In addition, 6% of adults in the U.S. owe more than $1,000 in medical debt, and 1% of adults owe medical debt of more than $10,000.
Twenty-three million people (nearly 1 in 10 adults) owe "significant" medical debt of more than $250 in unpaid medical bills as of December 2019, according to a new research brief from the Peterson-KFF Health System Tracker.
It used the survey of income and program participation to conclude that many people have "significant" medical debt: 6% of adults in the U.S. owe more than $1,000 in medical debt, and 1% of adults owe medical debt of more than $10,000.
However, the research brief also found that the burden of medical debt isn't evenly distributed. Although all demographic groups experience medical debt, certain groups of people are disproportionately affected by significant medical debt.
For instance, middle-aged adults are more likely than young adults to have significant medical debt, which makes sense considering people's health often deteriorates as they age.
However, in a telling twist, the share of adults with significant medical debt decreases when people reach Medicare age: 12% of adults ages 50 to 64 report having significant medical debt, compared to just 6% for those ages 65 to 79.
In addition, Black Americans are far more likely to report significant medical debt: 16% of Black Americans report have significant medical debt, compared to 9% of white and 4% of Asian Americans.
Also unsurprising is that women are more likely to report having medical debt (11%) than men (8%) likely because of childbirth expenses and lower average income among women. In fact, an unrelated study recently showed that pregnancy and delivery can cost some patients close to 20% of their annual income.
Significant medical debt is also more common for people with disabilities and poorer health status. Disabled adults are more likely to report owing over $250 in medical debt (15% vs. 7%). Similarly, significant medical debt is more likely for people who say their health status is "fair" or "poor" than whose health is "very good" or "excellent."
Income and insurance status also plays a role. For instance, 12% of adults with incomes below 400% of the federal poverty level saying they have significant medical debt.
According to the research, other people that are more likely to be burdened by significant medical debt include people living in:
Rural areas
The South
States that did not expand Medicaid under the Affordable Care Act
Although it doesn't solve the problem of significant medical debt, there was a recent glimmer of hope for people with trouble paying it.
Paid medical collection debt will no longer be included on consumer credit reports as of July 1.
Medical collection debt won't appear on a consumer's credit report until it's been unpaid for a year, instead of the current six months, as of July 1.
Equifax, Experian, and TransUnion will no longer include medical collection debt under at least $500 on credit reports starting in the first half of 2023.
A study shows that pregnancy and delivery can cost some patients close to 20% of their annual income.
Pregnancy and childbirth can saddle families with "catastrophic" healthcare costs and their insurance status has a surprising link.
"This burden primarily affects those at lower incomes, especially if they have private insurance," corresponding author Jessica A. Peterson, MD, Maternal Fetal Medicine Fellow in Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai, said in a statement.
In fact, pregnancy and delivery can cost some low-income parents close to 20% of their annual income, found the retrospective, cross-sectional study from researchers at Mount Sinai and published in the journal Obstetrics & Gynecology.
Researchers used the Medical Expenditure Panel Survey from 2008 to 2016 to examine the prevalence, trends, and risk factors for catastrophic health expenditures in the year of delivery among birthing parents.
They identified more than 4,000 birthing parents of newborns and a 2:1 matched cohort of nearly 8,000 women who were of reproductive age but not pregnant. Researchers then looked for healthcare spending that was more than 10% of the family income during the year.
Here's what they found in terms of prevalence, trends, and risk factors.
Prevalence:
The study found that birthing parents were at a higher risk of medical spending that would create a financial burden than similarly situated people who were not pregnant
Birthing parents also reported higher rates of unemployment and high rates of gaining and losing Medicaid in the delivery year
Low-income birthing parents had the highest risk of catastrophic health expenditures or out-of-pocket payments for healthcare that exceeded 10% of family income in a given year
These families spent as much as about 19% of household income on healthcare expenses or nearly 30% when health insurance premiums were included in spending
Trends:
Implementation of the Affordable Care Act (ACA) did not significantly change the risk of catastrophic spending for parents
Although it was associated with reductions in uninsurance (29–24%) and gains in Medicaid coverage (15–19%) for the matched control cohort relative to pre-ACA years, there was no significant changes among birthing parents
Risk factors:
Public health insurance, including Medicaid, was associated with much lower risks of burdensome health costs than private insurance—particularly when health insurance premiums were included in spending—for birthing parents with low incomes
The study shows what reforms may be needed to the social safety net.
