United Health Group has released what it believes is the "path forward" for the healthcare industry as it charts a course for broad reform.
The healthcare insurance giant's new paper outlines four key goals it says the private and public sectors can achieve by building "on the strengths of the current system."
"Together, the private and public sectors can build on what’s working today and address shortcomings by continuing to develop innovative solutions that achieve universal coverage, make health care more affordable, provide better experiences for consumers and physicians, and improve health outcomes," the company wrote.
The policy priorities highlighted in the report are:
- Achieving universal coverage
- Improving affordability
- Enhancing the healthcare experience
- Boosting health outcomes
In the paper, UnitedHealth argues that building on Medicaid expansion and the Affordable Care Act's exchanges can reach the millions of people who lack health insurance. Expanding Medicaid nationally would offer coverage to 2 million on its own, according to the report.
In addition, creating a program to passively enroll those eligible for Medicaid would extend coverage to 7 million people, UnitedHealth Group said. Extending this passive enrollment to the exchanges would further cover 9 million, according to the report.
To address affordability, the report suggests three broad swath ideas: Accelerate the adoption of value-based care, eliminate surprise billing and shift more services to lower-cost sites of care. Finding success in these three areas could lead to $1.5 trillion in government savings.
Transition to value-based pricing arrangements for prescription drugs would lower consumer out-of-pocket costs 28% on its own, according to the report.
On surprise billing, UnitedHealth argues that setting a median rate for out-of-network providers would reduce premiums for employers and consumers by $250 per person each year, saving $40 billion nationally.
A rate-setting approach to mitigate surprise billing is deeply unpopular among providers, as it would cut reimbursement rates. They instead favor using baseball-style arbitration to settle disputes, and the divide on an approach has snared multiple pieces of surprise billing legislation in Congress.
Other reforms the report suggests include deploying clinician communication tools and enhance approaches to improve health literacy, which could reduce emergency department visits by 10% and hospital admissions by 18%.