Health Plan Weekly

UnitedHealth Group — which in recent months has been tightening the screws on spending drivers like unnecessary emergency care and out-of-network utilization — is signaling that its greater goal for cost containment comprises much more than simply site-of-care management. Rather, the diversified managed care company’s emphasis on its care-delivery assets during its second-quarter earnings conference call may suggest that UnitedHealth is increasingly pursuing the strategy of “if you can’t beat them, own them.”

“I think you’re really starting to see OptumHealth…starting to demonstrate [its] capacity for growth because of the scale of the footprint that they now [have] established across the country,” UnitedHealth CEO Andrew Witty said of the company’s health services division during a July 15 call to discuss quarterly earnings.

In President Joe Biden’s new executive order aimed at promoting competition in the American economy, he directs HHS Secretary Xavier Becerra to “implement standardized options in the national Health Insurance Marketplace” in a bid to “ensure that Americans can choose health insurance plans that meet their needs and compare plan offerings.”

Standardized plans on the federally run health insurance exchange, HealthCare.gov, are not a new concept: They were initially introduced during the Obama administration before being rolled back by the Trump administration. And several states that run their own exchanges currently have some form of standardized plans. But industry experts tell AIS Health that a move to standardize plans at the federal level will only work this time around if it’s done with several key principles in mind.

A new set of rules included in the latest update to health care data interoperability standards could be transformative in improving population health for LGBTQ+ patients, especially transgender people. The new data standard could eventually help identify disparities and inequities experienced by people in LGBTQ+ communities and lead to changes in the ways benefit design, network agreements, capitation and grants are designed and administered, experts say.

The new rule, which HHS released on July 9, is the latest in a series of federal guidance for carriers and providers regarding electronic health record (EHR) interoperability. An HHS press release says that with the new guidance, “health IT stakeholders nationwide will have clearer direction toward the standardized, electronic exchange of social determinants of health (SDOH), sexual orientation, and gender identity (SO/GI) among several other updated data elements.” The goal, according to HHS, is “lay[ing] the foundation for the provider community to start systemizing the capture and use of SDOH and SO/GI data in the clinical setting.”

✦ President Joe Biden was slated to issue an executive order on July 9 aimed at “promoting competition in the American economy,” which notably includes the health care sector. It calls on federal agencies to “enforce antitrust laws vigorously,” recognizing that they have the authority to challenge “prior bad mergers.” In particular, enforcement should focus on “labor markets, agricultural markets, healthcare markets (which includes prescription drugs, hospital consolidation, and insurance), and the tech sector,” stated a White House press release.

✦ HealthPartners, a Minnesota-based integrated health system, will offer a single bill for pregnancy care delivered at Ridgeview, a provider system with three hospitals. Per a press release, the so-called “bundle” will include “several clinic visits, numerous tests, ultrasounds and a hospital stay…as long as no non-routine tests or services are required during pregnancy or delivery.” Ridgeview said in the release that the billing approach is possible because of higher integration across its affiliated clinics and specialists, which “results in high-quality care and birth experiences for pregnant patients, better coordination of services and billing, lower costs of care, and lower insurance costs.”

On the heels of walking back a hotly debated policy restricting emergency room coverage, UnitedHealthcare is now rolling out a different policy aimed at lowering health care costs by clamping down on some members’ out-of-network benefits. However, one industry observer predicts the latest policy change won’t see nearly as much blowback as UnitedHealth’s ER move.

In an email to AIS Health, a spokesperson for UnitedHealthcare stated that the insurer is updating its commercial certificate of coverage around out-of-service-area/out-of-network coverage of medical and behavioral health services — a change it will roll out through 2021 and 2022.