"Given the association between pregnancy, delivery, and catastrophic health expenditure—as well as the protective effects of public insurance—it is imperative that we create policies that not only ensure insurance coverage for pregnant people but also make it affordable," Peterson said. "Possible avenues to improve access to affordable health insurance include Medicaid expansion, as well as regulation of insurance cost-sharing and benefit designs."
The measures will remove nearly 70% of medical collection debt tradelines, which could help improve poor patient financial experiences for organizations.
Big changes are coming to how patient medical collection debt is reported on people's credit reports.
As of July 1, paid medical collection debt will no longer be included on consumer credit reports, according to a joint statement from Equifax, Experian, and TransUnion.
It'll also take longer for unpaid medical collection debt to appear on a consumer's credit report. Instead of six months, medical collection debt won't appear until it's been unpaid for a year, giving consumers longer to work with insurers and healthcare providers to address their debt before it's reported on their credit file.
This alone could help improve poor patient financial experiences for organizations.
In addition, in the first half of 2023, Equifax, Experian, and TransUnion will no longer include medical collection debt under at least $500 on credit reports.
These joint measures will remove nearly 70% of medical collection debt tradelines from consumer credit reports.
They agencies said that the changes stem from the COVID-19 pandemic and "a detailed review of the prevalence of medical collection debt on credit reports."
In their statement about the changes, the agencies point to research from the Kaiser Family Foundation which shows that two-thirds of medical debts are the result of a one-time or short-term medical expense arising from an acute medical need.
Indeed, a new research brief from the Peterson-KFF Health System Tracker analyzed the Survey of Income and Program Participation to understand how many people have medical debt and how much they owe.
They included medical debt at the individual level for adults who reported owing over $250 in unpaid medical bills (which they define as "significant" medical debt) as of December 2019.
The analysis found:
23 million people (nearly 1 in 10 adults) owe significant medical debt
6% of adults in the United States owe over $1,000 in medical debt
1% of adults owe medical debt of more than $10,000
Currently, the Consumer Financial Protection Bureau estimates that $88 billion in medical debt is reflected on Americans' credit reports. However, that number might be extremely underreported for many reasons.
For instance, "when people pay for a medical expense on a credit card or fall behind on other payments in order to keep up with medical bills" medical debt can be masked as other forms of debt, the Peterson-KFF Health System Tracker brief notes.
Atrium Health's vice president of revenue cycle management shares how their health system navigates outsourcing decisions and finding the right balance between internal and external processes.
No two revenue cycles are alike and neither are their decisions on how to outsource.
The decisions that revenue cycle leaders make about which tasks are best performed inhouse and which should be outsourced depend on many unique factors, from the facility's location and the patient populations they serve, to their payer mix and the skills and training of their employees.
That's why it's important for leaders to be honest, self-analytical, and strategic when evaluating each of these factors. Doing so will help them develop a healthy mix of in-house and outsourced functions that are right for their own revenue cycle.
Identify your strengths
For Chris Johnson, vice president of revenue cycle management at Atrium Health, those decisions have come down to a couple of key factors: Focusing on what their team does best and at the best cost, and to some extent, which functions have the closest ties to the patient.
For instance, Johnson says Atrium Health’s patient financial services (PFS) team excels at insurance claim filing and insurance collections from government payers and commercial and managed care plans.
"Our cash numbers continue to show that we do that well," he says.
Similarly, he thinks the PFS team handles denials really well.
"There is a tremendous amount of work that goes on between the initial denial and the final denial write-off, and between those two, we are really good at getting those denials overturned," he says. That's thanks to an internal team of experts who work denials, such as employees with clinical knowledge who can write effective appeals letters.
In fact, the amount of money that they stop chasing makes up less than 0.5% of their revenue.
"Industrywide, that is an exceptional number," says Johnson. He credits the vice president for the hospital business office for this low number, who's responsible for this function.
Their internal call center for self-pay accounts and their pre-registration and insurance verifications are also kept inhouse.
"We feel strongly about that personal touch," Johnson says. "Providers have a vested interest in their patient experience."
Evaluate outsourcing opportunities carefully
Atrium Health's outsourcing decisions have come down to striking a balance between the cost to do something internally and how much time it takes staff to accomplish the task.
A good example of this is its decision to outsource all its payment plans. Atrium Health used to offer internal plans for payment windows of six months or less and outsource the rest. But they found that not only were team members spending a lot of time trying to explain the difference between the internal and external options, but less than 1% of people opted for the internal six-month program anyhow.
