UnitedHealth Pulls the Switch

Get ready to renegotiate your contracts with the nation’s largest health insurer, which just announced that it plans to tie a greater part of provider fees to performance goals. As CMS rolls out various demonstration projects intended to experiment with payment forms beyond fee-for-service, UnitedHealth has jumped in with both feet announcing, that between 50% and 70% of the carrier’s insured members could be affected by 2015, according to an article in the Wall Street Journal.

Unlike Wellpoint and Aetna, which previously announced plans to improve and incentivize primary care, UnitedHealth intends to include the 5,500 hospitals as well as the specialists within its 550,000-physician network. How might radiology contracts be affected?

With such ideas on the table as preventing hospital readmissions and ensuring that members get screenings, there could be plenty of opportunities for radiologist involvement, beginning with finding new ways to ensure that patients get regular mammograms and extending to imaging follow-up of suspect lesions and nodules.

In the upcoming issue of Radiology Business Journal, Woojin Kim, MD, writes about Presto at the University of Pennsylvania, which can alert radiologists when pathology results are available.  What about a system that can alert an administrator when patients don’t come in for that 6-month follow-up of the liver lesion?