The possible threat of new competitors like Amazon entering the pharmaceutical business and technology companies that provide medical care through cell phones has led former adversaries to become partners, which encourages insurers to partner with hospitals and groups of doctors. They seek to provide attention in novel ways, outside the expensive environment of a hospital. While the combination with CVS allows Aetna to experience providing medical care in a retail environment, insurers also seek to partner directly with doctors and health systems.
Through its Optum unit, which operates a large pharmacy benefits manager and offers a wide variety of health care services, UnitedHealth Group is one of the most diversified and successful insurers.
The acquisition of DaVita Medical Group, which includes high-profile organizations such as HealthCare Partners and Everett Clinic, is the latest move by UnitedHealth to expand in the field of health care delivery as a way to reduce costs. The company already operates medical practices in Southern California and elsewhere, and has about 250 MedExpress urgent care clinics. Clinics offer much of the same care available in a hospital emergency room, but at a reduced cost.
Last January, UnitedHealth also acquired a chain of surgical centers, a measure that the company said could reduce the costs of outpatient surgery by more than 50 percent. The company expects to perform approximately 1 million surgeries and other procedures this year.
Insurers increasingly work with doctors and hospitals, experimenting with different methods to pay for care and trying to provide better supervision of potentially expensive chronic conditions such as diabetes or heart failure.
While these new partnerships promise to change the way people receive care, by organizing better information about patients and directing them to less expensive and more convenient places, be it an urgent care clinic or a pharmacy, keeping that promise can be challenging . DaVita, who purchased HealthCare Partners five years ago as a way to become a major player in the care of people with chronic diseases, found herself struggling to make money in her medical group. Describing the group's most recent quarterly financial results, DaVita CEO Kent J. Thiry said they were "extremely disappointing."
Consumers may also see their choice of physician or pharmacy heavily limited under these agreements while insurers attempt to drive patients in the groups over which they have the most control. Both Aetna and UnitedHealth insist that their goal is to develop a new model of care that is available to people outside their respective health plans, and Optum says it now works with more than 80 health plans.
Continue reading the main story