United Health Group Acquisition of Change Healthcare... Healthcare Data Goldmine
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- Опубліковано 24 вер 2022
- United Health Group's (UHG) acquisition of Change Healthcare was challenged by the Department of Justice on grounds of anti-trust violation.
However, in September 2022 a Federal Court sided with UHG so now the purchase of Change Healthcare may proceed.
Change Healthcare is the main billing clearing house for 5,500 hospitals and 800,000 doctors to send their bills to commercial insurance companies.
Change Healthcare processes $1 Trillion of claims annually.
Change Healthcare is a very small company compared to UHG with only $3.1 Billion in annual revenue compared to United's $288 Billion.
The claims data that Change Healthcare has for all the commercial health insurance plans including CVS Aetna, the Blue Cross plans and Cigna gives United a wealth of opportunities:
1. United could use the claims data to more accurately price their fully-insured quotes to take groups away from their competitors.
2. United could use the claims data to identify and target healthier seniors who just became eligible for Medicare Advantage so United can sign them up for their Medicare Advantage Plans.
3. United could identify the outlier 3-5% of specialists that have very high rates of surgeries and procedures compared to their peers and carve them out of the network to create a 'High Performing Network.' This network would be more cost effective and still be very large, with only 3-5% fewer of the most procedure-intensive specialists.
Sources:
www.bloomberg.com/news/articl....
www.healthcareitnews.com/news...
kvgo.com/guggenheim/change-he...
en.wikipedia.org/wiki/Change_...
www.ledgerinsights.com/change...
www.bassberry.com/experience/...
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Dr. Bricker , you really nailed it. With recent ransomware why no mention of this huge impact by MSM. Very stunning to know the data breach impact and consequence.
Thank you for watching and for your comment.
This should be illegal
Great explanation. I worked for Change Healthcare during the announcement of UHC's acquisition. Most talented people have retired or left. I left in August 2021.
Thank you for sharing your experience.
You were fortunate when you left, Some of us were re-deployed to OptumServe, it’s a call center where most of us have left. UHG, lie like rugs. These people have everyone’s information and that should never be allowed.
Thank you for exposing this
Another well presented subject Dr. Bricker. There is the potential for concern and time will tell how this all works out.
Thank you for watching and for your feedback.
This aged well
Thank you for noticing. 😉
I thought the same thing! Lol!
What a predictor of sorts this video is! This is not over
Agreed - I would be curious which Judge thought it was a good thing to let this M&A go through
I don't think this is over yet. I can't imagine that Aetna, the Blues and Cigna, not to mention other regional/local payers are going to sit idly by while UHC has access to their allowed amounts and group utilization data.
We shall see.
Appreciate you watching and leaving a comment.
Hey Dr Bricker, love your videos, another side to the Change Health Acquisition: They have access to every Rx transaction on the network. They will be able to see how much pharma is paying on all of the manufacturer assistance programs, what are the pay rules and how much is going to the PBM/plan. In addition, every other PBM reimbursment terms. This is bad for America.
Thank you for the additional information. Appreciate you watching!!
It’s bad…Period!
I think another important factor that was not brought up enough was provider contracts with payers. They basically could see all of the contracts with their competitors and either start lowballing reimbursement or cutting what they currently pay regionally for specific providers or procedures.
Great point. Thank you for watching and for your comment.
Bingo
This is exactly what I was hoping to stumble into regarding this topic… I’ve been trying to puzzle over the move… thank you!!!
Thank you for watching and for your feedback.
Although this is inherently anticompetitive, the lawyers have yet to prove that vertical integrations in the healthcare space will necessarily result in negative outcomes for patients. Vertical integration is already prevalent, this is more of the same (in my view)
Thank you for sharing your thoughts, Rick. Appreciate you watching.
Another thing to note for MA signups, is that avoiding sick patients may not be the best strategy. Why? Medicare risk adjustment. Sure the first year turning 65 their RAF will be pure demographic, but after that, due to MLR regulation of 0.85 and uncapped RAF for MA, it’s not obvious that any particular risk profile is advantageous. One could argue easier that targeting sicker patients may be the better play.
Great point. Thank you for sharing.
WELL they're all screwed now
Thank you for your comment.
@@ahealthcarez any time, I enjoy the videos, I worked in a different medical billing clearinghouse than Change Healthcare
this reminds me how the SEC tried to separate investment banks from consumer banks as a reaction to the great depression, which got merged back together in the late 1990s leading directly to the 2008 financial crash
Good point. Thank you for sharing.
Daaaaaaang and now Change Healthcare/UHC/Optum got hacked last week….
Yes. Thank you for watching.