"We were spending more time trying to explain these two things than we were getting people to sign up," Johnson says.
That made the decision to outsource its payment plan program extremely strategic and unique to the organization.
A significant advantage of the external payment plans is the vendor's upfront funding program, Johnson says. Based on criteria agreed upon between the vendor and Atrium Health, the vendor pays Atrium Health the patient account balance due upfront. Additionally, allowing interest-free or low-interest options provide the flexibility and personalization that patients need, Johnson says.
For instance, the interest-free repayment window goes up as the patient's account balance increases.
"It's not a static 12 months, or 15 months, or 24 months," Johnson says. "The higher the balance, the longer period of time that you have to pay."
He adds that they've had zero patient complaints from the program.
Make it personal
Johnson says Atrium Health's decisions about outsourcing don't necessarily represent the best way or the only way to do things, and what works for one organization may not work for other revenue cycles. Instead, leaders must do their own, in-depth analyses and determine for themselves the appropriate path forward.
Those decisions must be ongoing as well. For instance, Atrium Health is working on a one-touch, text-to-pay tool for patients. The organization is currently exploring how to implement the functionality and determine whether the method that's most efficient and best for patients will be built internally or externally.
It's a decision that they'll make depending on their own unique circumstances.
"Let's focus on what we can do the best at the lowest cost," he says.
The requirement is exacerbating problems that revenue cycles have been trying to solve for years, and the American Hospital Association (AHA) is pleading to CMS for changes.
A lack of automation and an extremely labor-intensive process is not only making it hard for revenue cycles to fulfill the No Surprises Act's good faith estimate requirement, but it's also delaying other parts of the patient experience and putting a heavy burden on front-end employees.
That's according to a letter from the AHA asking CMS to "revise its estimates based on the actual experience of providers since implementation on Jan. 1, 2022."
The letter says that "the government has substantially underestimated the burden associated with implementing the good faith estimates and patient-provider dispute resolution process.” The letter also highlighted the strain it's placing on many areas of the revenue cycle.
In fact, the requirement is highlighting and exacerbating problems that revenue cycles have been trying to solve for years, such as:
A lack of automation and reliance on manual processes: The AHA notes that "the lack of currently available automated solutions strongly indicates that this process will require a significant manual effort by providers when enforcement begins" on January 1, 2023, as CMS is currently utilizing enforcement discretion regarding the collection and compilation of good faith estimates. It also points out that "there is currently no method for unaffiliated providers or facilities to share good faith estimates with a convening provider or facility in an automated manner."
Long patient wait times: Revenue cycles have worked diligently over the years to reduce patient wait times, but the current requirement adds a step backwards. The AHA writes that"estimates regularly take between 10-15 minutes to produce." According to the AHA, "one member hospital reports that their staff can only process 75 estimates per day, which is barely meeting demand at this point. A member health system with several locations reports needing to do 1,500 per day across the system."
Snags in the pre-registration and check in/check out processes: Because of this long, manual procedure, other elements of the front-end process are being delayed, such as completing the pre-registration process and sharing pre-care materials with patients.
Difficulty in guaranteeing price accuracy: Accurately estimating the price and scope of medical care is inherently tricky because "slight changes in medically necessary care can increase the overall cost, leaving even the most diligent patients and transparent providers with unexpected changes in the cost of care," AHA notes.
Burnout and workforce shortages: So much price estimate work falls to the front-end staff, which already has a lot of responsibilities to ensure a smooth and accurate registration process. The current pandemic burnout and workforce shortages are only making it harder.
Here's what the AHA is asking for:
Delay in enforcing the good faith estimate requirement until after an automated standard for exchanging this information is developed and implemented across all providers
Remove the need for procedure-specific insurance verification and enable providers to treat patients with "group health insurance"
Require a final bill to be at least 10% more than the good faith estimate (instead of $400 more) for it to be eligible for the dispute resolution process
Fully align No Surprises Act and federal price transparency requirements
The AHA’s approach to asking for changes after gaining firsthand experience with the rule as it's written is a wise move. This echoes the approach Eric D. Hargan, former deputy secretary of the U.S. Department of Health and Human Services, recommends for price transparency.
"You can't act until you know what the problem is. And the problem doesn't show up until there's an attempt to implement," he told HealthLeaders last year. "That's where you get credibility in re-approaching this rule."
A lawsuit accuses hospitals of failing to ensure that eligible low-income patients received the charity care to which they were legally entitled.
