What happens if UnitedHealth Opts out of ObamaCare?

By Larry Hodge, CEO HealthTECH Resources, Inc.

UnitedHealth Group is forecasting losses and considering an early exit from the Obamacare exchanges. With 20+ years of past experience in the healthcare IT industry, I believe that this would create problems for the payer market. How will this affect the healthcare IT sector, as those 3 ½ million people will have to figure it out for themselves or they walk around, again, with no health care? If managed health care insurance, our payer market, start opting out of the system, it will affect our business as people will no longer need to be on-boarded into the system in those insurance clients not participating.

For the first ten years in this business, HealthTECH focused on the payer side of healthcare.  We saw the Provider market take off after ObamaCare mandated the adoption and implementation of electronic health records along with incentive payments for their Meaningful Use. Most major hospitals in the U.S. were behind schedule with Stage 2 compliance, designated as “the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible” by the Centers for Medicare and Medicaid Services. After significant industry feedback, CMS released an update to the Meaningful Use program on October 16th, 2015. All providers are now in Stage 2 of Meaningful Use, with those who were previously in Stage 1 moved to a “Modified Stage 2”. The new deadline for attestation is February 29th, 2016. CIO’s know that if they don’t get through these stages by the deadline set by the government, they may not get reimbursed for Medicare, or worse.

HealthTECH focuses on EHR Market for Meaningful Use Compliance

HealthTECH focuses on the EHR market, with specialized support for regional hospitals under 100 beds, to larger hospital clients nationwide with more than 200-400 beds. In my view, in addition to ObamaCare, another significant reason the payer market has been challenged is due to the intense M&A and consolidation activity in the Insurance market over the last 5-7 years.  United, Aetna, Anthem and Coventry have bought everybody seemingly (or considered them). If one of them didn’t acquire them, one of the other already owns them. There used to be dozens of reputable insurance companies to choose from and now there are a handful. That affects the IT professionals we hire to meet demand.

The majority of our resource requirements are now on the Provider side. We still maintain a very strong bench of top talent in the payer market as we continue to support our payer clients nationwide. Five years ago, I saw just the opposite. Provider consultant bill rates are higher than our payer bill rates across the board nationwide. Of course, we take care of everybody but the demand for payer resources is less, I feel due to consolidation in the payer marketplace. I am starting to see the same thing beginning to happen on the Provider side. Consolidation and M&A activity has increased naturally and we support that activity as prudent business practices.  Whether it be clients like Cedars, Banner, or St Josephs buying up smaller hospitals, we are vigilant of this trend and understand the support issues that follow a major acquisition, migration or upgrade.

I’ve kept an attentive eye on this over the years, and I see this as a big snowball coming down the mountain. I feel there is now way to really “slow” this trend, regardless of Congress interventions.  People are living longer. They are utilizing hospital systems to live longer. There is no way to stop this transition in the Hospital and EHR market. Hospitals can’t push back, or they won’t be Meaningful Use compliant, they won’t receive Medicare reimbursements, or they will be acquired many times against their will…..it is a “process” we must continue to work through and in my opinion we cannot “stop the snowball” that has been underway. We have to be prepared for it and plan for it accordingly.

Experience with every EHR Application

HealthTECH has expertise with all major EHR applications, whether it be a major implementation, migration to a different EHR, or required upgrade along the way. We have resources available for Payer and Provider clients in all 50 states nationwide, on site, for any duration. It doesn’t matter where you are located or what EHR application you choose, HealthTECH has over 20 years of implementation/upgrade experience that includes every available EHR application. We understand Meaningful Use guidelines and the various stages of compliancy required for Meaningful Use. We know the critical efforts to move from ICD-9 to ICD-10. Our consultants understand this complexity and their role in our client’s objectives. It may sound easy, but it is a nightmare at times…we understand that. We can support you through this transition as we have been for Payers and Providers since the 90’s. This is all we know, and we understand the task at hand as we have specialized in this arena for over two decades and evolved through the process.


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