UnitedHealthcare recently awarded more than $54 million in bonus payments to more than 4,000 care providers named winners of the PATH Excellence in Patient Service Awards.*
The recipients achieved the highest adherence levels for key quality measures by successfully closing gaps in care when treating UnitedHealthcare Medicare Advantage members.
The PATH program annually rewards physicians who meet certain performance-based criteria, including achieving or exceeding compliance targets for 17 specific Healthcare Effectiveness Data and Information Set (HEDIS) measures, including the percentages of eligible UnitedHealthcare Medicare Advantage members who received a breast cancer screening or colorectal cancer screening. Other measures evaluate the percentages of members who adhere to their medications to help manage their diabetes, high blood pressure or cholesterol.
Health plans and the Centers for Medicare & Medicaid Services use HEDIS as a tool to measure performance on important dimensions of health care and service.
“We are committed to recognizing and rewarding physicians through the PATH Excellence in Patient Service Awards for consistently helping our plan participants live healthier lives,” said Sam Ho, M.D., chief medical officer of UnitedHealthcare. “As UnitedHealthcare continues building deeper, more collaborative relationships with care providers, these awards are an example of how we are supporting the transition to a value-based health care system in which payment is increasingly based on ensuring the people we serve receive the quality care they need.”
According to the Centers for Disease Control and Prevention, fewer than half of adults ages 65 and older were up to date with core preventive services, such as tests and screenings, despite getting regular check-ups from their doctors.** Preventive care becomes even more important with advancing age because many chronic conditions are more common in older adults. Preventive care can identify health issues at an early stage, before they have an opportunity to intensify and lead to costly complications that can have a negative impact on people’s quality of life.
UnitedHealthcare created the PATH program to help its Medicare Advantage members be as healthy as possible by encouraging greater use of preventive health care services and proactive monitoring of chronic conditions. The program provides support and incentives for both care providers and Medicare Advantage members to enhance their engagement in their health care and willingness to take action on their doctors’ treatment plan, thereby closing gaps in care.
The PATH program has four components:
Patient Support and Communication: UnitedHealthcare supplements care providers’ patient engagement efforts through comprehensive communications to educate Medicare Advantage members about the importance of taking proactive steps to keep their health on track. Mailings, emails and phone calls to members emphasize the importance of working with their doctors to create a personalized preventive care plan as well as getting their annual care visit and any recommended tests and screenings. Reminders and financial incentives offer further encouragement to follow through on scheduling appointments and tests.
Actionable Patient Data and Reporting: UnitedHealthcare provides participating care providers with monthly Patient Care Opportunity Reports that include detailed patient-level and practice-level data in a format that is easy to use. The data facilitate the delivery of coordinated care by giving care providers a more complete picture of their patients’ health, including their hospitalizations, care they receive from other doctors and adherence to prescribed medications. On an ongoing basis, care providers can see at a glance the number of UnitedHealthcare Medicare Advantage patients who are overdue for an annual care visit or cancer screenings, for example, so they can take action to engage these patients and close their gaps in care.
Financial Compensation for Doctors: Because this type of patient engagement can require extra effort on the part of care providers, the PATH program offers financial compensation to care providers who exceed quality-based performance targets. Care providers who improve specific HEDIS measures for eligible UnitedHealthcare Medicare Advantage members can earn an annual bonus payment.
Practice-Based Support: UnitedHealthcare collaborates with care providers to provide additional tools, resources and support that can help facilitate care coordination and improve health outcomes. Given that every practice is different and has unique needs, UnitedHealthcare engages with practices in a variety of ways to offer customized support, such as joint communication efforts and on-site administrative and clinical resources.
In 2015, nearly 1 million UnitedHealthcare Medicare Advantage members are being treated by doctors who participate in the PATH program.*
The PATH program is part of UnitedHealthcare’s commitment to help shift the nation’s health care system to one that rewards quality and value instead of the volume of procedures performed. To facilitate this shift, the company offers a variety of fee-for-value payment arrangements, including incentive programs like PATH, performance-based contracting, bundled payments and accountable care organization (ACO) relationships.
Care providers nationwide are showing strong interest in a shift to value-based care. UnitedHealthcare’s total payments to physicians and hospitals that are tied to value-based arrangements have nearly tripled in the last three years to $38 billion.* By the end of 2018, UnitedHealthcare expects that figure to reach $65 billion.*
Serving nearly one in five Medicare beneficiaries, UnitedHealthcare is the largest business dedicated to the health and well-being needs of seniors and other Medicare beneficiaries.*
For more information about UnitedHealthcare’s full spectrum of value-based initiatives, visit www.AccountableCareAnswers.com.
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. UnitedHealthcare 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 www.uhc.com or follow @myUHC on Twitter.
* Internal UnitedHealthcare Data, 2015
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare- approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premium and/or co-payments/co-insurance may change on January 1 of each year.