Massachusetts Medical Society’s Post

As of November 2023, UnitedHealth Group, the parent company of UnitedHealthcare, employs or has affiliations with about 90,000 doctors, which is around 10% of all physicians in the United States. This is more than any other hospital system or clinic chain. UnitedHealth's Optum Health division is the largest employer of physicians, with 70,000 employed or affiliated physicians across the country Is this totally correct factual information with evidence of the following matter of https://lnkd.in/gt35qABy How UnitedHealth harnesses its physician empire to squeeze profits out of patientsBy Bob Herman , Tara Bannow , Casey Ross ,  and Lizzy Lawrence July 25, 2024This is the first in a periodic series about how UnitedHealth Group wields its unrivaled physician empire to boost its profits and expand its influence.UnitedHealth Group started out as a small, Minnesota health insurance company and has since morphed into a modern-day Standard Oil, exerting unmatched dominance over health care in the United States.It’s no secret that UnitedHealth is a colossus: It’s the country’s largest health insurer and the fourth-largest company of any type by revenue, just behind Apple. And thanks to a series of stealthy deals, almost 1 in 10 U.S. doctors — some 90,000 clinicians — now either work for UnitedHealth or are under its influence, more than any major clinic chain or hospital system.ADVERTISEMENTBut behind those statistics, there’s a lot UnitedHealth doesn’t want you to know. A STAT investigation reveals the untold story of how the company has gobbled up multiple pieces of the health care industry and exploited its growing power to milk the system for profit. UnitedHealth’s tactics have https://lnkd.in/gnCTMZ6B

A recent STAT investigation reveals that UnitedHealth Group compensates its own Optum physician groups far more generously than other practices in the same markets for comparable services. Rather than using its massive scale to reduce patient costs, UnitedHealth leverages its dual role as insurer and provider to increase prices and maximize profits. This disparity distorts fair competition and escalates healthcare costs for patients and employers nationwide. As healthcare systems contend with shrinking margins and growing premiums, it’s critical to demand greater accountability from insurers. https://lnkd.in/gGePMmgw

If United Healthcare Group were in the insurance market, the profits would vary by year. In some years, they would make a tremendous profit, and in others, they would lose. However, the profits march up year over year because they have offloaded the risk on: • Patients through high premiums, deductibles, max-out-of-pocket, co-pays, co-insurance, delays, and denials of care. • Physicians by underpaying them and clawing back payments • Pharmacists, the same as physicians Another reason for the increasing profits is Optum RX, which earns a fortune by selling access to the drug market. Employers would be better off using a third-party payer and self-insuring than using UNH.

Smaller PBMs that advertise themselves as transparent have gained traction over the last few years as health insurers, employers and government entities look to deviate from the traditional spread pricing model. Many of these companies have said 2024 was their largest selling year, with an increasing number of large customers showing interest.

🚨 UnitedHealthcare’s Dirty Little Secret 💸💉 Here’s the deal: UnitedHealth Group owns Optum, their healthcare provider arm, and guess what? They pay Optum MORE than independent providers for the same exact services. 🧐💵 Why? Two possible reasons: 1️⃣ They’ve realized running a practice is way more expensive than their low reimbursements to everyone else. (Welcome to reality, UHG 👋). 2️⃣ They’re double-dipping like it’s chips and guac: - Collect premiums ✅ - Pay Optum extra ✅ - Pocket those sweet profits ✅ Either way, it’s not saving healthcare dollars—it’s making patients and providers foot the bill while they rake in cash. 👉 Independent providers? Getting squeezed harder than a stress ball in a Monday morning meeting. 👉 Patients? Paying more and getting fewer choices. 👉 Healthcare costs? Staying sky-high so UHG can keep padding their profits. As a practice owner, it’s maddening. While we work to deliver quality care and stretch every dollar, they’re gaming the system for their gain. 💬 What do you think? Drop your thoughts below. Independent practices deserve better—and so do patients. #Healthcare #PhysicalTherapy #FairReimbursement #privatepractice #unitedHealthcare #doubledip https://lnkd.in/erR5Bukq

