Cameual Wright, MD, MBA

UPDATE: Aetna Medicare Contract Negotiations Gothenburg Health is affected by the ongoing contract negotiations between CHI Health Partners and Aetna. Despite great efforts by the CHI Health Partners Payer Strategy and Relationships team to negotiate new agreements with Aetna in Nebraska and Iowa, Aetna has been unwilling to agree to responsible terms that help address the unprecedented financial challenges experienced by health care providers in CHI Health Partners during the last several years. As a result, the CHI Health Partners Medicare Advantage contract with Aetna ended at 11:59 p.m. on Sept. 30, 2024. This means Aetna Medicare Advantage will no longer include CHI Health Partners hospitals, providers and ancillary services as in-network beginning Oct. 1, 2024. This includes Gothenburg Health as well as our employed providers. The CHI Health Partners contract with Aetna for commercial plans will remain in place through Nov. 26, 2024, at 11:59 p.m. Patients with Aetna commercial plans may continue to receive in-network care through that date. The CHI Health Partners Payer Strategy and Relationships team will continue to negotiate with Aetna in good faith with the goal of securing a new, financially responsible Aetna agreement. Contact Aetna at the number on the back of your insurance card. Ask that Aetna work with CHI Health Partners to protect your in-network access to the care you need and deserve. Learn more about Traditional Medicare coverage after Jan. 1, 2025. As a patient with Medicare Advantage, you may be able to change your coverage to direct Medicare (Traditional) coverage and purchase a Medigap plan that would cover health care services that are not covered under Traditional Medicare. This may not be an option for all patients, and we suggest you investigate this option based on your needs and situation. Patients can also contact the CHI call center or reference the up-to-date information available on our website at https://lnkd.in/g5ytmpey. Call Center Information: Phone: 866-726-8362 Hours: Monday-Friday — 10 a.m.-10 p.m. Saturday-Sunday — 10 a.m.-6 p.m.

UnitedHealth’s Army of Doctors Helped It Boost Medicare Payments Biggest Medicare Advantage insurer gave physicians checklists of potential diagnoses ( Christopher Weaver, Anna Mathews and Tom McGinty, The Wall Street Journal,01/01/25 ) HIHUB.TECH🌎Health Innovation♾️Leaders🧬NEWS Like most doctors, Nicholas Jones prefers to diagnose patients after examining them. When he worked for UnitedHealth Group, though, the company frequently prepared him a checklist of potential diagnoses before he ever laid eyes on them. UnitedHealth only did that with the Eugene, Ore., family physician’s Medicare Advantage recipients, he said, and its software wouldn’t let him move on to his next patient until he weighed in on each diagnosis. The diagnoses were often irrelevant or wrong, Jones said. UnitedHealth sometimes suggested a hormonal condition, secondary hyperaldosteronism, that was so obscure Jones had to turn to Google for help. “I needed to look it up,” he said. The government’s Medicare Advantage system, which uses private insurers to provide health benefits to seniors and disabled people, pays the companies based on how sick patients are, to cover the higher costs of sicker patients. Medicare calculates sickness scores from information supplied by doctors and submitted by the insurers. In the case of UnitedHealth, many of those doctors work directly for UnitedHealth. More diagnoses make for higher scores—and larger payments. A Wall Street Journal analysis found sickness scores increased when patients moved from traditional Medicare to Medicare Advantage, leading to billions of dollars in extra government payments to insurers. Patients examined by doctors working for UnitedHealth, an industry pioneer in directly employing large numbers of physicians, had some of the biggest increases in sickness scores after moving from traditional Medicare to the company’s plans, according to the Journal’s analysis of Medicare data between 2019 and 2022. Sickness scores for those UnitedHealth patients increased 55%, on average, in their first year in the plans, the analysis showed. That increase was roughly equivalent to every patient getting newly diagnosed with HIV, the virus that causes AIDS, and breast cancer, the analysis showed. That far outpaced the 7% year-over-year rise in the sickness scores of patients who stayed in traditional Medicare, according to the analysis. Across Medicare Advantage plans run by all insurers, including UnitedHealth, scores for all newly enrolled patients rose by 30% in the first year. A spokesman for United-Health said in a written statement that the company’s practices lead to “more accurate diagnoses, greater availability of care and better health outcomes and prevention, including less hospitalization, more cancer screenings and better chronic disease management.” https://lnkd.in/dRfKBUc8

