While most Americans have been focusing on the recent problems surrounding the rollout of the new healthcare.gov website, another health insurance story has been largely overlooked. Last month, just as Medicare's open enrollment period was set to begin, UnitedHealthcare dropped thousands of physicians nation-wide, including thousands in Connecticut, from its Medicare Advantage programs without an explanation.
Who are these physicians and why were they dismissed from United's Medicare Advantage plans en masse without being dropped from any of United's commercial programs? Company executives remain notably tight-lipped despite public inquiries from physicians, newspapers and lawmakers. Connecticut's five-member congressional delegation and attorney general have become involved. Based on the information available, it is clear that the company's end goal is to unload its sickest, costliest patients.
Typically insurance companies entice patients to join by including large networks of highly regarded providers. United's doctor drop, however, accomplished almost the exact opposite, wiping out entire services in some areas and removing the most talented physicians from the network.
Many of the physicians in question carry United's premium designation, the company's official recognition of excellence in "quality of care and cost efficiency." In Florida, United dropped an estimated 45 percent of its Medicare Advantage provider network, including the nationally renowned Moffitt Cancer Center in Tampa. United also dropped the only nephrologists in Connecticut's greater New Britain area as well as the entire Yale Medical Group, which represents more than 1,000 physicians on the faculty of the Yale School of Medicine. It is not only specialists that United is targeting — more than a third of the 2,250 physicians dropped in Connecticut are primary care providers.
What does this mean for patients? Thousands of senior citizens now must either find new in-network physicians, enroll with a different company's Medicare Advantage plan, or go back into traditional Medicare before open enrollment ends on December 7th.
Finding a new doctor can be challenging because many doctors, especially primary care physicians, either do not accept new patients or have long waiting times for new patient appointments. Many of our nation's seniors have complicated, ongoing health problems and complex medical histories — they cannot afford to wait months to see a new doctor. Their current physicians are familiar with their health needs; abruptly changing doctors only serves to disrupt their care.
The healthiest patients who rarely need medical care are more profitable for United; these patients may not have developed strong physician-patient relationships. Patients undergoing costly, long-term treatments such as dialysis and chemotherapy, however, are more likely to choose to leave United's Medicare Advantage programs in order to stay in the care of their current physicians.
When Medicare Advantage programs debuted, they tended to attract younger, healthier patients. Now that those patients are getting older and sicker, the cost of their care is increasing, pushing United to look for a way to remove them selectively from their coverage programs.
If managed care is meant to represent successful health maintenance, however, then the patients United has been covering for the past decade should be healthier than average. United should enact policies that aim to retain these policyholders rather than drop physicians in order to encourage the patients to go elsewhere for coverage. Getting expensive patients to leave the United network enables United to maximize its own revenue and protect its 2014 projected earnings, but it comes at the expense of the other insurers and traditional Medicare which will be forced to absorb this high-cost patient population.
Ultimately, what United has done is enact a back door plan to unload the sickest, costliest patients and put the financial burden back onto traditional Medicare and other health insurance companies.