UnitedHealth is building a suite it can offer other insurers as well as clinics and hospitals, helping the former build cost-efficient networks and discover efforts to skirt the rules, assuring compliance for the latter.
Ingenix, the technology unit of UnitedHealth, continued its buying spree by agreeing to buy Executive Health Resources, which bills itself "the physician advisor company" and which does compliance reviews done to assure care is needed under Medicare and Medicaid.
As is usual with the company, UnitedHealth is not mentioned in the release on the deal. EHR is based in a suburb of Philadelphia.
This follows by a just a few weeks the company's purchase of Picis, which along with other firms purchased in the last year is building it a suite of technologies that can monitor doctors and hospitals for low costs, and assure that its network only includes the most cost-effective providers.
This is a feature, not a bug, of insurance-led health reform. Its previous attempt to control costs, a database of "usual and customary" charges, was shut down as a "scheme to defraud" by the New York attorney general.
CMIO notes that EHR works in the area of "medical necessity," using its technology and people to question whether a procedure, drug or device is really needed.
That is, while rival Aetna may just work closely with a major vendor, IBM, in search of alliances and best practices, UnitedHealth is building a suite it can offer other insurers as well as clinics and hospitals, helping the former build cost-efficient networks and scout out efforts to skirt the rules, while assuring compliance for the latter.
The new effort also carries a benefit to government, since as with EHR these systems will help uncover Medicare fraud, or any effort to over-charge for government health services.
As the New York shut-down indicates, efforts to use technology in controlling costs have been ongoing. This is not a political story. Even if the new health reform law is enabling the new strategy it's highly likely the company would be moving in this direction anyway.
Separately, Ingenix said it was offering a version of its CareTracker, a web-based medical record and financial management package, to community clinics qualified for federal work. The service can fulfill the requirements of "meaningful use," the company said in its press release.
The new service includes many features UnitedHealth has been buying through Ingenix, including eligibility verification, reporting modules to assure compliance with federal rules and the printing of Continuing Care Records in a variety of languages.
Overall, what this shows is UnitedHealth is willing to play the technology "bad cop" for all federal efforts to control health care costs, both public and private.