UnitedHealth’s Army of Doctors Helped It Boost Medicare Payments Biggest Medicare Advantage insurer gave physicians checklists of potential diagnoses ( Christopher Weaver, Anna Mathews and Tom McGinty, The Wall Street Journal,01/01/25 ) HIHUB.TECH🌎Health Innovation♾️Leaders🧬NEWS Like most doctors, Nicholas Jones prefers to diagnose patients after examining them. When he worked for UnitedHealth Group, though, the company frequently prepared him a checklist of potential diagnoses before he ever laid eyes on them. UnitedHealth only did that with the Eugene, Ore., family physician’s Medicare Advantage recipients, he said, and its software wouldn’t let him move on to his next patient until he weighed in on each diagnosis. The diagnoses were often irrelevant or wrong, Jones said. UnitedHealth sometimes suggested a hormonal condition, secondary hyperaldosteronism, that was so obscure Jones had to turn to Google for help. “I needed to look it up,” he said. The government’s Medicare Advantage system, which uses private insurers to provide health benefits to seniors and disabled people, pays the companies based on how sick patients are, to cover the higher costs of sicker patients. Medicare calculates sickness scores from information supplied by doctors and submitted by the insurers. In the case of UnitedHealth, many of those doctors work directly for UnitedHealth. More diagnoses make for higher scores—and larger payments. A Wall Street Journal analysis found sickness scores increased when patients moved from traditional Medicare to Medicare Advantage, leading to billions of dollars in extra government payments to insurers. Patients examined by doctors working for UnitedHealth, an industry pioneer in directly employing large numbers of physicians, had some of the biggest increases in sickness scores after moving from traditional Medicare to the company’s plans, according to the Journal’s analysis of Medicare data between 2019 and 2022. Sickness scores for those UnitedHealth patients increased 55%, on average, in their first year in the plans, the analysis showed. That increase was roughly equivalent to every patient getting newly diagnosed with HIV, the virus that causes AIDS, and breast cancer, the analysis showed. That far outpaced the 7% year-over-year rise in the sickness scores of patients who stayed in traditional Medicare, according to the analysis. Across Medicare Advantage plans run by all insurers, including UnitedHealth, scores for all newly enrolled patients rose by 30% in the first year. A spokesman for United-Health said in a written statement that the company’s practices lead to “more accurate diagnoses, greater availability of care and better health outcomes and prevention, including less hospitalization, more cancer screenings and better chronic disease management.” https://lnkd.in/dRfKBUc8

UnitedHealth’s Army of Doctors Helped It Boost Medicare Payments Biggest Medicare Advantage insurer gave physicians checklists of potential diagnoses ( Christopher Weaver, Anna Mathews and Tom McGinty, The Wall Street Journal,01/01/25 ) HIHUB.TECH🌎Health Innovation♾️Leaders🧬NEWS Like most doctors, Nicholas Jones prefers to diagnose patients after examining them. When he worked for UnitedHealth Group, though, the company frequently prepared him a checklist of potential diagnoses before he ever laid eyes on them. UnitedHealth only did that with the Eugene, Ore., family physician’s Medicare Advantage recipients, he said, and its software wouldn’t let him move on to his next patient until he weighed in on each diagnosis. The diagnoses were often irrelevant or wrong, Jones said. UnitedHealth sometimes suggested a hormonal condition, secondary hyperaldosteronism, that was so obscure Jones had to turn to Google for help. “I needed to look it up,” he said. The government’s Medicare Advantage system, which uses private insurers to provide health benefits to seniors and disabled people, pays the companies based on how sick patients are, to cover the higher costs of sicker patients. Medicare calculates sickness scores from information supplied by doctors and submitted by the insurers. In the case of UnitedHealth, many of those doctors work directly for UnitedHealth. More diagnoses make for higher scores—and larger payments. A Wall Street Journal analysis found sickness scores increased when patients moved from traditional Medicare to Medicare Advantage, leading to billions of dollars in extra government payments to insurers. Patients examined by doctors working for UnitedHealth, an industry pioneer in directly employing large numbers of physicians, had some of the biggest increases in sickness scores after moving from traditional Medicare to the company’s plans, according to the Journal’s analysis of Medicare data between 2019 and 2022. Sickness scores for those UnitedHealth patients increased 55%, on average, in their first year in the plans, the analysis showed. That increase was roughly equivalent to every patient getting newly diagnosed with HIV, the virus that causes AIDS, and breast cancer, the analysis showed. That far outpaced the 7% year-over-year rise in the sickness scores of patients who stayed in traditional Medicare, according to the analysis. Across Medicare Advantage plans run by all insurers, including UnitedHealth, scores for all newly enrolled patients rose by 30% in the first year. A spokesman for United-Health said in a written statement that the company’s practices lead to “more accurate diagnoses, greater availability of care and better health outcomes and prevention, including less hospitalization, more cancer screenings and better chronic disease management.” https://lnkd.in/dRfKBUc8