30,000 Strong and Counting, UnitedHealth Gathers a Doctor Army

UnitedHealth closely guards information about OptumCare. While a list of OptumCare groups is available online, the company won’t say which markets it operates in, how many doctors it employs, or how much of its business comes from UnitedHealth’s insurance customers.

Seizing Advantage

A review of publicly available plan information shows UnitedHealth is in some cases nudging insurance customers toward its doctors. New West Physicians, a group of about 120 doctors and care providers in the Denver area it bought last year, is a favored practice in a plan with limited physician options for UnitedHealth’s commercial customers. Seeing doctors in the group can come with out-of-pocket expenses that are 20% to 30% less than treatment elsewhere, for some customers.

In other locations, UnitedHealth sells Medicare Advantage plans for seniors that offer lower costs to see OptumCare doctors, such as those in the company’s WellMed group. Hayek says OptumCare groups have similar arrangements with other insurers and the goal is to have them work with more.

Adding more doctors could bolster UnitedHealth’s position as the top provider of Medicare Advantage plans, by improving quality ratings that influence how much insurers are paid by the government, said Gorman, the consultant.

There’s currently little geographic overlap between UnitedHealth’s Medicare Advantage membership and OptumCare’s practices, according to an analysis by Tory Wolff, managing director of consulting firm Recon Strategy. But streamlining care in places where the company has both doctors and insurance customers can give the company an edge even if it makes its doctors available to everyone, Wolff said.

Nevada Roots

UnitedHealth first entered the care business in a big way in 2008, when it bought Nevada insurer Sierra Health Services and its then 250-doctor Southwest Medical Associates. The company saw how much the captive medical group could improve patients’ experience while delivering care at a lower cost, Hayek said.

Over the next few years, UnitedHealth went on a nationwide shopping spree, adding thousands of doctors through at least a dozen large deals. It bought Monarch HealthCare, which manages 2,500 doctors south of Los Angeles, in 2011. The same year, it bought WellMed and its 14,000 doctor offices in Texas and Florida. In some cases it buys companies that oversee large groups of affiliated doctors, and in others it directly employs the physicians.

From there, the company continued to diversify, adding urgent-care chain MedExpress for $1.5 billion in 2015 and Surgical Care Affiliates, which runs outpatient surgery centers, for $2.3 billion last year. In December, it agreed to pay $4.9 billion for DaVita Medical Group. That deal is expected to close this year, according to DaVita.

UnitedHealth now has about 230 MedExpress urgent-care sites, more than 200 ambulatory surgery centers and surgery hospitals, and 30,000 doctors, a figure that includes physicians who are employed by Optum units, or who partner or contract with the firm.

“The smartest participants in the system are the ones who are going to be able to provide quality care at the lowest cost setting,” said Ken Marlow, an attorney who leads the health care department at the law firm Waller Lansden Dortch & Davis LLP and works on hospital deals. “Whoever gets there first, and whoever is able to do that, I think will be the winner.”

— Read Trump Ending ACA Subsidies Lowered Insurance Cost for Many on ThinkAdvisor.

— Connect with ThinkAdvisor Life/Health on Facebook and Twitter.