Expanding Value-Based Care in New England

UnitedHealthcare has a vision for addressing a fragmented, complex health system and creating one that delivers greater levels of value to consumers, customers and society, as a whole. Fulfilling that mission depends significantly on making health care more affordable, and shifting away from a fee-for-service model. Lowering costs is the pivotal element to improving and sustaining access, even as quality is enhanced. One way to achieve this is through high-performing providers, such as Accountable Care Organizations (ACOs), which work to provide greater care for people at lower costs. 

That is why UnitedHealthcare is creating network designs that will increasingly emphasize these high-performing care providers — those who share the vision of where health care needs to go. This will align reimbursement incentives to include full clinical and financial accountability with provider partners who are willing to bear both upside and downside risk.

One example of this strategy is NexusACO. UnitedHealthcare is collaborating with high-performing physicians and health systems throughout New England that have a proven record of working towards offering high quality, lower costs and a better patient experience. The plan pulls the triple aim focus- improving health care affordability, outcomes and the patient experience - together to provide the member with direct access to care from these established providers.

Similar employer-sponsored ACOs that work with UnitedHealthcare are starting to show positive results, based on recent data:

  • 11 percent fewer hospital admissions
  • 7 percent fewer hospital readmissions
  • 14 percent fewer ER visits
  • 9 percent shorter inpatient length of stay
  • A positive increase in PCP visits and cancer screening compliance

NexusACO hopes to follow those trends by putting an emphasis on encouraging employees to use in-network physicians who consistently work towards high quality and cost efficiency — to coordinate their care. Plan participants work with a primary care physician (PCP) – a medical resource who will coordinate the member’s health care and help members navigate the health care system. The PCP serves as the patient’s main point of contact, and will work to proactively engage their patients more often, hoping to ensure at-risk patients receive timely, appropriate health screenings, while helping people manage chronic diseases like diabetes, heart disease and arthritis.

“We know that employers throughout New England are looking for quality care at a lower cost, so we designed this strategy to deliver a competitive option that’s both patient centered and cost effective,” said Stephen Farrell, UnitedHealthcare CEO of New England. “In addition to delivering higher quality care, the plan will also offer potential cost-savings for companies, and also may offer employees lower monthly premiums compared to similar health plans.”

While the NexusACO roll out is primarily in New England, covered members across many areas throughout the rest of the nation will also have access. If employers have employees in more than one state, they can still offer consistent benefits to most of their workforce.

As of Jan. 1, 2020*, NexusACO will be available in Rhode Island in collaboration with Coastal Medical Group and Integra Community Care Network, in Connecticut with St. Francis Health Care Partners, and in Massachusetts with Reliant Medical Group.

*Pending regulatory approval