UnitedHealthcare Offers Health Data Support For Medicare Advantage ACO

UnitedHealthcare has struck a deal with national physician group Privia Health under which it will offer more and better data on patients enrolled in the payer’s Medicare Advantage plans. The agreement builds on the payer’s relationship with Privia’s ACO, which has been in place since 2017.

Under the terms of the new agreement, starting January 1, 2020, UHC will give Privia access to a richer trove of patient data, including information on their underlying medical conditions, past treatments, gaps in care and medication regimen. UHC will also offer predictions on the patients’ future care needs.

Rather than offering insight on broad trends, UHC will offer specific data on individual patients in an effort to improve the focus of their care. For example, they note, the data UHC is offering will help doctors identify patients who are at elevated risk of emergency department visits or hospital readmissions.  Physicians will also be able to share the data with chronically ill patients to help them manage their conditions more effectively.

Generally speaking, I’d argue, this agreement makes sense. There’s little doubt that payers should make these kinds of deals with providers, as ACOs are unlikely to achieve strong results without access to the right patient data.

On the other hand, I find this specific announcement to be a little odd.  From the looks of things, UHC offering top-notch (they call it “enhanced”) data analytics support only to some of its partners, under certain circumstances, The data Privia will be getting in 2020 sounds like it would be useful to any outside partner with which UHC works, but perhaps UHC is productizing and selling these services instead.

If so, this approach comes with fallout. If UHC is only offering such data to providers who can afford it, it may end up helping one subset of its contracted providers compete more effectively with its other providers.  Is that an outcome it has in mind?  Does it want the care that some of its providers to be of measurably lower quality? I doubt that would be OK with its customers.

Ultimately, if UHC has data available that can be used to make care more efficient and effective, I can’t imagine why it would make sense not to share it with every provider with whom they do business. Even if some of the physicians it works with aren’t as sophisticated as Privia seems to be, one would think that UHC’s goal would be to pull them up to that level. I suspect there’s more going on than meets the eye here.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

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