Direct Primary Care (DPC) is transforming healthcare with a membership-based model that enhances patient care and clinician satisfaction. Here’s why: 🔹 Autonomy & Flexibility: Clinicians have full control over their practice, leading to a more tailored and fulfilling work experience. AAFP data shows a growing trend of physicians moving to DPC for better work-life balance. 🔹 Stronger Patient Relationships: Smaller patient panels allow for deeper connections and higher care quality, leading to 94% clinician satisfaction in DPC practices compared to 57% in traditional settings. 🔹 Financial Transparency: Say goodbye to insurance complexities. DPC offers clear, predictable costs through membership fees, reducing financial surprises for patients. 🔹 Enhanced Patient Care: More time with each patient means better preventive care and health outcomes. Patients benefit from direct, accessible communication with their clinicians. Interested in exploring DPC? Discover more and read our latest blog at https://lnkd.in/g2YEZJHw

Why the whole physical therapy industry is not dropping UnitedHealth Group is mind boggling to me. I understand the large corporations/institutions getting higher reimbursement maintaining their contracts (Higher reimbursement that most likely is not deserved). All while the heart and soul of the healthcare industry and this country, the independent practice owner, are thanked with pennies and headaches. These prior authorizations should be illegal, especially when a patient hasn’t met their deductible. When a patient calls me asks if I take UHC. I explain to them why I don’t take UHC. I’m sure to detail the behaviors of their insurance company. #healthcare #unitedhealthcare #healthinsurnace #physicaltherapy #apta

Excellent article from CNBC Shares of major health-care companies fell nearly 5% on Wednesday on concerns related to potential changes to their complex business models. That includes UnitedHealth Group, Cigna and CVS Health, which operate three of the nation’s largest private health insurers and drug supply chain middlemen called pharmacy benefit managers. The stock reaction on Wednesday appeared to be in response to new bipartisan legislation that aims to break up pharmacy benefit managers. UnitedHealth Group Cigna Healthcare CVS Health #Healthcare #Drug What is next for the Healthcare delivery model through leveraging of Generative AI - https://lnkd.in/g2Gxadxq

UnitedHealth is using its power to game the system. A new investigation by STAT reveals UnitedHealth Group pays its own Optum physician groups significantly more than it pays other practices in the same markets for similar services. Instead of leveraging its size to lower costs for patients, UnitedHealth uses its dual role as insurer and provider to inflate prices and boost profits. This imbalance undermines fair competition and drives up healthcare costs for patients and employers across the country. As health systems face tightening margins and rising premiums, we must demand accountability from insurers operating at this scale. https://lnkd.in/e25b6k8U

Thoughts on Digtial Health in the New Year Although there are many innovations in digital health and AI, I think the real benefit of these cannot be realized without changes in affordability and accessibility of healthcare. Two major barriers became clear this year: 1 - PBMs, pharmacy benefit managers. Four companies dominate this realm and as middle men, extract a huge amount of wealth out of the system and make many drugs unaffordable (with the exception of generics). One promising sign is from Mark Cuban who is disrupting this trend. https://lnkd.in/gxvJRkNZ 2- Medicare Advantage- while this was meant to make Medicare more comprehensive to many offering free or low cost policies, the denials of care and high deductibles have harmed both patients and providers while allowing insurance companies massive profits. See this Wall Street article for more information. https://lnkd.in/gzsA-3Z4 Regarding AI - While the hyped promises of revolutionizing healthcare are everywhere, I think a focused approach of actual use cases is essential. It is helpful to see both the government and professional organizations like the AMA establish ethical guidelines. One concern I have is the energy and water it takes to sustain AI. See this NYT article: https://lnkd.in/gBkMpcve Regarding digital health, I think here again a focus on successful use cases such as diabetes self-care, remote monitoring of chronic conditions (also empowering patients) and greater use in clinical trials. As noted above, without affordable and accessible care for all, the impact on chronic conditions will be limited.