UnitedHealth Group’s Optum plans to grow its ASC business in markets where it already operates, a strategy that puts more ASCs alongside a parent insurer that has negotiated lower rates than rival payers.
The footprint: Optum’s SCA Health runs more than 370 ASCs and surgical hospitals in 38 states.
The plan: On UnitedHealth’s Oct. 13 earnings call, Optum Health CEO Krista Nelson named surgery centers among the “high performing service lines” where she sees “lots of opportunity for growth in those services to go deeper in our existing markets,” according to a transcript. She said Optum Health serves 20 million patients, about 4 million of them in fully accountable relationships.
Optum Health’s third-quarter revenue fell 10% to $22.9 billion, which UnitedHealth attributed to serving fewer value-based care patients in markets where it lacked enough presence. Its operating margin was 3.2%. On the call, Ms. Nelson said Optum Health is targeting a 6% to 8% margin by 2028.
The rate data: UnitedHealthcare paid its own ASCs $1,690 for a colonoscopy, $1,625 less than the $3,315 paid by Blue Cross Blue Shield, Aetna and Cigna at those centers, according to a September Health Affairs study of 2023 negotiated rates. For arthroscopy, UnitedHealthcare paid $4,401, $1,439 below rivals.
UnitedHealthcare also paid less at ASCs it does not own: $2,618 vs. $3,502 for colonoscopy and $5,463 vs. $7,149 for arthroscopy. The gap largely disappeared in highly concentrated insurer markets, and the researchers found no evidence that UnitedHealthcare ownership raised prices industrywide.
A separate Health Affairs analysis of Medicare claims from 2013 to 2021 found no significant change in procedures, physicians or patient mix after UnitedHealth acquired ASCs, and no decline in quality.
The market: Tenet’s United Surgical Partners International, the largest ASC operator, had interests in 535 ASCs and 25 surgical hospitals in 37 states as of Sept. 30. Its third-quarter revenue rose 7.5% to $1.37 billion. Same-facility cases fell 1.5%, while revenue per case rose 6.1% on higher acuity and service mix, according to Tenet’s third-quarter earnings release.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
