Was UnitedHealthcare CEO Brian Thompson shot and killed for supporting a change in our approach to health care?
"At an investor meeting last year, he outlined his company's shift to "value-based care," paying doctors and other caregivers to keep patients healthy rather than focusing on treating them once sick.
"Health care should be easier for people," Thompson said at the time. "We are cognizant of the challenges. But navigating a future through value-based care unlocks a situation where the … family doesn't have to make the decisions on their own."
Thompson also drew attention in 2021 when the insurer, like its competitors, was widely criticized for a plan to start denying payment for what it deemed non-critical visits to hospital emergency rooms.
"The University of Iowa graduate began his career as a certified public accountant at PwC and had little name recognition beyond the health care industry. Even to investors who own its stock, the parent company's face belonged to CEO Andrew Witty, a knighted British triathlete who has testified before Congress.
"When Thompson did occasionally draw attention, it was because of his role in shaping the way Americans get health care."
~Excerpt from the story UnitedHealthcare CEO kept a low public profile. Then he was shot to death in New York (Adam Geller and Tom Murphy, AP, 12-4-24)
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'The words "deny," "defend" and "depose" were scrawled on the ammunition, Kenny said. The messages mirror the phrase "delay, deny, defend," which is commonly used by lawyers and critics about insurers that delay payments, deny claims and defend their actions.' ~ WTOP
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As I read about the shooting, wondering what might have made someone angry enough to shoot a CEO.
In a section on Understanding the issues health care reform should address (on my own website), this was the first article I had linked to:
How UnitedHealth harnesses its physician empire to squeeze profits out of patients (Bob Herman, Tara Bannow, Casey Ross, and Lizzy Lawrence, Physicians for a National Health Program, PNHP, reprinted from STAT News, Investigation: Health Care’s Colossus, 7-25-24)
"UnitedHealth is a colossus: It’s the country’s largest health insurer and the fourth-largest company of any type by revenue, just behind Apple. A STAT investigation reveals the untold story of how the company has gobbled up multiple pieces of the health care industry and exploited its growing power to milk the system for profit. UnitedHealth’s tactics have transformed medicine in communities across the country into an assembly line that treats millions of patients as products to be monetized."
"Doctors said the company had a fixation with medical coding to generate more revenue — encouraging clinicians through bonuses and performance reviews to identify more health problems in patients, even if those conditions seemed dubious. By controlling doctors, UnitedHealth can lean on them to practice in ways that benefit the insurer, and use its insurance arm to funnel cash back to its clinicians — similar to how Standard Oil amassed power as both the buyer and seller in oil refining.
"Doctors interviewed by STAT said they were initially seduced by the company's sales pitch that it would be hands-off and help them provide high-quality care, but they quickly became disillusioned. Patients, meanwhile, are wondering why their doctors are rushing through their appointments — if they can get seen at all — and have expressed alarm when concerning diagnoses pop up in their medical records, many of which were never mentioned by their physicians.
"While UnitedHealth expanded in patient care, it also grew its dominance in Medicare Advantage, the alternative to traditional Medicare that is run by private insurers and now covers more than half of all Medicare beneficiaries. Medicare Advantage insurers have gamed the system by excessively coding their members, resulting in massive overpayments to the companies. Overpayments based on coding alone are expected to total $50 billion this year..."
More on:
What is "value-based care"?
Better health at lower costs: Why we need Value-Based Care now (Aetna, an insurance provider)
"Value-Based Care (VBC) is a health care delivery model under which providers — hospitals, labs, doctors, nurses and others — are paid based on the health outcomes of their patients and the quality of services rendered. Under some value-based contracts, providers share in financial risk with health insurance companies. In addition to negotiated payments, they can earn incentives for providing high-quality, efficient care. VBC differs from the traditional fee-for-service model where providers are paid separately for each medical service. While quality care can be provided under both models, it’s the difference in how providers are paid, paired with the way patient care is managed, that provides the opportunity for health improvements and savings in a VBC environment."
"We spend too much and we get too little."
"The U.S. spends the most on health care, but has the worst outcomes and highest disease burden among developed nations."
....
What are the value-based programs? (Centers for Medicare & Medicaid Services)
https://www.cms.gov/medicare/quality/value-based-programs
"Our value-based programs are important because they’re helping us move toward paying providers based on the quality, rather than the quantity of care they give patients.
"What are CMS’ original value-based programs?
There are 5 original value-based programs; their goal is to link provider performance of quality measures to provider payment:
End-Stage Renal Disease Quality Incentive Program (ESRD QIP)
Hospital Value-Based Purchasing (VBP) Program
Hospital Readmission Reduction Program (HRRP)
Value Modifier (VM) Program (also called the Physician Value-Based Modifier or PVBM)
Hospital Acquired Conditions(HAC) Reduction Program
Other value-based programs:
Skilled Nursing Facility Value-Based Purchasing (SNFVBP)
Home Health Value Based Purchasing (HHVBP)"