Phil Castle, The Business Times
United Healthcare will bring expertise and analytical resources to a health care network in Mesa County that will help in efforts to provide better services at lower costs, according to the president of St. Mary’s Medical Center in Grand Junction.
“We’re pretty excited about it,” said Dr. Brian Davidson.
In acquiring Rocky Mountain Health Plans, United Healthcare became a partner along with St. Mary’s and Primary Care Partners in Monument Health.
Monument Health brings together physicians and the hospital to care for patients, while the insurer offers health plans and works with employers and organizations that provide self-funded benefits to employees.
Federal regulations define what’s called a clinically integrated network as a program to evaluate and modify practice patterns to raise quality and lower costs through interdependence and cooperation. While network partners collaborate, they remain independent entities.
A unit of UnitedHealth Group based in Minnesota, United HealthCare serves about 1.2 million people in Colorado. Based in Grand Junction, Rocky Mountain Health Plans and its affiliated entities provide services to more than 280,00 enrollees.
As part of one of the largest health insurers in the country, United Healthcare brings expertise in a variety of markets as well as proprietary analytical tools that can help in managing care for a population, Davidson said. The ability to better assess risks and predict costs also could result in lower insurance premiums, he said.
Monument Health offers a way to accommodate changes in the way health care providers are paid for services, Davidson said, in shifting from what’s long been a fee-for-services model to paying providers based on the quality, rather than quantity, of their care. “All of health care is going that way.”
A fee-for-services model creates incentives for providers to order additional services for patients, even if they’re not clinically demonstrated to be necessary, Davidson said. That in turn drives up health care costs. Under a values-based model, providers that achieve measurable results and lower costs share in some of the money from the savings.
Sharing health records and coordinating care helps in streamlining care, avoiding redundant or unnecessary services and making sure providers and patients follow up, Davidson said.
Such an effort also works well in caring for patients which such chronic conditions as diabetes and high blood pressure, he said. Proactively managing their care reduces the necessity of more costly treatments in an emergency room or hospital.
Another part of the process is changing who’s providing certain health care services, Davidson said. Sometimes it isn’t necessary for a doctor to provide certain services when well-trained professionals, including educators and case managers, could provide those services at a lower cost.