For context, in the US, insurance companies are required to pay out a certain percentage of premiums in the form of care. UnitedHealthcare got around this by opening their own pharmacy, OptumPharmacy, and then inflating prices there so that the profits would land in the pharmacy part of the business, instead of the insurance part. The did pretty much the same thing with a number of medical practices, where they wouldn’t pay enough for doctors to stay in business…but would then buy the office, and pay higher amounts to themselves. This has the feeling of a revenge killing by somebody hurt by these practices, though we don’t know for sure.
Live Updates: Police Hunt for Gunman After UnitedHealthcare C.E.O. Is Killed in Midtown Manhattan
Submitted 2 weeks ago by silence7@slrpnk.net to nyt_gift_articles@sopuli.xyz
Rubisco@slrpnk.net 2 weeks ago
Not guilty.
anthropomorphized@lemmy.world 2 weeks ago
You were right the first time. Switching to a “value-based” model in 2023 is late and probably only bc gov repercussions. I’ve been out of the industry 10 years, but was doing “value-based” trials at one of Dallas/FTW (Texas, US) largest hospital systems with Medicare, Medicaid, Aetna, BCBS, and other carriers back in 2014. It was a secondary initiative to an Obama era push to modernize healthcare (read put docs on electronic systems) called “Meaningful Use”. Early adopters were rewarded, and by 2015 or 16 were being fined if they weren’t electronic, eprescribing, and interoperable. Before all this doctors made the most money on procedures, and there was no money in treating chronic illness. To reverse that incentive, enter “value-based” blah blah. So United here, after the vertical integration of their own pharmacy (can make up their own prices on meds) and their own doctors (can pay themselves whatever they want for services provided) only Then, did they move to a value-based model. See, only once they were sure they could capture profits elsewhere they aligned with the industry, at least the public payers.
This point is not as evil as using AI to automatically deny claims… But that context should undermine the seemingly altruistic adoption of a “value-based” model. It was a gov mandate from 2008, and they probably got some form of punishment for being so late to adopt.
The payers are the most responsible for high costs in the American healthcare system, full stop. Then for-profit hospitals and urgent cares.
Rubisco@slrpnk.net 2 weeks ago
Thank you for the clarification! That checks out.
AtariDump@lemmy.world 2 weeks ago
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AtariDump@lemmy.world 2 weeks ago
Wait, aren’t you the most abundant protein in the world‽
Rubisco@slrpnk.net 2 weeks ago
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*enzyme