UnitedHealthCare Cuts Access to 73% of Doctors

Minneapolis -- The relationship between "quality measurement" and health care rationing just went public, says Citizens' Council on Health Care (CCHC).

Using a metric rating system to rate quality and cost control, UnitedHealthCare ousted from its preferred list of providers nearly 75 percent of the physicians in its Missouri network, according to the St. Louis Post-Dispatch. This means UHC policy holders in Missouri-900,000 in St. Louis alone-have 75% fewer doctors to choose from, unless they are willing to pay more for their care.

"UnitedHealthCare is using data to perfect the art of rationing. They call it quality measurement, but that's just a code name. " says Twila Brase, president of CCHC.

She adds, "This action makes it clear that UnitedHealthCare cares only about dollars - getting them in premiums and keeping them in profits."

The mass deletion of physicians from preferred status became news when BJC Healthcare, the largest health care system in the St. Louis, Missouri region, announced last week its decision to terminate its contract with UnitedHealthCare, one of the area's largest insurers. The scheduled date of termination is August 13, 2005.

At the center of the dispute is the new UnitedHealth Performance program, rolled out in February and now being tested in 13 markets. Using patient claims data and the metric rating system, UHC gives "stars" to physicians that comply with HMO-approved treatment protocols and meet cost control criteria. The "star" designation has a real impact on cost and access. Patients choosing physicians without "star rating" pay more out of pocket.

In its original cut, the "star" performance rating went to only 27 percent of the 7,876 Missouri physicians in the United network. And only four (4) of Washington University's 1,144 full-time faculty physicians, who admit patients solely to BJC facilities, were listed as "star" performers.

"Physicians and patients are no doubt seeing stars. But these stars come from the blow inflicted by UnitedHealthCare's latest strategy to cut care and preserve profits," said Ms. Brase.

To schedule an interview with Twila Brase, contact her at 651.646.8935 or MediaContact@cchfreedom.org