Texas Doctors Earn More Than $5.7 Million in Quality of Care Bonus Payments for Improving Health Outcomes for UnitedHealthcare Medicare Advantage Members

UnitedHealthcare Infographic

UnitedHealthcare Infographic

UnitedHealthcare recently recognized more than 100 care providers in Texas with the 2015 UnitedHealthcare PATH Excellence in Patient Service Awards for their commitment to improving health outcomes for people enrolled in its Medicare Advantage plans.

These care providers earned more than $5.7 million in quality of care bonus payments for achieving performance metrics in the UnitedHealthcare PATH Program and successfully addressing care opportunities when treating more than 30,000 of UnitedHealthcare’s Medicare Advantage members in Texas. They are among more than 1,900 care providers nationwide who received the award and earned more than $148 million in quality of care bonus payments.

UnitedHealthcare created the PATH program to help people enrolled in its Medicare Advantage plans be as healthy as possible by encouraging greater use of preventive health care services and proactive monitoring of chronic conditions.

The program annually rewards physicians who meet certain performance-based criteria, including achieving or exceeding targets established by the Centers for Medicare & Medicaid Services (CMS) for specific Healthcare Effectiveness Data and Information Set (HEDIS) measures. Health plans and CMS use HEDIS as a tool to measure performance on important dimensions of health care and service.

Examples of the quality measures used to evaluate care providers’ performance in the 2015 PATH program include:

  • the percentages of eligible UnitedHealthcare Medicare Advantage members who received a breast cancer screening or colorectal cancer screening;
  • the percentage of members with diabetes who received an eye exam; and,
  • the percentage of members who received advice from their doctor to maintain or enhance their level of physical activity.

By achieving the PATH program’s performance metrics, care providers also proactively addressed care opportunities for UnitedHealthcare’s Medicare Advantage members. A care opportunity exists when an individual hasn’t received a health care service or medication recommended based on his or her age or health status. In 2015, care providers nationwide participating in the PATH program addressed nearly 1.8 million care opportunities for UnitedHealthcare’s Medicare Advantage members.

Since UnitedHealthcare established the PATH program in 2013, participating care providers have earned more than $213 million in quality of care bonus payments. Nearly 1 million UnitedHealthcare Medicare Advantage members are currently being treated by doctors who participate in the PATH program.

“The care providers in Texas who earned a PATH Excellence in Patient Service Award deserve recognition for their commitment to improving our plan participants’ health and well-being,” said Efrem Castillo, M.D., chief medical officer of UnitedHealthcare Medicare & Retirement. “These awards are one of the ways we are supporting the transition to a value-based health care system that rewards physicians for the quality of care they deliver to the people we serve.”

The PATH program provides support and incentives for both care providers and Medicare Advantage members to enhance their engagement in their health care and willingness to take action on their doctors’ treatment plan. The program has four components:

  1. Patient support and communication
  2. Actionable patient data and reporting
  3. Financial compensation for doctors
  4. Support for physician practices to enhance care coordination

The PATH program is part of UnitedHealthcare’s commitment to help shift the nation’s health care system to one that rewards quality and value instead of the volume of procedures performed. To facilitate this shift, the company offers a variety of value-based payment arrangements, including incentive programs like PATH, performance-based contracting, bundled payments and fully integrated accountable care organization (ACO) relationships.

Care providers nationwide are showing strong interest in a shift to value-based care. UnitedHealthcare’s total payments to physicians and hospitals that are tied to value-based arrangements have tripled in the last three years to $48 billion. By the end of 2018, UnitedHealthcare expects that figure to reach $65 billion.

For more information about the PATH program and UnitedHealthcare’s full spectrum of value-based initiatives, visit www.UHC.com/valuebasedcare.

Serving one in five Medicare beneficiaries, including nearly 759,000 in Texas, UnitedHealthcare is the largest business dedicated to the health and well-being needs of seniors and other Medicare beneficiaries.

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