UnitedHealth Group CEO: Pandemic pushes providers to take more serious look at shift to value

A financial chart
Drops in revenue have caused providers to take another look at transitioning to value-based care, executives with UnitedHealth Group and SSM Healthcare say. (Getty/Ca-ssis)

More providers are looking at moving to value-based care as a result of the COVID-19 pandemic, UnitedHealth Group CEO David Wichmann said Thursday.

In particular, there was a strong surge of interest in moving to value-based care models at the outset of the pandemic when providers saw volumes flag and financial pressures grow amid stay-at-home orders, Wichmann said while speaking at a virtual event hosted by Optum, which is part of UHG.

That surge dissipated for a time when funding from the CARES Act came in to help providers plug financial holes caused by the pandemic, he said. But now that the funding from the CARES Act, which allocated $175 billion for providers, has dissipated, UHG is seeing a renewed surge of interest, Wichmann said.

He was speaking alongside Laura Kaiser, president and CEO of St. Louis-based health system SSM Health, who has seen a similar trend. 

The drop in revenue from Medicare fee-for-service has been “scary but thought-provoking for people to think about,” she said. “This was really very vulnerable, and it has been vulnerable for a long time.”

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However, the executives said that while they want to see a shift toward value-based care due to the pandemic, it will be a difficult journey.

Wichmann said not “all risk-bearing is created equal.” He said UHG typically takes three years to fully transition a physician practice to value-based care.

“You have to have a lot of skills and resources, in particular data analytics, mechanisms to manage your practice very differently,” he said. “The transition to it is very expensive.”

The journey can also be much different depending on where a provider is geographically, he said.

Part of it has to do with "being accepted within the community where you are operating,” Wichmann added.

It remains unclear how exactly the pandemic has changed healthcare use long-term and how that impacts the equation of moving away from fee-for-service.

The onset of the pandemic had patient volumes dropping precipitously as hospitals were forced to cancel elective procedures and doctors' offices temporarily shuttered. Those patient volumes have since rebounded, but Kaiser reports that, for SSM, the emergency department volume remains down.

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“The patients we are seeing are presenting more appropriate for the emergency room,” Kaiser said. “A lot of people coming to [the emergency department] in the past were in need of a level of care lower like urgent care.” She added that people are more “thoughtful about the care they are seeking.”

This is especially true among patient populations more at risk from the pandemic, Wichmann added.

He said this reluctance has increased the use of a digital tools like telemedicine and remote patient monitoring

“It is opening up this whole notion of the digital clinical home,” Wichmann said. “The whole receptivity around that is booming.”

Kaiser said accountable care organizations, which agree to take on financial risk to get a share of any cost savings, are a “key ingredient on moving us more to value-based [care] but we need to do that in partnership with others.”

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