Hospitals are again coming under fire for their charity care practices, this time in Washington State, where Attorney General Bob Ferguson has filed a consumer protection lawsuit against five Swedish Health Services hospitals and nine Providence Health & Services-affiliated facilities.
The lawsuit accuses the hospitals of failing to ensure that eligible low-income Washingtonians received the charity care to which they were legally entitled, as well as aggressively collecting money from those eligible patients.
Washington's charity care law requires hospitals to forgive some or all out-of-pocket costs of essential healthcare for Washingtonians whose household income is at or below 200% of the federal poverty level. It applies to both insured and uninsured patients.
The lawsuit alleges that the hospitals:
Trained employees to aggressively collect patient payment despite their eligibility for financial assistance. Employees also had to use a specific script to tell patients they were expected to pay for care. Providence instructed employees, "don't accept the first no," according to the lawsuit.
Failed to notify patients they were eligible for charity care financial assistance when the providers determined they qualified for assistance.
Sent more than 54,000 patient accounts to debt collection, despite knowing the patients were eligible for financial assistance.
The attorney general is seeking restitution in the form of full write-off of medical debts and refunds, plus interest, for patients who did not receive financial assistance, as well as millions of dollars in civil penalties.
Providence called the charges "inaccurate and unfair," saying that when the attorney general's office "first raised their concerns with us two years ago, we cooperated fully and in good faith. That is why it is inconceivable that the AG has chosen now to file this complaint, which runs counter to the facts we provided to his office."
Ferguson has had success with these types of lawsuits twice before:
CHI Franciscan provided$41 million in debt relief and $1.8 million in refunds, in addition to rehabilitating the credit of thousands of patients who were not offered charity care when they were eligible at eight of its hospitals in Washington. It also paid $2.46 million to the Attorney General's Office to cover the costs of the investigation and enforcement of the Consumer Protection Act.
Capital Medical Center provided at least $250,000 in refunds and more than $131,000 in debt relief for violating charity care rules. In addition, Capital paid $1.2 million to the Attorney General's Office.
Washington lawmakers are currently seeking to improve consumer protections from hospital bills. HB 1616 would increase the number of Washingtonians eligible for financial assistance with their out-of-pocket healthcare costs.
Hospitals are increasingly coming under fire for their charity care practices. For instance, a report from the North Carolina state treasurer's office found that hospitals there are routinely billing low-income patients who should qualify for charity care.
The American Medical Association, the National Association of Accountable Care Organizations (NAACO), and others are urging Congress to better incentivize participation in alternate payment models.
Keeping Medicare financially afloat is behind a new push to better incentivize providers to participate in value-based payment arrangements and alternative payment models (APM).
The American Medical Association, NAACO, and other organizations are urging Congress to do what it can to speed up adoption of these payment models, not only because they lower spending and improve quality of care and patient satisfaction, but because they could help with another imperative: Prolong the solvency of the Medicare trust fund.
The latest Medicare Trustees' Report to Congress says that Medicare program assets will be depleted by 2026, the groups noted in a letter to the U.S. Senate Committee on Finance Subcommittee on Fiscal Responsibility and Economic Growth.
This news should "sound the alarm to Congress" that it's time to update laws to encourage new providers to enter APMs and keep ones that are already participating.
Specifically, the groups are pushing for the bipartisan Value in Health Care Act (H.R. 4587), which would:
Increase shared savings rates for ACOs to restore them to the levels when the Medicare Shared Savings Program (MSSP) was launched
Remove ACO beneficiaries from the regional benchmark
Extend the Advanced APM bonus that Congress created in the Medicare Access and CHIP Reauthorization Act of 2015 for an additional six years
Although APMs save money, the organizations writing to Congress say they're not doing so fast enough to counter increased spending.
Here's their reasoning:
Since 2012, ACOs have saved Medicare $13.3 billion in gross savings and $4.7 billion in net saving.
Data shows that ACOs are lowering Medicare spending annually by 1%–2%.
Since Medicare Parts A and B cost $636 billion in 2018, a 2% reduction in spending would save nearly $200 billion when compounded over a decade, assuming Medicare spending will grow at 4.5% per year without ACOs.
The estimated overall impact of ACOs, including "spillover effects" on Medicare spending outside of the ACO program, lowered spending by $1.8–$4.2 billion in just 2016.
In the first three years of the MSSP, ACOs improved their performance on 82% of the individual quality measures compared to their baseline. After the first three years, 98% of ACOs met or exceeded quality standards.
