Our goal is simple: help people live healthier lives and make the health system work better.

At UnitedHealthcare, this is the yardstick we use to determine whether value-based care is delivering better results. It fuels our imaginations as we create improved health plans and new partnerships for our members.

This page spotlights some early outcomes of our progress using value-based care to improve people’s health.

Early evidence indicates that value-based care is keeping people healthier:

  • Patients turn more often to primary care providers for care, rather than putting off care or relying on emergency rooms.
  • Patients have 8 percent fewer emergency room visits and as many as 16 percent fewer hospital admissions.
  • Patients who have the highest-risk, most complex health needs – usually due to multiple chronic complex diseases – have fewer hospital visits. This 5 percent of the population accounts for 50 percent of medical costs.
  • Medicare super-utilizer patients have 6.5 percent fewer inpatient admissions.
  • Medicaid super-utilizer patients have 24.5 percent fewer inpatient admissions.

Because these patients received more coordinated care, they were able to avoid hospitalization and ER visits – events that are expensive, potentially risky and time-consuming. These patients also had lower health care costs.

Most importantly, patients are receiving more appropriate care, with the goal of supporting better health in individual patients and in populations.

Learn More from Our Value-Based Care Fact SheetOpens a new window

Recent data shows that care providers at accountable care organizations (ACOs) are making a difference in people’s health.

Case Study 1: Prevention Works at WESTMED—a New York ACO

During the first year of an ACO arrangement, WESTMED Medical Group, a large multispecialty group medical practice in New York, had significant improvements in health quality metrics and reduced health care costs.

WESTMED ACO Change in Utilization and Costs, 2011 to 2012

  • Emergency Room Visits down 8%
  • Hospital Inpatient Costs down 5%
  • Risk-Adjusted Costs per Member down 1.3%

WESTMED ACO Emphasis on Prevention and Condition Management

  • 90% of diabetic patients received A1C test
  • 89% of eligible patients received cervical cancer screening

Learn more: Patient outcomes from WESTMED Medical Group accountable care organization.

WESTMED ACO Change in Utilization and Costs, 2011 to 2012

Case Study 2: Costs Decline at Monarch Healthcare—A Medicare ACO

In California, a new Medicare ACO reduced total spending by 6.5 percent compared to a reference cohort.

Learn more: Patient outcomes from Monarch HealthCare’s value-based plan

Monarch Healthcare ACO Change in Total Medicare Spending, 2011 to 2012

Case Study 3: Screenings Rise at Integrated Health Network—A Wisconsin ACO

Enhancing care coordination and paying for value—not volume—of care is improving health for 60,000 UnitedHealthcare members receiving care from Integrated HealthNetwork providers through an accountable care organization (ACO).

Integrated Health Network ACO Improves Patient Health

UnitedHealthcare rewards care providers who improve individual patients’ health. We also provide support to help care providers measure and improve their care of their overall patient population.

Through a combination of shared accountability and rewards, we are building a stronger health care system for patients, care providers and populations.

In 2016 alone, we’ve provided more than $148 million in bonus payments Opens a new windowto more than 1,900 Medicare physicians who were named winners of the PATH Excellence in Patient Service Awards.

Our spectrum of value-based care payment models returns rewards to meet the level of readiness for any care provider. Learn more about UnitedHealthcare’s payment models.

One of our flagship value-based initiatives is our UnitedHealth Premium physician designation program, now available to 90 percent of our commercial membership.

  • UnitedHealth Premium allows physicians to receive quality and cost-efficiency data to understand and improve the care they provide patients.
  • Evidence-based and national industry standards, coupled with feedback from medical and professional societies, recognize physicians for providing quality and cost-efficient care.
  • Physicians may earn recognition as a UnitedHealth Premium Care Physician or as Tier 1.
  • The Premium program focuses on 47 specialty areas that account for more than 80 percent of employers’ average medical spending.

Increasing numbers of physicians – 40 percent of primary care physicians and 31 percent of specialists – who work with us have earned Tier 1 recognition, which means they have  received the Premium Care Physician designation for meeting UnitedHealth Premium program quality and cost-efficient care criteria.

Comparison of UnitedHealth Premium Care Physicians
to Non-Premium Care Phyicians

More Efficient Care and Better Quality

Between a Premium Care Physician and a non-Premium Care Physician, 16 Premium specialties evaluated.

Implantable Cardiac Device

Premium Care specialists with cardiology procedure episodes had:

Lower average
complication rates
Fewer average
redo procedures

23% Lower CostsKnee Replacement Surgeries

Premium Care specialists with orthopedic procedure episodes had:

Lower average
complication rates
Fewer average
redo procedures

Remarkable Savings From Premium Care Physicians

  • 18 percent cost savings: For all 16 Premium specialties evaluated in the UnitedHealth Premium program, the incremental savings between a UnitedHealth Premium Care Physician and a non-Premium Care Physician is 18 percent.
  • Up to 6 percent savings for self-funded employers: Our customer-specific and composite analyses show that an average self-funded employer can save up to 6 percent of its annual medical spend by encouraging employees to use Premium Care Physicians.
  • Even greater savings for surgical specialties: Because surgical specialties have higher costs per episode than primary care or other specialties, they can offer even greater savings – up to 28 percent for orthopedic/neurosurgery specialties.

Want to learn more about UnitedHealthcare’s value-based care programs? Visit our Knowledge Center, ask your local UnitedHealthcare Network Provider Services contracting representative about adding value-based programs to your relationship with UnitedHealthcare or contact us.