Physicians Provide Higher Quality Care Under Set Monthly Payments Instead of Being Paid Per Service, UnitedHealth Group Study Shows

August 11, 2020 | 2 min Read
  • Global capitation payments provide strong incentives for physicians to prioritize prevention, avoid unnecessary interventions, and increase overall wellness

Primary care physicians paid under global capitation, which pays a set amount per month per patient, achieve key quality metrics at higher rates than those paid under fee-for-service (FFS), according to new research by UnitedHealth Group (NYSE: UNH). The findings indicate that capitation provides the right incentives for value-based care, including delivery of the right care, at the right time, and in the right setting.  

By identifying meaningful quality differences using metrics from the National Committee for Quality Assurance’s Healthcare Effectiveness Data and Information Set (HEDIS) related to preventive care and chronic conditions, the study showed patients treated under global capitation compared to FFS:

  • Were screened at higher rates for breast cancer (80% versus 74%) and colorectal cancer (82% versus 74%).
  • Demonstrated higher controlled blood sugar levels (89% versus 80%) and were given more eye exams (84% versus 74%).
  • Received higher rates of functional status assessment (96% versus 86%) and medication review (97% versus 92%).  

“Global capitation benefits patients, physicians and, more broadly, the health care system,” said Dr. Richard Migliori, chief medical officer, UnitedHealth Group. “Patients benefit because their doctors prioritize preventive care to keep them healthy and out of the hospital. Meanwhile, providers can offer valuable services that may not be paid for under fee-for-service. These findings underscore the importance of value-based care as a key element in building a better performing health care system for everyone.”

The analysis of more than 5 million UnitedHealthcare Medicare Advantage enrollees and tens of thousands of primary care physician practices concluded that physicians paid under capitation are better positioned to:

  • Prioritize preventive services and care management programs.
  • Spend more time engaging with patients.
  • Use evidence-based clinical guidance.
  • Avoid unnecessary patient interventions.
  • Focus on keeping patients out of the hospital.

UnitedHealth Group has a long-standing commitment to promoting and incenting value-based care. Optum works with providers and across the country to move from fee-for-service to value-based care, creating new choices for patients, delivering higher quality, lower cost sites of service, customizing payment models with payers, and supporting physicians to focus more on delivering care.

Through UnitedHealthcare’s value-based partnerships and strong provider relationships, physicians continue to progress toward use of risk-based payment models, including capitation. Today, UnitedHealthcare works with more than 113,000 physicians and 1,200 hospitals in some form of value-based relationship, including more than 1,250 accountable care organizations. The company’s collaboration with these providers delivers meaningful results and better health outcomes to more than 17 million members.

About UnitedHealth Group

UnitedHealth Group (NYSE: UNH) is a diversified health care company dedicated to helping people live healthier lives and helping to make the health system work better for everyone. UnitedHealth Group offers a broad spectrum of products and services through two distinct platforms: UnitedHealthcare, which provides health care coverage and benefits services; and Optum, which provides information and technology-enabled health services. For more information, visit UnitedHealth Group at www.unitedhealthgroup.com or follow @UnitedHealthGrp on Twitter.