So, here’s a clever way to bolster an insurance company’s annual profit report: Charge physicians to access claims payment data. Sound crazy? Well, that’s what UnitedHealthcare was doing, until recently, through its electronic Optum Pay platform.
Physicians and hospitals use historic claims payment data to review trends in pricing, analyze total costs and patient value, and review coding accuracy—in other words, this data helps hold insurers accountable. That’s one reason why tucking this data away behind a paywall didn’t sit right with the American Hospital Association (AHA) and many other groups, which have pushed back on these fees.
In response, United has backed off—even if only to a degree. The insurer is still not giving away complete access for free. United’s concession might be enough for the AHA, or perhaps we can expect further objections on behalf of providers. The AHA certainly has its hands full challenging other United moves, such as edging physicians out of the medication process and its policies that funnel care away from providers.
