Intermountain, UnitedHealthcare create ACO for Medicare Advantage members

Intermountain Healthcare, a 24-hospital system based in Utah, and insurer UnitedHealthcare have established an accountable care organization that aims to improve care coordination and health outcomes for the payer’s Medicare Advantage members.

ACOs are networks of physicians and hospitals that share financial and medical responsibility for coordinating patient care with the aim of reducing unnecessary spending, according to Kaiser Health News. Essentially, providers in ACOs earn more if their patients remain healthy. There were 558 Medicare ACOs serving more than 12.3 million beneficiaries, with hundreds more commercial and Medicaid ACOs, as of January 2020, according to the National Association of ACOs.

Through the new ACO, UnitedHealthcare will link provider reimbursement to health outcomes for eligible Medicare Advantage members in Utah. Plan members receiving care from primary care physicians employed by Intermountain, as well as other participating primary care providers in Utah, are eligible for the ACO. There are about 136,000 UnitedHealthcare Medicare Advantage members in the state.

The providers participating in the ACO will coordinate care for patients with the support of Intermountain and Castell, a company created by the health system that provides tools and services to support the transition from fee-for-service to value-based care. Castell will help participating providers with care management, network services and documentation.

“We’re always looking for ways to provide a better healthcare experience for those we serve through our Medicare Advantage plans and believe this expanded relationship with Intermountain will help us do that,” said Marc Briggs, CEO of UnitedHealthcare Medicare & Retirement in Utah, in a press release.

UnitedHealthcare will also share data with Intermountain providers about its members’ underlying conditions, past treatments, gaps in care, prescriptions and potential care needs in the future. Providers can use the data to identify patients at high risk for poor health outcomes, like being readmitted to a hospital or needing to go to the emergency room, and intervene in time, according to the press release. Providers can also use the data to help patients manage chronic conditions and keep tabs on their medication intake.

The ACO is the latest joint effort in the long-term association between the health system and payer, which extends back to 2004.

“Expanding our long-standing relationship with UnitedHealthcare provides our patients with enhanced benefits and program options while still emphasizing affordability,” said Dr. Marc Harrison, president and CEO of Intermountain, in a press release. “Good health goes beyond physical care, which is why we take an approach to health and wellness through programs such as care coordination. The goal is to help seniors live healthier lives.”

Photo credit: erdikocak, Getty Images



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