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UnitedHealthcare teams up with ACO

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Summit-based Optimus Healthcare Partners, an accountable care organization, and the health insurer UnitedHealthcare announced Wednesday they are working together to provide coordinated health care. Their goal: improving quality and reining in costs for the 17,000 New Jerseyans enrolled in UnitedHealthcare's employer-sponsored and Medicare health plans.

The agreement with UnitedHealthcare brings to about 80,000 the number of patients in the Optimus ACO, which was launched in 2012 with Medicare patients. Optimus later expanded its ACO to patients of Horizon Blue Cross Blue Shield of New Jersey and Aetna.

Dr. John Vigorita, chief executive of Optimus Healthcare Partners, said the agreement with UnitedHealthcare means nearly all of the Optimus patients are now part of the ACO.

This kind of rounds out our market,” he said. Optimus physicians now can “treat all their patients along the same lines, reporting very similar quality metrics and not worrying about who the insurer is and who the payer is.”

The first patients who were enrolled in the ACO in 2012 were Medicare patients, and Dr. Jim Barr, chief medical officer of Optimus, said preliminary results from Medicare have identified Optimus as one of 29 ACOs deemed successful so far, out of more than 300 ACOs across the country.

Vigorita said, “We achieved our quality benchmarks and produced significant savings for our patient population.”

He said the dollar amount of savings to the Medicare program will be announced by the government in September.

Barr said, “Our approach is to proactively manage patient populations and help them obtain the appropriate preventive screenings and more successfully manage their chronic disease and help improve overall care coordination.”

Vigorita added, “That helps us to reduce unnecessary hospitalizations and also help us reduce unnecessary hospital re-admissions.”

Optimus Healthcare Partners is one of more than a dozen ACOs that have taken shape across New Jersey in the wake of national health care reform. ACOs get physicians, hospitals and other health care providers to work in tandem with health insurers, Medicare and other health plans. In April, UnitedHealthcare announced an ACO partnership with the Atlantic Health System.

Optimus has more than 550 physicians – more than 170 primary care physicians and 380 specialists – who coordinate care and are accountable for quality, cost and patient satisfaction for the health care they provide.

The people enrolled in UnitedHealthcare’s employer-sponsored and Medicare plans who currently receive care from Optimus providers will not have to do anything differently to get the benefits of the ACO. In fact, some have already experienced them: The Optimus ACO program became available for UnitedHealthcare Medicare Advantage enrollees April 1, and for UnitedHealthcare’s employer-sponsored health plan participants July 1.

UnitedHealthcare said its members who have a doctor-patient relationship with an Optimus physician will have all aspect of their care coordinated by care teams with the goal of providing the right care in the right place at the right time.

UnitedHealthcare continues to work with care providers statewide to help enhance health services and improve coordination of care for patients,” said Michael McGuire, CEO of UnitedHealthcare of New York and New Jersey. “We believe our collaboration with Optimus Healthcare Partners will deliver enhanced quality, better outcomes and greater efficiency for our health plan customers in New Jersey.”

The Optimus ACO includes the Optimus physicians and six hospitals: Morristown Medical Center, Overlook Medical Center, Newton Medical Center, Somerset Medical Center, St. Barnabas Medical Center and Warren Hospital. 


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