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The Successful Shift of Joint Replacement Surgeries from Hospital Inpatient to Outpatient Settings is Saving the Health Care System $6 Billion This Year and Will Save $70 Billion over the Next Decade
Shifting more care to higher-value sites of service represents an opportunity to drive substantial savings for the health care system, including for government programs, while delivering clinically effective medical care that is better for consumers.
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Advancing Value-Based Care in the U.S. Health Care System
Value-based care shifts the focus from treating individual health issues as they arise to actively supporting people in staying healthy and achieving better long-term outcomes. Unlike fee-for-service, which incentivizes additional procedures and uncontrolled spending, value-based care aligns payments with patient outcomes.
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Home Delivery Supports Greater Medication Adherence and Lower Total Costs Among Medicare Beneficiaries
Home delivery pharmacies advance medication adherence by offering consumers convenience and timely access to long-term medication regimens. If 80 percent of non-adherent beneficiaries with hypertension became adherent to their hypertension medications, Medicare savings would reach $5 billion in the first year and exceed $60 billion over ten years.
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Prescription Drug Prices Are Driving Cost Increases for Employers and Commercially Insured Individuals
Total prescription drug spending by health plans on commercially insured individuals more than doubled between 2014 and 2024, driven by an 84% increase in the average price of a prescription.
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The Successful Shift of Joint Replacement Surgeries from Hospital Inpatient to Outpatient Settings is Saving the Health Care System $6 Billion This Year and Will Save $70 Billion over the Next Decade
Shifting more care to higher-value sites of service represents an opportunity to drive substantial savings for the health care system, including for government programs, while delivering clinically effective medical care that is better for consumers.
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UnitedHealthcare’s Level2® Care Initiative: Empowering Individuals with Type 2 Diabetes to Improve their Health by Meaningfully Reducing Blood Glucose Levels
Although diabetes is often chronic and progressive, it does not have to be. With appropriate treatment and management, many patients with type 2 diabetes can become healthy again.
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Fully Integrated Plans for Dual Medicare-Medicaid Enrollees: Helping Individuals Receive Long-Term Services and Supports at Home While Containing Medicaid Costs
When beneficiaries requiring Long-Term Services and Supports (LTSS) are aligned under a single plan that coordinates all Medicaid and Medicare benefits, enrollees have greater use of home and community-based services relative to nursing home care, and Medicaid LTSS costs are lower.
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UnitedHealthcare is Helping over 5 Million Medicare Advantage Enrollees Reduce Financial and Food Insecurity to Improve Their Health Outcomes
UnitedHealthcare is increasing Medicare Advantage enrollees’ purchasing power and access to over-the-counter wellness products, healthy food, and utilities to improve their health outcomes and reduce avoidable hospital inpatient admissions and emergency department visits.
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Less than 7% of Commercial Health Premiums Goes to Administration – with Clinical Access and Support, Technology, and Consumer Engagement Representing Most Administration Costs
The vast majority of fully insured commercial premiums is dedicated to medical spending, which covers preventive services, scheduled clinical visits, ongoing care for chronic conditions, and unexpected needs.
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Optum Health Primary Care Practices Outperform Hospital-Based and Other Physician-Owned Practices on Quality and Cost for Medicare Patients
As primary care practices seek needed partnerships, Optum Health offers a better alternative than hospital ownership by aligning the interests of patients, physicians and payors.
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Increased Use of Home Delivery Pharmacies by Commercially Insured Individuals Can Save Consumers and Employers an Additional $23 Billion on Prescription Drug Costs over 10 Years
U.S. consumers and employers are already saving an estimated $600 million annually on home delivery of maintenance medications.
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Medicare Advantage Costs the Federal Government Less than Medicare FFS and Provides $60 Billion Annually in Additional Value through Lower Out-of-Pocket Costs and Additional Services
The additional benefits offered in Medicare Advantage – which are not covered by Medicare FFS – are delivered for no additional cost to the federal government and with out-of-pocket savings to the beneficiary.
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Surest is Providing High-Quality Health Coverage that is Affordable, Predictable, and Equitable
UnitedHealthcare’s Surest, a value-based copay plan with a broad provider network, offers predictability to consumers and helps employers incorporate health equity principles into their health benefits.
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All 23 Million Uninsured Individuals Are Eligible for an Existing Source of Health Coverage
Making existing sources of coverage more affordable and accessible can reduce the number of uninsured people in the U.S.
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Medicare Beneficiaries Achieve Greater Medication Adherence with Home Delivery 90-Day Prescriptions
Up to 32% fewer individuals are non-adherent compared to those with retail 90-day prescriptions.
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Commercially Insured Individuals Achieve Greater Medication Adherence with Home Delivery 90-Day Prescriptions
Up to 38% fewer individuals are non-adherent compared to those with retail 90-day prescriptions.
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Surest Enrollees Have 54% Lower Out-of-Pocket Costs and 11% Lower Total Medical Costs than Other Commercially Insured Individuals
UnitedHealthcare’s Surest, a value-based copay plan with a broad provider network, is engaging consumers with clear and actionable information on the effectiveness of different providers and treatment options and the cost of health care services.
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Beneficiaries in Medicare Advantage Receive Better Value and Spend 45% Less than Beneficiaries in Medicare FFS
Compared to Medicare FFS, MA beneficiaries with chronic conditions receive more preventive care and have fewer emergency department visits and hospital admissions.
