Optum’s naviHealth acquisition will help lower the total cost of care for UHC members and Optum physician practice patients

• UnitedHealth Group’s Optum business has acquired naviHealth, a company that manages post-acute healthcare services, according to an article in Modern Healthcare.
•  NaviHealth works with health plans, hospitals and physician groups to improve a patient’s healthcare experience and clinical outcomes after being discharged from the hospital and saving costs, according to the same article.
• NaviHealth also serves 4.5 million Medicare Advantage seniors across 50 states and more than 140 hospitals in the CMS’s Bundled Payments for Care Improvement Advanced program, Modern Healthcare reported.

On May 21, Modern Healthcare reported, “UnitedHealth Group’s Optum business has acquired naviHealth, a company that manages post-acute healthcare services. Brentwood, Tenn.-based naviHealth works with health plans, hospitals and physician groups to improve a patient’s healthcare experience and clinical outcomes after being discharged from the hospital. It aims to do so while saving costs.

“NaviHealth serves 4.5 million Medicare Advantage seniors across 50 states,” according to the same Modern Healthcare article. “It serves more than 140 hospitals in the CMS’ Bundled Payments for Care Improvement Advanced program.” In the article, an Optum spokesperson commented on the transaction by stating, “Bringing together naviHealth’s post-acute clinical model and data-driven insights with Optum’s community-based health care and clinical capabilities will help meet the growing demand for highly personalized, value-based care coordination for patients with complex health conditions across the entire care spectrum.”

Takeaway

The transaction rounds out Optum’s capabilities (see bulleted list below) to ensure that UHC members — particularly MA members and Optum’s practices’ patients — receive the right care in the right setting at the right time after a hospitalization (or for MA in lieu of a hospitalization).

Optum’s capabilities, which have provided UnitedHealthcare with the potential to disrupt referrals for its 50 million members, include:

• 50,000 employed physicians
• 265 urgent care clinics
• 211 surgery centers in 35 states
• Massive claims and administrative data sets

It’s not surprising they would acquire a platform that will help them steer Optum patients to high-value post-acute care (PAC) providers and manage the length of stay (LOS), appropriately based on data, for similar patients. Not only will this help them reduce their medical loss ratio (MLR) for United Healthcare (UHC) MA products, but it will help any Optum practice participating in a Medicare fee-for-service (FFS) alternative payment model (APM).

When thinking about what’s missing from their portfolio, I wouldn’t be surprised if the next acquisition was a hospital-at-home company that could help deploy the model in markets where Optum practices have large numbers of UHC MA members under management.