Kevin is chief managed care and revenue strategy officer at Unlock Health.
This post is the second in a series on the state of managed care by Kevin Thilborger. Check out the first post here.
If you have attended one of our speaking engagements or read any of our thought leadership, it might be easy to think we are a little obsessed with UnitedHealth Group. Truth is, we are a little obsessed. Every other health plan in the U.S. watches United and parrots its strategy in some way. So it’s not unreasonable to think that UnitedHealth Group is, in effect, the U.S. healthcare system.
I could use 10-12 emails or blog posts to unpack United’s corporate strategy and its implications for the healthcare system. Today, I will just focus on one small but very important aspect of that strategy.
In my friend Wendell Potter’s Health Care un-covered newsletter, he cites analysis by STAT News, quoting:
“UnitedHealth Group is so big that it doesn’t have to publicly announce a vast majority of its acquisitions. But a STAT analysis of company financial documents shows the healthcare conglomerate quietly acquired dozens of outpatient facilities in 2023, with a particular focus on surgery centers." — NOTE: this is on top of major acquisitions like LHV Group, Amedisys, Change Healthcare, and others. — "And it’s not adding random surgery centers, either. There seems to be an explicit strategy: Many of United’s new centers sit in geographic areas where the company is the biggest Medicare Advantage player, based on the latest insurance market share data. That overlap reinforces how UnitedHealth is looking to funnel more of its insurance members toward providers that it owns, with the overarching goal of capturing more profit."
As an example, STAT said it stumbled upon an entry — “buried within UnitedHealth’s annual report” — that revealed the company’s previously undisclosed December acquisition of National Cardiovascular Partners (NCP), which operates 21 cardiac catheter and vascular labs. Not coincidentally, NCP’s facilities are “in places like Phoenix and large metro areas in Texas where UnitedHealth has the biggest [Medicare Advantage] market share.”
According to Health Care un-covered, the situation underscores the perverse state of affairs in which United, which comprises some 2,642 separate companies that collectively raked in $371.6 billion last year, has arguably profited from the desperation inflicted on the healthcare system by the hacking of its Change computer systems in late February. An estimated half of all healthcare transactions are processed or somehow otherwise touched by Change, a rollup of dozens of healthcare technology firms that provide 137 software applications that have been affected by the outage. And United has already acquired two large physician practices who suffered financial distress as a result of the Change debacle — so there’s that.
Understanding UnitedHealth Group is important for two reasons:
- Know the other side. It’s important to know what United is doing when you deal with them, but also important to know what other health plans are likely to be doing. You must factor this intel into your own strategy.
- Craft the right narrative. So much of what United does is good for them but not necessarily good for hospitals, health systems, consumers, employers, and maybe all humans. Use factual information and analysis to paint a picture, and drive the right narrative.
Should your team need support in addressing any payor, Unlock Health is here to help negotiate these issues and many others in the complex world of payor-provider contracting. Our full-service managed care consulting group helps providers set their managed care strategy, negotiate contracts, and handle all the contract modeling, analytics, and performance. And when negotiations are difficult or contentious, we pioneered the use of strategic marketing communication campaigns to protect the provider’s brand and create pressure on the payor for a fair and reasonable settlement of contract negotiations. Email Kevin Thilborger, our chief managed care and revenue strategy officer, at [email protected].
Like what you’re reading? Check out the next post in this series on the state of managed care here.