Program Details

Name of Payment Reform Program
  Accountable Care Organization (ACO)
Organization Name
  UnitedHealthcare
Program Contact Name
  Lisa McDonnel
Program Contact Title
  SVP Network Strategy and Innovation
Program Contact Email
  placayo@uhc.com
Program Contact Phone
  952-979-6669
Program location(s)
  In this market and other markets
Market(s) (Ctrl-Click for multiple states)
  AZ, AR, CA, CO, CT, FL, GA, HI, IL, IA, MA, MO, NE, NJ, NY, NC, OH, OK, RI, TN, TX, UT, VA, WI
Lines of business
  Self-insured commercial, Fully-insured commercial, Medicare, Medicaid
Stage of implementation
  Expansion mode (e.g. passed initial pilot stage and broadening reach)
Date of Implementation
  January 1, 2012
Payment reform model alignment
  Other
Other non-FSS based reform models
  FFS-based Shared-savings with quality -Some shared risk and capitation as well
Base payment methodology
  Other
Other base payment methodology
  FFS (includes discounted fees, fixed fees, indexed fees) - Where contract is capiitated the capitation payment is the payment
Participating provider types
  Primary care physicians, Hospital inpatient, Other
Other types of providers
  The types of providers included in our ACO programs vary by location. Some ACOs include hospitals and some do not as part of the incentive arrangement.
Related outcomes for policies on non-payment for specific services associated with complications that were preventable or services that were unnecessary
  N/A
Performance measures used
  Achievement (relative to target or peers) of Clinical process goals (e.g., prophylactic antibiotic administration, timeliness of medication administration, testing, screenings), Achievement (relative to target or peers) of Clinical outcomes goals(e.g., readmission rate, mortality rate, A1c, cholesterol values under control), Improvement over time of NQF-endorsed Outcomes and/or Process measures, PATIENT SAFETY (e.g., Leapfrog, AHRQ, medication related safety issues), Longitudinal efficiency relative to target or peers, Patient experience, Financial results, Utilization results, Pharmacy management
Type(s) of benefit and/or provider network design features that create member incentives or disincentives to support the payment reform program
  Other
Other features
  Once an ACO has achieved better than market average quality and cost outcomes, UnitedHealthcare may look to partner with the ACO around a narrow network product creating steerage to drive business to the ACO. To date, we have built narrow networks around certain ACOs.
Information transparency
  Other
Other information transparency
  Once an ACO has achieved better than market average quality and cost outcomes, UnitedHealthcare may look to partner with the ACO around a narrow network product creating steerage to drive business to the ACO. To date, we have built narrow networks around certain ACOs.
Evaluation and results for program
  Program not evaluated yet