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Value-Based Contracting and Accountable Care Organizations

UnitedHealth Network Strategies

Summary

UnitedHealthcare is evaluating a variety of value-based contracting strategies to increase quality, reduce medical costs, improve patient outcomes and share risk as well as responsibility for controlling medical cost trend.

UnitedHealthcare considers Accountable Care Organizations (ACOs) to be an important element of its value-based contracting strategy. The goal of value-based contracting is to move the delivery system toward increased collaboration between the health care community and greater emphasis on shared risk accountability for improved outcomes. The transformation of industry-wide payment models is evolving and will require a variety of strategies to suit the needs and diversity of consumers and health care providers in individual communities across the country. UnitedHealthcare is currently pursuing a variety of value-based contracting models from performance based contracting incentives to full capitation. In addition to these historic models, UnitedHealthcare is currently active with one ACO pilot in Tucson, Arizona, and is working on adding eight to 12 pilots across the country by 2012.

The Patient Protection and Affordable Care Act of 2010 contains provisions surrounding the establishment of ACOs under the Medicare Shared Savings Program. Under the final rule issued by the Centers for Medicare & Medicaid Services (CMS), ACOs, defined as a group of physicians, hospitals and other health care professionals working together, would coordinate care and share in certain savings or losses for Medicare beneficiaries assigned to their group. The primary goal of the program is to improve quality while lowering the costs for patients enrolled with CMS in original Medicare (fee-for-service) – Medicare Parts A and B programs. The regulations do not apply to Medicare Advantage plans, Medicaid or private insurers.

The Medicare Shared Savings Program will be established on January 1, 2012.

For More Information

  • Viewpoint(Opens a new window): Value-Based Contracting and Accountable Care Organizations
  • News Release: WESTMED Medical Group Launches Accountable Care Organization (ACO) in Collaboration with UnitedHealthcare and Optum (March 20, 2012)
  • News Release: Tucson Medical Center, Independent Area Physicians Establish Region's First Fully Operational Accountable Care Organization (June 9, 2011)

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