A major health insurer says the government can save big money on health care by sending patients to cheaper, more efficient doctors, reducing hospital visits by the elderly and cutting down on unnecessary care.
Those are among 15 suggestions made Wednesday by UnitedHealth Group Inc., a Minnesota-based health management company that said the proposals could save $540 billion over 10 years, mostly through savings for the government's Medicare insurance program for the elderly.
The proposals come as Congress and the Obama administration are working on a major health care overhaul aimed at reducing costs and extending coverage to 50 million uninsured Americans.
Some of the proposals could be cast as attempts to ration health care — one of the attack lines some conservatives have been using against emerging proposals from the Democratic-controlled Congress.
Like other groups with an interest in the outcome, UnitedHealth is trying to position itself as a constructive voice in the debate — and avoid becoming a target itself as lawmakers try to reshape the nation's $2.5 trillion health care system.
"We very strongly support the idea that the national health care system needs to be modernized," said Simon Stevens, director of UnitedHealth Group's center for health reform and modernization. "What we're doing is attempting to be constructive and practical in responding to that challenge."
Among the top cost-savers United identified are:
- $166 billion by providing skilled nurse practitioners at nursing homes to manage illnesses and prevent avoidable hospitalizations;
- $37 billion by steering patients to physicians rated best on quality, efficiency and cost;
- $13 billion by cutting down on unnecessary use of advanced imaging technologies such as MRIs; physicians would have to receive prior authorization from a radiology benefit manager.
The proposals drew some praise but also skepticism from outside experts who questioned United's forecast for savings. They noted that many of the ideas involve voluntary actions by patients, without fully reforming the underlying payment system that tends to reward quantity over quality.
"I think this comes under the category of wishful thinking," said Robert Laszewski, a former health insurance executive turned policy consultant.
UnitedHealth released the proposals even as the health insurance industry, doctors, hospitals and other groups are working to make good on a promise to President Barack Obama to reduce their own costs by $2 trillion over 10 years.
UnitedHealth said its proposals were separate but complementary to that effort. The industry groups are supposed to report back to the White House in early June.