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Medicare Advantage is Addressing Social Determinants of Health at Scale to Improve Health Outcomes and Advance Health Equity
Helping Medicare beneficiaries address social needs by connecting them to government and community-based programs can improve health outcomes, enrollees’ quality of life, and support effective use of the health care system.
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Self-Insured Employer Plans Offer Innovations that Lower Costs and Improve Employees’ Health
Over 100 million people in the U.S., 65 percent of those with employer coverage, are covered through self-insured plans.
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Telehealth Enabled a 13% Increase in Outpatient Behavioral Health Visits among Medicare Advantage Enrollees
Ensuring access to behavioral health care for older adults and individuals with disabilities is an important priority.
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Seniors Receiving In-Home Clinical Visits Realize Improved Outcomes and Receive More Preventive Services
One way to improve or maintain seniors’ health outcomes over time is to actively engage them through in-home clinical visits that close and prevent gaps in care by assessing health risks, identifying preventive care opportunities, and supporting primary care delivery.
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Comprehensive Programming for Families of Children With Special Health Care Needs Improves Experiences While Lowering Costs
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Telehealth Enabled a 26 Percent Increase in Outpatient Behavioral Health Visits Among Commercially Insured Individuals
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High-Performing Skilled Nursing Facilities Could Prevent 100,000 Medicare Hospital Readmissions per Year and Save $56 Billion over 10 Years
Skilled nursing facilities (SNFs)—which play the vital role of helping patients recover after surgical procedures and medical conditions requiring hospital care—provided post-acute services to over 2 million Medicare beneficiaries at a cost of over $40 billion in 2019.
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Enrolling Elderly and Disabled Medicaid Beneficiaries in Managed Care Can Achieve Better Outcomes and Save $150 Billion over 10 Years
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Shifting Common Outpatient Procedures to ASCs Can Save Consumers More than $680 per Procedure
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Medicaid Can Cover 45% More Uninsured People than Public Exchanges for the Same Cost
Medicaid leverages state-based coverage platforms and proven managed care models to provide high-quality, cost-effective health insurance to 75 million low-income people without other coverage options - an increase of 12 million people since 2013.
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Beneficiaries in Medicare Advantage Receive Better Value and Spend 40% Less than Beneficiaries in Medicare FFS
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Waving the Medicaid Best Price Rule Could Boost Savings from a Commercial Value-Based Arrangement by $4 Billion
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Capping Exclusivity for Biologics Could Save $20 Billion on Drug Spending
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Performing Joint Replacements in Ambulatory Surgery Centers Could Help 500,000 People Avoid Overnight Hospital Stays and Save $3 Billion Annually
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OptumCare Primary Care Practices Deliver More Value to Patients, Outperforming Hospital-Owned Practices on Quality and Cost
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Consumers Can Save More than $300 per Diagnostic Imaging Test
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Improving Health Literacy Could Prevent Nearly 1 Million Hospital Visits and Save Over $25 Billion a Year
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Global Capitation Payments Result in the Highest-Quality Primary Care for Seniors
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10 Million Children with Limited Access To Primary Care Could Receive Annual Checkups in Urgent Care Centers
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The Medicare Program Could Save $11 Billion Over Five Years by Reforming Medicare Part B Drug Payment Policy
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Lowering Hospital Prices to the National Average Price Could Save the Health Care System $225B
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Consumers Could Save Nearly $50 Billion a Year with Reduced Price Variation of Health Care Services
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Pharmacy Benefit Management Can Save Medicaid Drug Programs over $110 Billion
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High-Value Physicians Can Save the Medicare Program Over $286 Billion in Health Care Costs
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Administering Specialty Drugs Outside Hospitals Can Improve Care and Reduce Costs by $4 Billion Each Year
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Hospital Price Increases for Inpatient Services Will Cost Consumers and Employers $250 Billion over the Next Decade
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18 Million Avoidable Hospital Emergency Department Visits Add $32 Billion in Costs to the Health Care System Each Year
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What is Driving Increases in Health Care Premiums?
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Out-of-Network Emergency Physicians Increase Health Care Prices for Consumers by $6 Billion Each Year
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High-Performing Physicians Can Save Consumers Over $700 Billion in Health Care Costs
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Addressing the Nation’s Primary Care Shortage: Advanced Practice Clinicians and Innovative Care Delivery Models
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Freestanding Emergency Departments in Ohio
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Freestanding Emergency Departments in Colorado
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Freestanding Emergency Departments Treating Common Conditions at Emergency Prices
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Advancing Primary Care Delivery: An Update
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Successful Medicaid Enrollment Strategies to Cover the Uninsured
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Advancing Primary Care Delivery: Practical, Proven, and Scalable Approaches
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The Growth of Specialty Pharmacy: Current Trends and Future Opportunities
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100 PERCENT OF OUR FUTURE: Improving the health of America’s children (WP 10)
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Medicare and Medicaid: Savings Opportunities from Health Care Modernization (WP 9)
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FAREWELL TO FEE-FOR-SERVICE? A “Real World” Strategy For Health Care Payment Reform (WP 8)
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Personalized Medicine: Trends and prospects for the new science of genetic testing and molecular diagnostics (WP 7)
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The United States of Diabetes: Challenges and opportunities in the decade ahead (WP 5)
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US Deficit Reduction: The Medicare and Medicaid Modernization Opportunity (WP 4)
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Modernizing Rural Health Care: Coverage, quality and innovation (WP 6)
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