WESTMED Accountable Care Collaboration with UnitedHealthcare and Optum Yields Significant Health Improvements

November 12, 2013
  • Health care measures and patient satisfaction continue to improve, while reducing health care costs
  • Westchester County patients benefit from greater care coordination and enhanced health services

WESTMED Medical Group announced that its accountable care organization (ACO) program with UnitedHealthcare and Optum improved on nine of 10 health quality metrics, increased patient satisfaction and reduced health care costs.

Since establishing the ACO in mid-2012, WESTMED, a large multispecialty group medical practice in Westchester County, has seen significant improvements in patients taking their prescription medications properly; and for diabetics, more routine screening and better control of blood sugar levels.

The ACO is performing above the 90th percentile of National Committee for Quality Assurance (NCQA) Quality Compass® 20121 for providing the highest level of coordinated care for breast cancer and cervical cancer screenings.2 Its patient-centered medical home program already had received the highest level of recognition (Level 3) from NCQA for providing coordinated, efficient and quality primary care. NCQA is a private, nonprofit organization dedicated to improving health care quality.

“We are committed to providing best-in-class care to our patients, so when we joined together with UnitedHealthcare and Optum, we were optimistic that with greater physician commitment, enhanced technologies and data, and cooperation from our patients that we would improve care, while reducing costs,” said Simeon Schwartz, M.D., president and CEO of WESTMED.

“Our initial results exceeded our expectations. We will continue to look for ways to collaborate and share accountability for patient care to surpass these already strong results,” said Barney Newman, M.D., medical director of WESTMED.

WESTMED received a nearly $1 million bonus under its ACO agreement with UnitedHealthcare by reducing practice variation, decreasing duplications in care and promoting the proper setting for care. Participating physicians who met both care quality and cost metrics focusing on providing the right level of care for patients may be eligible for bonuses. The medical group also will reinvest funds into ongoing technology enhancements to continue to improve quality of care, increase patient satisfaction and reduce health care costs.

“WESTMED physicians successfully achieved what they set out to do reaching their quality objectives while reducing overall costs in their first year as an ACO,” said Chris Pricco, senior vice president of Accountable Care Solutions at Optum. “We look forward to continuing our work with WESTMED and other clients as we expand our portfolio of capabilities, which focus on enabling care providers to transition from today’s fee-for-service environment to one in which care providers are truly managing the health of their patients.”

WESTMED physicians have benefited from detailed health intelligence that Optum’s analytical tools provide ranging from information about individual patient health to comparative data across entire populations. Regularly updated reports enable physicians to collaborate across specialties, helping them make informed medical care decisions based on a complete picture of each patient’s situation.

“Our initial results with WESTMED are a clear indication of the positive results that can be achieved when medical professionals and insurers come together for a common goal getting patients to the right care at the right time in the right setting for the best outcomes,” said Sam Ho, M.D., chief medical officer of UnitedHealthcare. “We look forward to the next phase in our ACO collaboration as we strive to help patients achieve better health.”

More than 13,000 UnitedHealthcare plan participants who reside in Westchester County and are covered under an Oxford Health fully insured commercial plan were part of the initial ACO collaboration. WESTMED and UnitedHealthcare will expand the ACO program to measure a greater number of metrics, and increase the number of plan participants in this program, including Westchester County-based UnitedHealthcare fully insured plan participants in the coming year, while continuing to improve health care quality and satisfaction for people in the initial group.

UnitedHealthcare is working with physician groups, hospitals and medical centers, and other health care delivery organizations across the country to achieve Institute for Healthcare Improvement’s “Triple Aim” objective improving population health and patient experience, delivering the best possible quality outcomes and reducing the overall cost of care. UnitedHealthcare’s value-based payment capabilities are designed to support this transformation of care delivery.

Today, more than $25 billion of UnitedHealthcare’s annual physician and hospital reimbursements is tied to accountable care programs, centers of excellence and performance-based programs. The company projects that will reach $50 billion by 2017.

About WESTMED Medical Group
WESTMED Medical Group is a large multi-specialty group medical practice, with headquarters in Purchase, N.Y. It is staffed by a team of more than 260 physicians dedicated to providing coordinated, efficient, quality patient care at its nine locations in central and lower Westchester County. The practice uses state-of-the-art systems and electronic medical records to enhance the health of the community. WESTMED has medical offices in White Plains, Rye, Ridge Hill in Yonkers, Purchase, Scarsdale and New Rochelle. Connect with WESTMED online at www.westmedgroup.com and Facebook and Twitter.

About Optum
Optum (www.optum.com) is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. Optum comprises more than 40,000 people worldwide who collaborate to deliver integrated, intelligent solutions that work to modernize the health system and improve overall population health.

About UnitedHealthcare
UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. The company offers the full spectrum of health benefit programs for individuals, employers and Medicare and Medicaid beneficiaries, and contracts directly with 780,000 physicians and other health care professionals and 5,900 hospitals and other care facilities nationwide. UnitedHealthcare serves more than 40 million people in health benefits and is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company.

1The source for data contained herein is Quality Compass® 2012 and is used with the permission of the National Committee for Quality Assurance (NCQA).Quality Compass 2012 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

2Based on UnitedHealthcare’s calculation of 2012 claims data of members receiving care through WESTMED compared to national Quality Compass® 2012 ratings, UnitedHealthcare reported that the ACO is performing above the 90th percentile of National Committee for Quality Assurance (NCQA) Quality Compass for providing the highest level of coordinated care for breast cancer and cervical cancer screenings.

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