Executives from UnitedHealth Group spoke Thursday in Boston at a conference for health care investors, and frustration with the No Surprises Act independent dispute resolution system was the hot group health topic.
Wayne DeVeydt, UnitedHealth’s chief financial officer, spent a lot of time talking about Medicare plans and state Medicaid plans. He then talked briefly about the costs UnitedHealth is facing as a result of high IDR system awards to doctors and hospitals involved in disputes with the company over out-of-network claims.
In the commercial coverage market, “the broader risk pools are changing, at least versus our expectations and assumptions,” DeVeydt said.
One factor pushing up commercial health coverage costs is the impact of Medicaid access cuts, and another is the impact of employers’ ongoing shift toward use of self-insured health plans, DeVeydt said.
But the high cost of IDR system awards to health care providers is another still factor holding down UnitedHealth’s margins and pushing up 2027 rates, DeVeydt said.
“With IDR, we’re pricing for what we’re seeing out there,” DeVeydt said. “That, unfortunately, puts more pressure on affordability for the consumer.”
UnitedHealth wants Congress to change the IDR system rules, DeVeydt said.
“We’re putting a lot of sunlight on the IDR process,” he said. “The greatest disinfectant is sunlight.”
A few companies are taking advantage of an IDR system loophole, and “we want Congress to understand what these companies are doing,” DeVeydt said.
DeVeydt and his UnitedHealth colleagues appeared at a conference organized by Wells Fargo.
UnitedHealth streamed its executives’ session live and has posted a recording online.
What it means: The level of attention that the IDR system fight is getting in Washington could escalate in the next few weeks.
The backdrop: Congress passed the No Surprises Act in an effort to reduce the odds that patients with commercial health coverage will end up with big bills resulting from costs not covered by their insurance.
The act requires payers and providers to resolve some health claim disputes directly, without involving the patients. The kinds of disputes eligible for the No Surprises Act system are air ambulance claims; claims for emergency services received at out-of-network hospitals; and claims for situations in which patients at in-network hospitals receive care from out-of-network doctors.
Providers argue that the IDR system looks unfair to the payers because the payers are doing a poor job of defending themselves.
The payers say they are having trouble defending themselves because the providers are flooding the IDR system with huge numbers of weak cases and huge numbers of cases that are not eligible for the IDR system in the first place.
The conferences: Investment banks and other organizations are now organizing a large number of investor conferences and the organizers call the sessions featuring the top company executives “fireside chats.”
Steve Nelson, the president of CVS Health’s Aetna unit, said nothing about the IDR system during his Wells Fargo conference fireside chat.
Nelson did talk, generally, about efforts to strengthen the company’s relationships with physicians and to expand efforts to steer patients toward high-quality providers.