UnitedHealthcare intervention in patient treatment generates concern
The letter, dated Dec. 7, reiterated the issues discussed with UHC executives in September.
"The AAFP is concerned that UHC is financially supporting these external third parties to care for patients without coordinating the care with the patient's primary care physician," the letter said. "This type of care undermines the doctor-patient relationship, damages continuity of care, and may put the patient at increased risk."
Despite the September discussion, UHC nurses continued to visit Medicare Advantage patients without notifying their physicians. In addition, the nurses installed monitoring equipment that transmitted updates directly to the insurance or a remote specialist rather than to the primary care physician.
The letter also discussed UHC conducting chart reviews on its Medicare Advantage patients. While the reviews may be necessary due to the Healthcare Effectiveness Data and Information Set requirements and Risk Adjustment Factor scores, the insurer should not conduct interventions in care without informing the physician.
"Services such as patient education; medication management and adherence support; risk stratification; population management; coordination of care transitions; and care planning are typically not reimbursed under traditional, fee-for-service models," the letter said. "These types of services are best performed by the family physician and the practice team rather than external third parties."
Organizations in this story
American Academy of Family Physicians 11400 Tomahawk Creek Pkwy Leawood, KS 66211