UnitedHealthcare reimburses its Optum providers at a 17% premium, study finds
A new study looking at price transparency may have uncovered that doctors and advanced patient care practitioners working for Optum are being paid more by its parent company—insurer UnitedHealthcare—than it reimburses to non-affiliated providers.
The analysis, published in Health Affairs, [1] looked at statistics provided by Turquoise Health,a payer data platform. For this study, the company released information on 14 different current procedural terminology (CPT) codes, totaling 385,000 different patient care billing encounters nationwide.
The authors of the resulting paper are Daniel Arnold, PhD, and Brent D. Fulton, PhD, both of whom are affiliated with University of California, Berkeley and the Commonwealth Fund—a nonprofit foundation that conducts research and provides policy analysis to improve the U.S. healthcare system, especially for vulnerable populations.
Looking at the data provided by Turquoise, 707 instances involved Optum and UnitedHealthcare, with reimbursement conducted within the vertical. By zooming out to see how those encounters compared to others in their given region involving the insurance giant and a non-Optum provider, the Commonwealth Fund found that doctors affiliated with Optum were consistently paid more.
According to the findings, Optum-affiliated practitioners were on average reimbursed 17% more than their competitors. Further, in areas of the country where UnitedHealthcare owned a larger market share of 25% or more, the payments were 61% higher.
"The results suggest that inter-company transactions within healthcare conglomerates may warrant scrutiny, as they may be signals of regulatory gaming or attempted foreclosure," Arnold and Fulton concluded.
However, it’s important to note that the sample size used for the study is small, limited to what one company was able to provide, and may not be an accurate portrait of the broader reimbursement trend. All the same, it's a useful data point for further research on payment rates between insurers and their affiliated patient care groups.
Given that other insurers also own provider groups, other research could look into if the same higher payment rate is present in those relationships. However, the Commonwealth Fund did not perform that comparative analysis in this particular assessment.
As the authors also noted, UnitedHealthcare also tends to pay providers more overall, even those unaffiliated with Optum. On average, physicians were paid 38% more by the insurer than its competitors who also operate in the same markets.
The full study is available at the link below.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.