committing more resources to a value-based care push designed to attract self-funded employers.
By Bruce Japsen, Forbes, Contributor
Nov 1, 2016 @ 08:00 AM – An ACO is an umbrella entity that includes doctors and hospitals, contracting with health insurers to improve quality, lower costs and keep any money saved from year to year based on the arrangement with the health plan. If the providers in the ACO can’t improve care and lower expenses, they could lose out on shared savings.
An ACO is an umbrella entity that includes doctors and hospitals, contracting with health insurers to improve quality, lower costs and keep any money saved from year to year based on the arrangement with the health plan. If the providers in the ACO can’t improve care and lower expenses, they could lose out on shared savings.
UnitedHealth’s NexusACO will be available in 2017 in 15 markets to self-funded employers with 100 or more workers during this fall’s open enrollment period. Launched by the company’s insurance business, UnitedHealthcare , NexusACO already has a dozen employers signed on, executives said, but wouldn’t disclose client names.
“This (ACO) will have a much more national view with consistency across how the product is designed,” Jeff Alter, UnitedHealthcare’s CEO of employer and individual coverage, said in an interview. “It’s sold as a product that happens to have a unique network attached to it.”
The NexusACO has a national network of UnitedHealth’s “tier1” physicians that are already meeting the insurer’s quality and efficiency measures and located in markets across the country. Such a designation, common among insurers, is designed to guide health plan enrollees to providers that have better outcomes and costs.
UnitedHealthcare said NexusACO is different from regional ACOs, which generally have contracts with providers only in certain markets. UnitedHealthcare, for example, already has contracts with more than 800 ACOs across the country, which is double what it had two years ago.
Its rivals, too, are escalating arrangements with ACOs. Aetna AET -0.04%, for example, has dramatically increased its ACO agreements to 275 since 2011, and that figure is expected to grow even more in the next year as the company shifts 50% of what it pays providers from fee-for-service medicine to value-based arrangements by 2018.
The NexusACO has providers participating from 15 markets, including Richmond, Va.; Phoenix and Tucson in Arizona; Los Angeles, Orange County and San Francisco Bay Area in California: Denver; Chicago; Northern New Jersey; Cleveland and Columbus in Ohio; Rhode Island; and Austin, Houston and San Antonio in Texas.