MINNEAPOLISUnited-Healthcare, a subsidiary of UnitedHealth
Group, has announced that it is further advancing its philosophies on
consumer choice and physician autonomy through an initiative called
Care Coordination. The new initiative makes obsolete certain programs
associated with traditional managed care, such as preauthorization
for inpatient hospital procedures.
Under the new system, physicians will be required to notify the
company when patients enter the hospital, require home care, or need
expensive procedures or medical equipment, but no request for
treatment or services covered in the members contract will be
denied. The company may request more information or suggest other
less costly treatments, but the final decision on care will lie with
The new Care Coordination program is intended to enhance patient care
and keep costs down by offering patients education about their
illness and closely coordinating and monitoring the care of members
who have chronic and complicated medical conditions.
The program involves seven core clinical activities: health
education, admission counseling, inpatient care advocacy, readmission
prevention, disease management, complex illness support, and pharmacy
Millions of dollars are spent every year on reviewing the
treatment decisions made by physicians, said Dr. Archelle
Georgiou, chief medical officer for UnitedHealthcare. Over the
last decade, we have seen the value to patients and employers of
these efforts diminish as runaway health care costs have been slowed
and services expanded. The vast majority of our reviews support the
physicians clinical decision, so it makes sense to focus on
other programs and efforts.
To help doctors and patients reach the best decisions,
UnitedHealthcare is leveraging its database of more than 14 million
patients to provide its doctors with data comparing the treatments
they are recommending for their patients against national treatment
The Care Coordination initiative was begun in 1998 and tested in six
markets prior to national implementation. Results from these markets
indicated that Care Coordination was able to improve the entire
health care experience without additional cost to the employer or member.
UnitedHealthcare has been a leader in the managed care industry in
providing innovative programs designed to increase consumer choice.
The company offers health care plans that allow members to see a
specialist without a referral from their primary care physician and
that provide coverage for cancer patients enrolled in NCI-approved
clinical trials (see Oncology News International, November
1999, page 1).