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Friday Dec 14, 2012

United Healthcare Acknowledges Payment Shortcomings

A little more than a year ago, AAFP leaders and staff members met with representatives of UnitedHealthcare at our headquarters in Leawood, Kan. During that meeting, the Academy spelled out for the large private payer that its policy of paying fee-for-service rates that are below Medicare rates creates distressed practice environments and jeopardizes patients' access to care.

At the time, United's leaders expressed surprise that the insurer was paying less -- in some cases far less -- than Medicare in some markets.

We recently met with United again at its Minneapolis headquarters. At that meeting, the company's representatives said they had looked into the information we presented at our previous meeting, and they acknowledged that we were right.

Now, they say, they plan to do something about it.

Unfortunately, United didn't offer specifics about what it plans to do in the affected markets. What we do know is that the company says it recognizes the value of effective primary care, and it is working to identify markets where it pays below Medicare. It also is developing solutions to address the problem.

So where does that leave America's family physicians? Those of us who contract with UnitedHealthcare should be aware that when our contracts are up for renewal, there is an opportunity for re-negotiation, especially for those who practice in areas where the company has been paying less than Medicare rates.

When negotiating a new contract, ask your United representative about opportunities for enhanced payment for primary care. The company's representatives told us United is willing to offer increased payments to primary care practices that meet certain criteria, such as offering electronic prescribing.

United has said that it ultimately intends to move away from a strict fee-for-service system to a "value-based contracting model" that will offer physicians rewards based on quality of care. The health plan hopes to have up to 70 percent of the patients it covers affected by this approach within the next three years.

United's representatives said they have seen the value of primary care in pilot projects in which the company is participating. The payer shared with us preliminary data from patient-centered medical home projects that showed it has reaped a 2-to-1 return on its investment in offering primary care physicians a blended payment that included care management fees, shared savings and enhanced fee-for-service.

Working with health plans -- and waiting for them to act on the information we provide -- can be a frustrating task. But we have an important message that needs to be heard: a strong primary care system results in better care for patients and lower overall health care costs.

Monday's four-hour meeting was just the first of many similar efforts for me. Every year, the Academy meets with some of the nation's largest private payers -- including Aetna, Cigna, Humana and WellPoint -- to discuss the value of primary care and the importance of fair payment for primary care physicians. I will keep you updated along the way.

Jeff Cain, M.D., is the President of the AAFP.

Comments:

Dr Cain- Unfortunately we are not given the opportunity to renegotiate with UHC- Their contracts roll over- They are paying 75% of Medicare in South Flrida- using a 2001 Medicare fee schedule. The AAFP should hold their feet to the fire on this one.

Posted by Richard Hays MD on December 17, 2012 at 12:26 PM CST #

I agree with Dr. Hays. Low pay is ultimately a quality issue. Care will drift down to the level of reimbursement. You get what you pay for.

Posted by Gregory Aslanian, M.D. on December 17, 2012 at 10:41 PM CST #

It is sobering and discouraging that united executives don't know about this.

Posted by John Frederick on December 18, 2012 at 01:53 PM CST #

Not only are we not given the opportunity to negotiate with UHC, but their standard contract only allows us to terminate on the anniversary of our contracting date, and only with 90 days advance notice. When I was contracted with them, I spent a year trying to get any provider relations staff from UHC to return a phone call to discuss errors they were making in payments, but was never able to get a response from them (in spite of over 100 phone calls from me, personally).

Posted by Don Stewart on December 20, 2012 at 02:46 AM CST #

Honestly, Dr. Cain, does United think we'll swallow this load of hooey? They ask us to believe that: "United's leaders" had no idea that for over two decades they've been forcing take-it-or-leave-it sub-Medicare contracts on family physicians ("Gambling in Casablanca? I'm shocked"); that, with all the resources of the country's largest insurer, they've been unable during the past 14 months to identify physicians with those contracts; that they're "developing solutions" while doing absolutely nothing; and that, icing on the cake, they "recognize the value of primary care" but, in the linked article say they will pay "incentive payments and fees GROWING (my caps) to a range of $0.45 to $3.30 PMPM" for medical home services. Dr. Cain, these are not decent, honorable people. They are con men: their words are lies, and their actions show nothing but contempt for the AAFP and family physicians. Every year, we read of these meetings, and every year things get worse. This approach does not work. Let me repeat: this approach DOES NOT WORK. The AAFP must take a strong adversarial approach if it wants to adaquately represent its members. A couple of suggestions: a major publicity campaign aimed at patients and employers outlining the actions/inactions of United and other insurers; a hot-line so physicians with these contracts can identify themselves, with the AAFP forwarding this information to United (along with the suggestion that, since their "leaders" didn't know about these contracts, they re-process all claims from the last 10 years!); a blog in which physicians can report their experiences in renegociating their contracts; and, most importantly, the AAFP must walk out of the PCPCC, with a simple, public statement that we can no longer work in any capacity with organizations that are so hostile to our members and so damaging to our speciality. No family physicians, no medical home: this would carry some weight! We must refuse to allow our good name and reputation to be used as cover by these groups. The AAFP HAS to draw a line beyond which they will no longer tolerate this abuse of their membership. Thank you.

Posted by D Claude on December 20, 2012 at 09:08 AM CST #

In 2009, UHC created a Medicaid prduct known as Americhoice which consistently underpaid.Worse than that, their management consistently provided misinformation and delays leading to underpayment and administrative costs for the practice. Their promises for timely credentialing were never kept and their local representatives seemed unaware of their won policies. This got so bad, that they "relabeled " themselves in late 2011 as United Health Care Community Plan. By this time we had repeatedly filed complaints withthe state insurance commission who simply forwarded our letters to UHC. Nothing changed except we were labeled a a "bad account", and terminated effective Jan 1, 2013. This means over 3,000 patients and 100 pregnancies are looking for a new doctor without any acknowledgment that MedicosMemphis provided active ER diversion with open access 7 days a week. These patients have been sent letters demanding that they find a new physician. The patients are given names and numbers of physicians who do not exist or who refuse to accept new Medicaid patients. We have names, dates, and other documents if it helps to reform the way United health Care rationed care through inconvenience and administrative delay.

Posted by wmrodney on December 20, 2012 at 09:51 AM CST #

I totally agree with the above comment that they are con men and undoubtedly know how much they are underpaying. I am equally skeptical of incentive programs, P4P, etc. They will decide whether we have met their goals and get the bonus. They only way to get their attention is to "leave" their poor contracts in significant numbers.

Posted by B Sundland on December 20, 2012 at 10:20 PM CST #

They didn't know they were low? That is a bald-faced lie. They will "study" improving it? That creates an unnecessary delay. The only way for us to negotiate is for ALL of us to use or practice management systems and compare our average pay by plan to our charges, THEN we must all do what is right for our practices. We MUST then cancel our participation in these poor paying health plans.

Posted by Rob Jackson MD on December 26, 2012 at 05:33 PM CST #

Tune in, turn on and drop out.

Posted by keith dinklage on December 28, 2012 at 08:14 AM CST #

Our group has cancelled our UHC contract a few years ago. It makes no sense for to help them drive out the ethical insurers from our local market that work with us to maintain fair rates.

Posted by David Lynch on January 10, 2013 at 11:32 PM CST #

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.