More Than 11 Million People Can Now Receive Health Care Services from Care Providers Paid by UnitedHealthcare Based on Quality and Patient Outcomes

February 17, 2015
  • Data show aligned care providers deliver better quality, better outcomes
  • Strong momentum away from fee-for-service as total medical spend tied to value-based relationships has tripled in the last three years, projected to hit $65 billion by 2018
  • Nearly 250 additional Accountable Care Programs to be created in 2015 as physicians, hospitals enhance their collaboration with UnitedHealthcare

More than 11 million plan participants enrolled in UnitedHealthcare’s individual, employer-sponsored, Medicare and Medicaid plans are now accessing care from a growing list of providers who are being compensated based on quality, better patient outcomes and lowering the overall cost of care. These arrangements are increasingly improving the care quality and overall value realized by UnitedHealthcare’s customers.

As UnitedHealthcare continues to lead the shift toward value-based care, the company expects to contract with up to 250 new Accountable Care Programs in 2015, engaging in deeper, more collaborative relationships with physicians and hospitals across the United States. UnitedHealthcare has more than 520 Accountable Care Programs active today.

Value-based health care can take many forms. From performance-based contracting and bundled payments for treating specific illnesses, to primary care bonuses and fully integrated population health, every value-based arrangement is centered on rewarding performance and helping care providers build a more integrated relationship with UnitedHealthcare and the patients they serve.

Care providers are showing strong interest. UnitedHealthcare’s total payments to physicians and hospitals that are tied to value-based arrangements have nearly tripled in the last three years to $36 billion. Those payments are expected to increase 20 percent to $43 billion in 2015 and hit $65 billion by the end of 2018.

“UnitedHealthcare is building more collaborative relationships with more care providers to ensure our plan participants have access to higher-quality, cost-effective care,” said Dan Rosenthal, president, UnitedHealthcare Networks. “Working with care providers to ensure they have the right support and incentives will help connect the people we serve to the most effective care, place a greater focus on the quality of their care, and compensate providers for improving patients’ health.”

UnitedHealthcare complements care providers’ practices by giving the additional support needed to manage overall population health rather than isolated individual health episodes, including technology and information that will help them take specific actions that improve quality and lower costs. Actionable data may include patient profiles, unaddressed care issues, and real-time emergency room and inpatient admissions data. In some instances, community-based care coordination programs are used to support patients, such as for transition plans after leaving the hospital.

UnitedHealthcare is seeing greater consistency in the delivery of quality care among its existing Accountable Care Organizations for individual, employer-sponsored and Medicaid plan customers. Results to date include:

  • Medicaid members have shown a 21 percent increase in primary care visits and a 14 percent decrease in readmissions within 30 days of leaving the hospital;
  • individual and employer-sponsored plan participants experienced an 11 percent reduction in hospital admissions and an eight percent reduction in emergency room admissions.

New York-based WESTMED Medical Group and UnitedHealthcare launched in 2012 an accountable care arrangement serving 13,000 employer-sponsored plan participants.

“Deeper, more integrated relationships with health plans like UnitedHealthcare are making a tangible impact on patients’ health,” said Simeon Schwartz, M.D., president and CEO of WESTMED. “We were already considered to be among the leaders in clinical care in our community. However, in the first year of our arrangement, our program improved nine of 10 health quality metrics, increased patient satisfaction and reduced health care costs. For example, there were significant improvements in patients taking their prescription medications properly and people with diabetes receiving more routine screenings to better control their blood sugar levels.”

A value-based approach to health care can help improve patient health and lower costs in a number of ways, including by:

  • integrating how the patient’s care is monitored among primary care physicians, specialists and facilities so that all aspects of an individual’s ongoing health care needs are connected in one place;
    rewarding physicians who encourage specific preventive care actions with their patients, such as proactive appointment scheduling, prescription adherence and follow-up care, while also following evidence-based care guidelines to make sure patients stay healthy; and
  • transitioning care providers away from a fee-for-service model that pays based on the number of procedures they perform (and may encourage unnecessary services) and instead pays based on overall value provided to the patient.

For more information about the full spectrum of UnitedHealthcare’s value-based programs, including case studies and more detailed results data on quality and cost improvements, visit

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, military service members, retirees and their families, and Medicare and Medicaid beneficiaries, and contracts directly with more than 850,000 physicians and care professionals, and 6,000 hospitals and other care facilities nationwide. Globally, UnitedHealthcare serves 45 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. For more information, visit UnitedHealthcare at or follow @myUHC on Twitter.

Be the First to Know

Stay up-to-the-minute on the latest headlines from UnitedHealth Group.