UnitedHealth gave doctors checklists and bonuses linked to diagnosing the company’s Medicare Advantage patients

UnitedHealth's Medicare Advantage Strategy and Broader Medicare Developments

UnitedHealth Group has faced scrutiny for its approach to Medicare Advantage, as well as wider shifts in Medicare policy under the Biden administration. Here's a breakdown of recent developments:

Stat: UnitedHealth Encouraged Doctors to Maximize Medicare Advantage Diagnoses

Internal communications from UnitedHealth managers in late 2020 reveal a strong push for doctors to increase patient visits and secure more Medicare Advantage-related revenue. Doctors were incentivized with tools such as $10,000 bonuses and leaderboards ranking their performance. Emails, often filled with cheerful language, carried an urgent tone: "Hit your targets to see more patients. We need to bring in more money." (Bannow, Herman, Ross, and Lawrence, 10/16)

Modern Healthcare: Medicare's Value-Based Care Goal Faces a Crucial Moment

The Biden administration's aim to transition all Medicare beneficiaries into value-based care arrangements by 2030 is at a critical juncture. The future of this initiative hinges on Congress renewing a bonus program designed to help providers shift from fee-for-service to value-based payments, with the program set to expire this winter. (McAuliff, 10/15)

Modern Healthcare: Biden's Impact on Medicare Advantage

President Joe Biden’s single term has brought sweeping changes to Medicare Advantage, rivaling the reforms of George W. Bush’s administration. Under Biden, the program has undergone significant adjustments to both funding and regulations, reflecting one of the most active periods in its history. (Early, 10/16)

Axios: Independent Pharmacies May Avoid Medicare's Low-Cost Drugs

Many independent pharmacies are reluctant to stock the first 10 drugs subjected to Medicare price negotiations. Concerns over upfront costs have driven this hesitation, potentially limiting seniors' access to lower-priced medications when price cuts begin in 2026. This issue is further compounded by closures of chain pharmacies, exacerbating accessibility challenges. (Goldman, 10/16)

Modern Healthcare: UnitedHealth Remains Optimistic Despite Medicare Advantage Challenges

Despite regulatory and financial headwinds, UnitedHealth Group CEO Andrew Witty expressed confidence in the company's Medicare Advantage offerings. As the leading Medicare Advantage provider by market share, UnitedHealth has focused on stabilizing its offerings and improving star ratings, a key quality metric for plans. These efforts come in the wake of a difficult year and a half for the program sector-wide. (Berryman, 10/15)