Despite these savings, participation has stalled:
There are currently more than 30 million traditional Medicare patients still in unmanaged, uncoordinated care, the letter said. That's compared to the just 11 million Medicare patients who receive care from a healthcare provider in a Shared Savings Program ACO as of January, finds new CMS data.
The same CMS data shows only modest year-over-year growth in ACO participation: Just 66 new ACOs joined the program and 140 existing ACOs renewed their participation.
Revenue cycle leaders are formalizing the training that they require for their employees, putting in place certifications and ongoing education for them, and even partnering with local universities.
For decades, coming in at entry level and learning on the job was typical for revenue cycle employees, and while this is still commonplace, more revenue cycle leaders are working to formalize the training requirements for workers.
"There's the growing expectation that it's more than just learning on the job," said Richard Gundling, FHFMA, CMA, senior vice president of professional practice for the Healthcare Financial Management Association (HFMA). "You want to make sure that people have the skills and the competencies to do the work because it's a complex system."
That's why a growing number of revenue cycle leaders are formalizing the education and training that they require for their employees, putting into place programs for certifications and ongoing education, and even partnering with local universities.
For instance, UC San Diego (UCSD) worked with its extension school to launch a specialized certificate program in revenue cycle.
"UCSD … recognized the need for a revenue cycle education program," Terri Meier, director of system patient revenue cycle for UC San Diego Health, told the HealthLeaders Revenue Cycle Podcastin October. "So, last year we launched—through the UCSD Extension—our revenue cycle certification program." Meier, who was among those to help develop that program's curriculum and is on its advisory board, noted although there are some formalized revenue cycle certificates, "a lot of it is with coding and billing."
"There's not really the same opportunity for revenue cycle that will teach them end-to-end and prepare them for the job," she said.
Similarly, Cal State LA works with Cedars-Sinai and Healthcare Business Insights to offer a Healthcare Revenue Cycle Administration Certificate, a non-credit course that aims to prepare students to work as a patient financial services/patient accounting representative in a healthcare setting.
Many healthcare organizations also work extensively with HFMA for training and certifications. For instance, Meier said UCSD applied for HFMA enterprise membership, "so all of our team members will be CRCR [Certified Revenue Cycle Representative] certified as part of our offering to them."
Sarah Ginnetti, associate vice president of revenue cycle at UConn Health, told HealthLeaders last month that she's also been working with her organization's vice president of finance to stand up an enterprise membership through HFMA.
Doing so will "help educate our staff about all of the nuts and bolts of revenue cycle that sometimes we expect people to just learn through osmosis," she said, which is important because learning the revenue cycle can be "like learning another language."
That new "language" is only getting more complex.
"Organizations know that they have to put more into training to make sure that their staffs are up to date, competent, [and] understand the laws and regulations and the billing compliance rules to be able to effectively bill and collect," says Gundling. "On top of that is growing consumerism and an expectation of a better patient financial experience."
Developing financial communication skills and helping patients understand their insurance coverage and financial obligations are also important, especially with the movement toward price transparency and no surprise billing.
"The revenue cycle people are the first ones to explain it [to patients]. So, they have to do that with empathy and competency. And that requires training," Gundling says.
Many health systems use HFMA as an educational and training resource, and often, successful completion of the CRCR certification program "is part of the onboarding process for new employees and a requirement of employment," says Bill Casey, HFMA senior vice president of member experience and business development.
HFMA also launched its enterprise membership program four years ago, which offers membership at the organization level. This allows member organizations to open up HFMA training opportunities to their employees.
Enterprise member organizations include Advocate Aurora Health, Allegheny Health Network, Ensemble Health Partners, and Kettering Health Network, and as of February 2021, 137 organizations had signed on, HFMA said last year.
Certification requirements and even advanced educational programs will continue to grow more important for employees as revenue cycle tasks grow increasingly more complex, career ladders are emphasized, and leaders recognize the need for early and extensive succession planning.
"Obviously, learning from your peers is really important," Gundling says. "But I think with the growing sophistication of billing systems, of IT systems, of insurance products, [and] expectations of patients, there's just a need that staff has that education."
Editor's note: This story was updated on March 15, 2021.
A new report found that most nonprofit hospitals didn't provide enough charity care to equal the amount of tax breaks they received for doing so.
North Carolina hospitals are routinely billing low-income patients who should qualify for charity care, highlighting a "widespread failure in accountability," according to a report from the state treasurer's office.
