Value-Based Care FAQs

Transforming the way we deliver and pay for health care is complicated. If you have questions, we have answers about how value-based care puts consumers at the center of the health care experience.

For specific information about how it affects you, please review our pages tailored to consumer benefits, care provider benefits and employer benefits.

Value-based care puts consumers at the center of the health care experience and strengthens their connection to the health professionals who are supporting their care.

It makes it easier to have a complete view of the patient by sharing important health information among each of the care providers involved in a patient’s treatment. And it pays doctors based on a person’s actual health outcomes and encourages services that are proven to deliver consistent, high-quality care – better health, better care and lower costs.

Value-based health care can take many forms, from performance-based contracts with physicians and hospitals to bundled payments for treating specific illnesses to primary care bonuses for closing specific gaps in care.

Learn more in our Knowledge Center.

By “value,” we mean a balance of quality, efficiency and lower costs to enhance both health care results and experiences.

Every value-based arrangement focuses on helping people live healthier lives by:

  • Helping care providers build a more integrated relationship with UnitedHealthcare and the patients they serve.
  • Compensating and rewarding care providers for the quality of care they deliver and improving patients’ health.
  • Connecting consumers to tools and guidance — including our Health4Me and Cost Estimator apps — that help them find the right care and save money.

Traditional fee-for-service medicine pays care providers based on the volume of office visits and procedures, and generally doesn’t reward or compensate for care coordination or whether patients are getting healthier from the care they receive. But paying for value encourages the best patient care.

Measuring value is rooted in industry guidelines for health care quality and patient outcomes.

We take into account numerous quality measures and industry benchmarks for appropriate health care utilization. For example, we use key measures from the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is widely used among health care companies to measure performance. It includes more than 80 measures to gauge effectiveness, patient experience and access to care. Examples include:

  • Percentage of eligible patients who receive a breast cancer or colorectal cancer screening.
  • Percentage of patients who adhere to their medications to help manage their diabetes, high blood pressure or other chronic illnesses.
  • Hospital admission and readmission rates.
  • How frequently a physician’s patients use the ER.
  • Whether physicians refer patients to in-network radiology centers and labs.
  • Whether equally effective generic medications are prescribed whenever available and appropriate for the patient.

UnitedHealthcare is building more collaborative relationships with care providers to ensure our plan participants have access to higher-quality, cost-effective care.

Working with care providers to ensure they have the right support and rewards will help to:

  • Connect the people we serve to the most effective care.
  • Place greater focus on the quality of care.
  • Reward providers for improving patients’ health.
UnitedHealthcare complements care providers’ practices by giving them additional support to manage overall population health, rather than isolated, individual health episodes.

We provide technology and information to improve quality and reduce costs, including data about:

  • Patient medical histories.
  • Unaddressed care issues.
  • Real-time emergency room and inpatient admissions data.
In some instances, care providers use community-based care coordination programs to support patients, such as for transition plans after leaving the hospital.

With 14+ million members already accessing care from physicians in value-based arrangements, UnitedHealthcare is helping place growing numbers of people at the center of our health care system.

We’re advancing value-based care by:

  • Creating health plans that are tailored to each community’s unique needs and that motivate consumers to choose high-performing, value-based care providers.
  • Collaborating with care providers and offering technology, data and other assistance while financially rewarding them for delivering best-practice care and excellent patient results at lower costs.
  • Connecting consumers to tools and guidance — including the Health4MeOpens a new window and Cost EstimatorOpens a new window apps — that help them find the right care and save money.
Learn more about value-based care in our Knowledge Center.