This week, our In Focus section reviews UnitedHealth Group’s The Path Forward to a Next-Generation Health System, an outline of policy recommendations to achieve a high-quality, affordable health care system. The paper focuses on four goals: 1) achieve universal coverage; 2) improve health care affordability; 3) enhance the health care experience; and 4) drive better health outcomes. UnitedHealth Group (United) advocates for expanding Medicaid in the remaining states, passively enrolling individuals into Medicaid and the Exchanges, implementing a Medicaid Buy-In program, transitioning Medicaid fee-for-service (FFS) programs to managed care, strengthening Medicare Advantage, eliminating surprise billing, expanding access to telehealth, in addition to other policies.
Achieve Universal Coverage
The Path Forward lays out ways to strengthen and expand existing coverage in order to get 28 million uninsured individuals health care.
The Medicaid program can cover an additional 9 million individuals if the remaining 12 states expand Medicaid and all states passively enroll eligible individuals into Medicaid, according to United. Expanding Medicaid could cover 2.3 million individuals, with an estimated 1.5 million of those with mental illness or substance use disorder (SUD), across the 12 states. Auto-enrolling individuals who are eligible for Medicaid but are not currently enrolled and simplifying eligibility determinations could cover 6.7 million individuals.
United also recommends implementing a Medicaid Buy-In program for low-income enrollees in Exchange plans to “reduce churn, lower the per capita cost of coverage by 43 percent on average, and increase choice in rural areas.”
Additionally, to save $100 billion over 10 years, United proposes transitioning all Medicaid FFS populations into managed care, including the dual eligible population. Today, about two-thirds of Medicaid enrollees are in managed care. United believes that managed care ensures high-quality care, increases access to well-care and primary care, provides access to enhanced services and supports not covered in FFS programs, and reduces costs. To help Managed Care Organizations (MCOs), United suggests broader flexibilities, including: designing localized, flexible health benefits; aligning provider payment rates to reward quality outcomes through value-based care programs; addressing social determinants of health through fully integrated medical and social services care models; and developing performance-based networks to improve quality by modernizing network adequacy standards and promoting premium physician designation based on quality and cost efficiency.
United recommends passively enrolling individuals eligible for subsidies into Exchange plans in order to cover an additional 9 million individuals. Those enrolled would have an option to opt-out. To further lower premiums, United believes the federal age rating requirement should be extended from 3:1 to 5:1 to encourage younger, unsubsidized populations. Currently, under the Affordable Care Act (ACA) age banding methodology, premiums charged for older adults are limited to three times the premium for a 21-year old.
According to the paper, to enroll an additional 10 million individuals, states should offer public and private coverage platforms to increase choice and competition. High-deductible plans can be modernized to allow coverage of high-value services before the deductible and fund Health Savings Accounts up to the maximum out-of-pocket limit.
Finally, United advocates protecting Medicare Advantage by ensuring its stability.
Improve Health Care Affordability
To make health care affordable for individuals, United recommends value-based care arrangements, eliminating surprising billing, and shifting care to lower cost sites.
To accelerate value-based care, United believes in transitioning to value-based arrangements for prescriptions drugs, leveraging private-sector innovation and clinical expertise in Medicare and Medicaid, and supporting Medicare Advantage with sustainable funding and increased flexibilities. According to United, value-based pricing arrangements for prescription drugs could lower consumer out-of-pocket costs by 28 percent.
To end surprise billing, United proposes establishing a median in-network rate for out-of-network provider services. The paper states this is would reduce premiums for consumers and employers by $250 per person annually.
To shift care to lower cost sites, United proposes modifying federal laws and regulations that restrict care to specific care settings and promoting benefit designs that reward physicians and consumers for choosing more efficient sites of care.
Enhance the Health Care Experience
United lays out ways to creating a system that is simpler and more transparent. Consumer engagement can be increased by creating financial and benefit incentives for Medicare and Medicaid beneficiaries who act on their health and by creating easy to use digital tools for consumers. To reduce physician burden, a single, national set of evidence-based care measures should be established and technologies that embed actionable clinical information in the physician workflow should be adopted. By simplifying and standardizing how physicians measure and track the quality of care, they can spend more time on patients. Additionally, United believes that the flexibilities in telehealth established during the Covid-19 pandemic should be made permanent.
Drive Better Health Outcomes
To improve health outcomes and quality of care, United recommends more flexibility in value-based provider reimbursement models and implementing a physician-designation program in Medicare and Medicaid that financially rewards providers practicing high-quality and efficient care. Medicare and Medicaid should have adequate funding for integrated medical, behavioral, and social determinants of health care models for individuals with multiple chronic conditions. Medicaid should also promote the use of comprehensive, outcomes-based maternal care models. Addressing low health literacy in patients by training clinicians and providing them with tools and resources can reduce emergency room visits and hospital admissions.