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  • Writer's pictureSpencer Dunlap

Payer Pulse: UnitedHealthcare

The healthcare industry is constantly evolving as hospitals, providers, and payers compete for market share, better technology, and new opportunities to advance their goals. With all the moving parts, it can be difficult to keep up with the news, so we've created our Payer Pulse to keep you in the know on what's going on. This article covers 3 of the top stories impacting UnitedHealth, the largest health insurer in the U.S..

UnitedHealthcare healthcare billing revenue cycle insurance hospital

UnitedHealth, Optum and Change Healthcare Merger

Back in January, 2021, United Health announced plans for their subsidiary, Optum, to merge with Change Healthcare, one of the largest claims clearinghouses, for $13 billion. However, the deal quickly hit roadblocks as the Department of Justice (DOJ) filed a lawsuit to block the deal, the American Hospital Association sent a letter to the DOJ raising concerns, and then went further to contact the DOJ and Federal Trade Commission requesting a revision of how antitrust agencies evaluate hospital transactions like this one. To summarize the concerns of these groups, the worry is that this merger would give UnitedHealth access to too much information on rival companies (who use Change Healthcare) which would result in a significantly unfair market advantage.

UnitedHealthcare healthcare billing revenue cycle insurance hospital

The acquisition was expected to initially resolve in the second half of 2021, but with the intense level of scrutiny from the DOJ, it was delayed until April 2022, and now, as of April 5, has been pushed back again to December 31, 2022 while court trials are resolved in August. The results of the court case will be paramount as they lay precedent for future mergers and, if successful, grant UnitedHealth a lot of new resources at their disposal.

United Health, Optum to buy home-health group LHC

UnitedHealth also has another merger underway, this time not being interrupted by any government lawsuits.

At the end of March this year (2022) Optum, a subsidiary of United Health, purchased LHC Group, one of the largest home-health organizations for about $5.4 billion.

UnitedHealthcare healthcare billing revenue cycle insurance hospital

Although a subsidiary of UnitedHealth, Optum themselves are also a significant force in the healthcare world, serving more than 125 million people, 90% of US hospitals, and reporting about $10.5 billion in revenue in 2020. LHC Group, based out of Lafayette, Louisiana, is the third largest home-health provider, performing more than 12 million in-home services a year and boasts quality ratings well above the industry average (4.39 relative to 3.25 average). Through this acquisition, Optum is looking to further the reach of their value-based care capabilities by offering better home-health services; a noble endeavor while they finish wrapping up their legal troubles.

UnitedHealthcare Cuts Paper Prior Authorizations

Unrelated to mergers and acquisitions, UnitedHealthcare made an announcement at their annual Investor Conference in November, 2021 that they would be working toward environmental sustainability to minimize their impact on climate change.

 UnitedHealthcare healthcare billing revenue cycle insurance hospital

As a part of this initiative, they pledged to go paperless in the next 2-3 years to reduce the ~3.4 billion pages of paper they send out a year.

UnitedHealthcare began taking steps towards the environmental goal this year when they announced in February (2022) that they will be discontinuing all paper appeal decisions, prior authorizations, and clinical decision letters to providers. Instead, providers will be directed to access their correspondence electronically through their website.

This plan has been rolling out as of March when UHC stopped their paper appeal decision letters for its Medicare Advantage and Commercial plans, and again on April 1 when they stopped mailing prior authorizations, clinical decision letters, or other letters related to approvals and denials.

As the largest health insurer in the U.S., the decisions that UnitedHealthcare makes are under heavy scrutiny by the industry as other payers vie for their market share and the law keeps them in check. As these events play out we'll be waiting expectantly to see how they impact UnitedHealthcare's hold on the market.

 UnitedHealthcare healthcare billing revenue cycle insurance hospital

This article is written entirely for the sake of news commentary and news reporting and is not reflective of any goods or services by Claim Capital.


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