UnitedHealthcare PCMH Program

Arizona, Colorado, Connecticut, Maryland, Missouri, New Jersey, New York, Ohio, Rhode Island, Texas

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* Featured in 2015 PCPCC Annual Report
Program Location: 
Minnetonka, MN
Payer Type: 
Commercial
Payers: 
UnitedHealthcare

Reported Outcomes

Description: 

UnitedHealthcare currently operates 13 medical home programs in 10 states for the commercially insured population  These programs include more than 2,000 participating physicians and 300,000 members. 

UnitedHealthcare’s medical home model integrates a range of capabilities. These include support for practice transformation, an engaged physician leadership, the integration of care management in practice workflow through a dedicated care manager, the exchange of data and analytics between the medical home and the payer that is real-time and bi-directional, upfront investments in HIT, and patient engagement in the care process over the long term. Even when all of these criteria are met, success also depends on a financial model that rewards value. 

 

Program Website
Improved Health: 
  • Independent third-party evaluations completed for four medical home programs in three states (Rhode Island, Colorado, and Ohio) showed improvement on quality measures for: preventive and chronic care, access, care coordination, use of health information technology
  • Success was notable for diabetes management. 
Cost Savings: 
  • An actuarial evaluation of four programs in Arizona, Colorado, Ohio, and Rhode Island, based on three full years of operation between 2009 and 2012 for 40,000 members, found average gross savings of 7.4 percent of medical costs in the third year compared to a control group. Every dollar invested in care coordination activities produced $6 in savings in the third year (a return on investment of approximately 6 to 1)
  • The costs of the interventions were 1.2 percent of medical costs and they offset 16 percent of the gross savings. Including the cost of the intervention, the programs saved approximately 6.2 percent of medical costs on average.
Other Outcomes: 

Not all measures met program targets, particularly those related to some cancer screenings, suggesting opportunities for improvement.

Data Source(s): 
UnitedHealth Group (September 2014)
Last updated April 2015
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