UnitedHealth report: Connecting Medicare patients with 'high-value' docs could save billions

Calculator that says "Medicare" on it on top of money, next to bottle of pills
A new report from UnitedHealth Group suggests Medicare should steer beneficiaries toward "high-value" physicians. (Getty Images/liveslow)

Ensuring Medicare patients are treated by “high-value” physicians could lead to billions in savings for the program, according to a new report from UnitedHealth Group. 

The health insurance giant estimates that connecting all fee-for-service Medicare patients with physicians who provide high-quality care at a lower cost could save the federal health program $20.5 billion in 2020 and $286.8 billion over the next decade. 

Medicare beneficiaries would also likely feel those savings in their pocketbooks, according to UnitedHealth, as the cost reductions trickle down in lower premiums and out-of-pocket costs. 

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UnitedHealth is basing these estimates on the performance of such providers in caring for UnitedHealthcare’s members. A high-value doc is one that meets quality and cost measures outlined in the insurer’s UnitedHealth Premium Program, according to the report, which includes quality benchmarks from the National Quality Forum and National Committee for Quality Assurance. 

RELATED: UnitedHealth study—Administering specialty drugs outside hospitals could save $4B 

“High-value physicians who care for patients with UnitedHealthcare insurance have higher rates of compliance with evidence-based medicine and lower rates of complications and revisions than other physicians,” researchers at the insurer wrote in the brief. 

For example, patients treated by cardiologists who met those quality and cost benchmarks saw 9% fewer complications and 15% fewer revisions for stent replacement, according to the report. Patients who received a knee replacement from high-value orthopedists experienced 10% fewer complications and 41% fewer revisions. 

Care provided by these physicians was also linked to significant reductions in the use of high-cost services among UnitedHealthcare’s Medicare members, according to the study.  

UnitedHealthcare Medicare beneficiaries who were treated 75% of the time by high-value docs had 64% fewer inpatient hospital days and 35% fewer emergency department visits—leading to 21% lower risk-adjusted spending per member per month compared to other patients. 

RELATED: CMS may overpay Medicare Advantage plans by billions, study finds 

UnitedHealth found that cost savings vary between physician specialties. That opens the door for more targeted spending reductions, researchers said.

“The significant difference in per-patient or per-episode cost within each specialty evaluated represents an opportunity to improve the cost-efficiency of physicians who already meet the quality criteria, driving substantial savings for seniors and the Medicare program,” the researchers wrote. 

Primary care should be a prime target, according to the report. As primary care physicians see by far the largest volume of patients among the specialties in the study (about 59% of patient volume), improving cost efficiency in this area could lead to $14.5 billion in savings to Medicare in 2020 and $202.9 billion over the next decade. 

That’s just over 70% of the total projected savings in the study, UnitedHealth said. 

Cardiology, pulmonology and neurology also present an opportunity, the report shows. Improving cost efficiency among these physicians could lead to $4.3 billion in savings for 2020 and $61.2 billion through 2029. 

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