The report found that although nonprofit hospitals received tax exemptions to provide charity care that were valued at more than $1.8 billion in 2020, most didn't provide enough charity care to equal the amount of those tax breaks.
Instead, "North Carolina's nonprofit hospitals billed the poor at an average rate up to almost three times the national average," the report said.
"Nonprofit hospitals are often more profitable than for-profits in North Carolina," the report said. "All the top 10 most profitable hospitals were nonprofits in fiscal year 2019."
It stems from a lack of benchmarks and oversight, the report says, since the "[IRS] has no explicit thresholds for charity care spending or eligibility" and North Carolina has "no public agency or official who actively enforces how nonprofit hospitals honor their charitable mission."
An estimated average of 11.9% to 28.7% of bad debt for North Carolina nonprofit hospitals should have been charity care, compared to the national average of 10%.
Only 18 hospitals reported actual dollar values for eligible bad debt in their 2019 federal tax filings. Among these hospitals, an average of 28.7% of bad debt should have been charity care in fiscal year 2019.
Although another 42 hospitals said they billed zero dollars to any poor patients eligible for charity care, those numbers aren't always supported by hospitals' disclosures on federal tax filings.
The most "diligent" hospitals said they used financial profiling technology to avoid billing eligible patients.
Fewer than 20 of 105 hospitals spent more on charity care than the value of their tax exemptions in fiscal year 2019.
Just five of the 15 most profitable hospitals provided enough charity care to exceed the value of their tax exemptions.
WakeMed was the only large system that publicly reported exceeding its tax exemption with charity care spending in 2020.
"The state is in desperate need of better oversight and stronger accountability," the report concludes. "The disparities between hospitals' charity care and bad debt prove the need for a benchmark level of charity care spending."
The report also points to other states that have taken action to protect patients and taxpayers, including:
Utah and Illinois, which require hospitals to spend more on their community benefits than they receive in property tax exemptions.
Oregon and Nevada, which have set a minimum benchmark for community benefit spending.
California, which mandated a charity care eligibility threshold of 400% of the federal poverty level.
As one example, MarinHealth's revenue cycle is being absorbed into Optum. Under the agreement, some of MarinHealth's employees will become Optum employees who will still work on that health system's revenue cycle operations.
A trend within the healthcare revenue cycle is that more health systems are outsourcing to companies who will run the revenue cycle for them, all the while using the health system's employees to do the day-to-day tasks.
As an example of this trend, California-based MarinHealth is the latest health system to team up with Optum on its revenue cycle operations, with an agreement that will see some of MarinHealth's employees become Optum employees who will still work on that health system's revenue cycle operations.
As part of the partnership, Optum will provide revenue cycle management services and supporting technologies to MarinHealth, as well as supply chain services.
Over the past few years, several health systems have entered into similar agreements with Optum, where their own revenue cycle employees become Optum employees.
Such arrangements allow health systems to keep their own experienced employees while using the technology, analytics, and other tools that they may not have had access to previously. In addition, Optum, "deliver[s] pre-negotiated outcomes based on an optimal future state of operation and take financial risk on that delivery," it says.
In October 2021, the midwestern health system SSM Health announced a similar deal with Optum.
Optum is part of UnitedHealth Group, which reported full year and fourth quarter 2021 earnings last month.
Optum full-year revenues were $155.6 billion, up $19.3 billion (14.1%) year-over-year, while its full-year operating earnings of $12 billion increased $1.9 billion (19.4%) compared to the previous year.
Its data, research, and analytics arm Optum Insight (which combined with Change Healthcare earlier this year), saw its revenue backlog increase by $2.2 billion in 2021 to $22.4 billion, driven by growth in managed services, such as with these health system partnerships.
UnitedHealthcare has its tentacles all throughout the healthcare landscape, and not every one of its decisions is popular, such as its decision to retroactively deny ED claims (a policy it later said it would delay).
Such a policy not only would have possibly violated the prudent layperson standard, but it also could have steered patients to medical facilities that OptumHealth owns, such as MedExpress, which joined Optum's clinical service offerings in 2015.
"If Optum puts pressure on people not to go to the ER, but to use urgent care centers instead, it's going to drive more patients to places that they own … it keeps everything within the UnitedHealthcare ecosystem," Doug Wolfe, co-founder and partner of the Miami-based law firm Wolfe Pincavage, told HealthLeaders over the summer. "Hospitals are competing with UnitedHealthcare from the Optum provider locations, but the hospitals do not have the same power to direct patients through coverage determination."
