United Health Group Acquisition of Change Healthcare... Healthcare Data Goldmine

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AHealthcareZ - Healthcare Finance Explained

Жыл бұрын

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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Пікірлер: 109

@sugumrayan1746 3 ай бұрын

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.

@ahealthcarez 3 ай бұрын

Thank you for watching and for your comment.

@fatcatkcfan 11 ай бұрын

This should be illegal

@martakramer3729 Жыл бұрын

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.

@ahealthcarez Жыл бұрын

Thank you for sharing your experience.

@Angel-ec6ow 4 ай бұрын

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.

@fatcatkcfan 11 ай бұрын

Thank you for exposing this

@jimmyc218 Жыл бұрын

Another well presented subject Dr. Bricker. There is the potential for concern and time will tell how this all works out.

@ahealthcarez Жыл бұрын

Thank you for watching and for your feedback.

@MDavidoff 4 ай бұрын

This aged well

@ahealthcarez 4 ай бұрын

Thank you for noticing. 😉

@edenscreek 4 ай бұрын

I thought the same thing! Lol!

@josryder7841 4 ай бұрын

What a predictor of sorts this video is! This is not over

@synsormed 4 ай бұрын

Agreed - I would be curious which Judge thought it was a good thing to let this M&A go through

@Jsimonlane 7 күн бұрын

Why did this age poorly? (Please forgive my uninformed-ness!)

@westernrehabilitationhealt9845 Жыл бұрын

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.

@ahealthcarez Жыл бұрын

We shall see. Appreciate you watching and leaving a comment.

@rickh1755 Жыл бұрын

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)

@ahealthcarez Жыл бұрын

Thank you for sharing your thoughts, Rick. Appreciate you watching.

@ThejOH007 Жыл бұрын

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.

@ahealthcarez Жыл бұрын

Great point. Thank you for watching and for your comment.

@Angel-ec6ow 4 ай бұрын

Bingo

@Qb344 Жыл бұрын

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.

@ahealthcarez Жыл бұрын

Great point. Thank you for sharing.

@user-kj3du6yr6z Жыл бұрын

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.

@ahealthcarez Жыл бұрын

Thank you for the additional information. Appreciate you watching!!

@Angel-ec6ow 4 ай бұрын

It’s bad…Period!

@FalanaBlessed Жыл бұрын

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.

@ahealthcarez Жыл бұрын

Thank you for watching and for sharing the additional information.

@dr.richardcohen3306 3 ай бұрын

You are correct. I am a chiropractor and we use Availity and Office Ally but were still crippled by the cyberattack on Change Healthcare...

@PharmDdiaries Жыл бұрын

This is exactly what I was hoping to stumble into regarding this topic… I’ve been trying to puzzle over the move… thank you!!!

@ahealthcarez Жыл бұрын

Thank you for watching and for your feedback.

@edenscreek 4 ай бұрын

Daaaaaaang and now Change Healthcare/UHC/Optum got hacked last week….

@ahealthcarez 4 ай бұрын

Yes. Thank you for watching.

@jenniferdang1863 2 ай бұрын

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

@kirbyman1kanden7pf 4 ай бұрын

WELL they're all screwed now

@ahealthcarez 4 ай бұрын

Thank you for your comment.

@kirbyman1kanden7pf 4 ай бұрын

@@ahealthcarez any time, I enjoy the videos, I worked in a different medical billing clearinghouse than Change Healthcare

@tomm7505 10 ай бұрын

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.

@ahealthcarez 10 ай бұрын

Good point. Thank you for your comment.

@melissammonroe 3 ай бұрын

THANK YOU.

@ahealthcarez 3 ай бұрын

Thank you for watching.

@alexk1575 Жыл бұрын

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!

@ahealthcarez Жыл бұрын

Thank you for watching and for your comment.

@OkikaHawaii 4 ай бұрын

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.

@ahealthcarez 4 ай бұрын

Thank you for sharing your thoughts.

@stinksterrekerinski4450 Жыл бұрын

Insurance should be socialized- without a doubt.

@ahealthcarez Жыл бұрын

Thank you for sharing your thoughts.

@presterjohn1697 Жыл бұрын

Absolutely. It immediately cuts all the rampant fuckery and stabilizes the system.

@fatcatkcfan 11 ай бұрын

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.

@ahealthcarez 11 ай бұрын

Thank you for sharing your perspective.

@HongPong 3 ай бұрын

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

@ahealthcarez 3 ай бұрын

Good point. Thank you for sharing.

@HongPong 3 ай бұрын

videos with a white board are so much better than random clip art as well. well done

@ahealthcarez 3 ай бұрын

Thank you for your feedback.

@JustanotherYouTuber66 Жыл бұрын

Some of KP pharmacy claims go through Optum that is owned by UHG too. Saw it on my EOB.

@ahealthcarez Жыл бұрын

#True.

@bawer234 Жыл бұрын

Do you know how vertical integration gets around the Stark anti-kickback laws?

@ahealthcarez Жыл бұрын

If it’s internal, it appears to not be an issue.

@jamespinkard3502 Жыл бұрын

United health care lies lies lies to me when i sign up

@ahealthcarez Жыл бұрын

I’m sorry. Thank you for sharing your experience.

@sood8484 11 ай бұрын

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.

@ahealthcarez 11 ай бұрын

Thank you for watching… Do you mean quoting on fully insured groups? Thank you for the clarification.

@leahkamin1562 Жыл бұрын

Who are Change Healthcare's competitors?

@ahealthcarez Жыл бұрын

None. Thank you for watching and for your question.

@sekhonkamal 3 ай бұрын

Milliman (Milliman Clinical Guidelines) is a the biggest competitor of InterQual (Change Healthcare's price transparency rate card @@ahealthcarez @leahkamin1562

@Dr.OSIFOF Жыл бұрын

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!

@ahealthcarez Жыл бұрын

Thank you for sharing your perspective.

@sanadbenali6993 Жыл бұрын

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

@ahealthcarez Жыл бұрын

Great question. No.

@ashleyodom7582 Жыл бұрын

Aren't participating MA plans required to not engage in marketing practices that discriminate based on health status?

@ahealthcarez Жыл бұрын

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.

@ranbo9390 5 ай бұрын

Several hospitals in my area will no longer take United Healthcare forcing me to change doctors I have had for years

@ahealthcarez 5 ай бұрын

Thank you for sharing your experience.

@MarkStanley57 Жыл бұрын

Does the divestiture of ClaimsXten change this outcome?

@ahealthcarez Жыл бұрын

Appears to be other software and data products that would still give UHC access to important data.

@MarkStanley57 Жыл бұрын

It's pretty frightening.

@Jackeyyyyy Жыл бұрын

Long $UNH 🎉🎉😊😊

@TheJeferka 4 ай бұрын

aannnnnnnd it just got hacked. 22 million ransom sent

@ahealthcarez 4 ай бұрын

Yup. Thank you for watching.

@fatcatkcfan 11 ай бұрын

Shady

@jimfeaster4837 6 ай бұрын

United health care sucks!

@ahealthcarez 6 ай бұрын

Thank you for sharing your thoughts.

@gregorymagazu6175 Жыл бұрын

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.

@ahealthcarez Жыл бұрын

Thank you for sharing your perspective.

@presterjohn1697 Жыл бұрын

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.

@davidroberts6774 Жыл бұрын

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.

@ferndog1461 Жыл бұрын

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.

@bryanh8292 Жыл бұрын

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.