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.
One example of this strategy is NexusACO. In Rhode Island, UnitedHealthcare is collaborating with high-performing physicians and health systems Integra Community Care Network and Coastal Medical of Rhode Island, both with 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, CEO, UnitedHealthcare 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.”
NexusACO, which will be available in Rhode Island as of Jan. 1, 2020, will include the Coastal Medical network, and the Integra Community Care Network. Integra Community Care Network includes the Care New England health system and Visiting Nurse Association, Rhode Island Primary Care Physicians Corporation (RIPCPC), South County Hospital and an affiliated network of specialists. Together, throughout the state, these ACOs will include more than 790 providers to serve more than 240,000 patients.
“Integra’s partnership with UnitedHealthcare clearly demonstrates what is possible when payers and providers align,” said John Minichiello, president of Integra Community Care Network. “Our patients have benefitted greatly from this relationship and we look for future opportunities to leverage each other’s strengths.”
“Coastal is proud to share in UnitedHealthcare’s vision of providing our community access to better health and better care at a lower cost,” said Dr. Alan Kurose, president & CEO of Coastal Medical. “Health care delivery is at an inflection point nationally and Coastal intends to lead the next wave in alignment with our pursuit of the Triple Aim.”
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.