They deserve it lol. Karma is a bitch. Now only time will tell if they or some other insurance company acquires dental xchange. Guess snail mail is the only secure way unless each insurance portal themselves has their own portal to send claims etc
As a person who works for a clearinghouse the process explained is not completely accurate. It’s not about all about the data it’s the technology that is why UHG acquired Change. Furthermore there are many clearinghouses that utilize one another for claim delivery and ERA delivery ie Availity, Trizetto, Experian and many more.
Thank you for watching and for sharing the additional information.
You are correct. I am a chiropractor and we use Availity and Office Ally but were still crippled by the cyberattack on Change Healthcare...
Dr. Bricker, love your videos as always. I seriously use them to stay up to date with the healthcare space. I'm currently launching my own health tech company and would love to have your input on it!
Thank you for watching and for your comment.
Insurance should be socialized- without a doubt.
Thank you for sharing your thoughts.
Absolutely. It immediately cuts all the rampant fuckery and stabilizes the system.
Just another reason why (when I turn 65 in April 2024) that I will not be choosing UHC for my MedSupp plan. The prime reason is their affiliation with AARP which I loath.
Good point. Thank you for your comment.
THANK YOU.
Thank you for watching.
I’m
Starting my career with United. They are allowing me to work remotely and I plan on continuing my education. Concurrently and maybe climb up within or pivot and do my own revenue cycle management consulting and services.
I’ll add that this merger is just what is going to be the norm for insurance and healthcare. So we just need to ensure patient outcomes and cost by members remain relatively stable or improved.
Thank you for sharing your thoughts.
Do you know how vertical integration gets around the Stark anti-kickback laws?
If it’s internal, it appears to not be an issue.
Is it legal to use the health information of members of a self-insured group and use it in underwriting/quoting? I felt it has to be strictly based on census.
Thank you for watching… Do you mean quoting on fully insured groups? Thank you for the clarification.
They hook enployers with low premiums and deductibles, but then they wont pay claims and put everything out of network. The can offer lower rates because they cheat providers and members.
Thank you for sharing your perspective.
videos with a white board are so much better than random clip art as well. well done
Thank you for your feedback.
United health care lies lies lies to me when i sign up
I’m sorry. Thank you for sharing your experience.
You’re absolutely right about seamless advantage of data in this acquisition. As a pharmacist turned Data Analyst/Product Manager, I already imagine prescription $$$ that UHG will make from access to member clinical records, through their pharmacy subsidiaries such as OptumRx!
Thank you for sharing your perspective.
Do healthcare insurance have a limited number of policies they can give?
Meaning in that example will healthy 65+ people be competing with people like the copd patient
Great question. No.
Some of KP pharmacy claims go through Optum that is owned by UHG too. Saw it on my EOB.
#True.
Who are Change Healthcare's competitors?
None. Thank you for watching and for your question.
Milliman (Milliman Clinical Guidelines) is a the biggest competitor of InterQual (Change Healthcare's price transparency rate card @@ahealthcarez @leahkamin1562
Aren't participating MA plans required to not engage in marketing practices that discriminate based on health status?
MA plans cannot deny coverage based on health status, but MA plans can do targeted marketing.
Appreciate you watching and thank you for your question.
Does the divestiture of ClaimsXten change this outcome?
Appears to be other software and data products that would still give UHC access to important data.
It's pretty frightening.
Several hospitals in my area will no longer take United Healthcare forcing me to change doctors I have had for years
Thank you for sharing your experience.
aannnnnnnd it just got hacked. 22 million ransom sent
Yup. Thank you for watching.
Long $UNH 🎉🎉😊😊
Shady
United health care sucks!
Thank you for sharing your thoughts.
Yea I have to disagree with you on this one. Although I am a big fan. This assumes that United Health Group is going to disregard HIPPA and HITECH standards around data security and usage. United Healthcare will not have rights to the data that Optum (the company that Change will be merged into) has access to. So the company would have to break the law to do this. Now I am not saying that large Healthcare companies have not broken the law for profits before, but I think it is very dangerous to just assume that is what companies are going to do. Not to mention the fact that if other insurance companies even suspect that is what is happening you can be sure they will take their claims processing elsewhere.
Thank you for sharing your perspective.
I can't help but think of Ancestry being bought out by a private equity firm. A firm who told the press it will not access data from Ancestry. Yeah right.......and I told Toyota I promise not to open the glove compartment on a car I bought yesterday.
I warned family members about sending DNA specimens to these companies years ago.
It's analogous to large retailers initially having embedded Amazon stores, then scattering when they realized the potential vulnerability.
I suspect other payors will move eventually as a precaution.
United Health group will hire legal talent and " bend " the law instead of breaking it. " Grey area, " " bend the law," are phrases for areas where companies draw new profits.
Nothing new under the sun.
Good one, but there are many ways to bypass HIPPA and HITECH legally. MA plans and brokers have been doing it for years to get access to patient info.