UnitedHealthcare negotiated significantly lower facility fees than rival insurers at the very ASCs it owns, according to a study published in the September issue of Health Affairs.
Researchers from Brown University, Columbia University, RAND Corp. and Cornell University used 2023 Transparency in Coverage data to compare UnitedHealthcare’s negotiated facility fees against those of Blue Cross Blue Shield, Aetna and Cigna, the three other largest U.S. commercial insurers by enrollment. UnitedHealthcare, now the second-largest ASC operator in the country with about 300 centers owned through Optum, paid less across the board.
Here’s what the study found on price:
- At non-UnitedHealthcare-owned ASCs, UnitedHealthcare paid $5,463 for arthroscopy on average, compared with $7,149 paid by other insurers, a difference of about $1,686.
- For colonoscopy at non-UnitedHealthcare ASCs, UnitedHealthcare paid $2,618 versus $3,502 from other insurers, a difference of about $884.
- At ASCs UnitedHealthcare owns, its own negotiated rate was $4,401 for arthroscopy, $1,439 lower than the $5,840 rival insurers paid those same centers.
- For colonoscopy at its owned ASCs, UnitedHealthcare paid $1,690, or $1,625 less than the $3,315 rival insurers paid.
The gap wasn’t uniform. For arthroscopy, UnitedHealthcare-owned ASCs had lower facility fees from every insurer, including rivals: other insurers paid those centers $5,840 on average, versus $7,149 at non-UnitedHealthcare ASCs, a difference the authors said “might reflect lower facility operating costs.”
Colonoscopy didn’t show that same pattern. What rival insurers paid at UnitedHealthcare-owned ASCs ($3,315) wasn’t significantly different from what they paid at non-UnitedHealthcare ASCs ($3,502). That’s a separate comparison from the $1,625 colonoscopy gap above, which is UnitedHealthcare’s own rate against rival rates at the same UnitedHealthcare-owned centers, not rival rates across ownership types.
The pricing gap also depended heavily on market concentration. UnitedHealthcare’s below-market payments to non-owned ASCs were most pronounced in markets with low insurer concentration, and the differential mostly disappeared in markets where insurer or provider markets were highly concentrated.
The authors said the findings should inform ongoing antitrust scrutiny of insurer-provider consolidation, even though the study did not find evidence that UnitedHealthcare’s ownership translated into higher prices industrywide.
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