UnitedHealth Group, which is the nation’s largest insurer by enrollment. Right now, it’s coming under some serious fire for its nursing home care practices. The company implemented a “Quality and Shared Risk” initiative to reduce unnecessary medical costs. This effort was said to have motivated nursing homes to reduce unnecessary hospital transfers. Republican critics of the move accused the administration of prioritizing cost savings over the quality of patient care. In turn, alarm grew over the threat to residents’ health, safety and quality of life.
Recent findings have learned that UnitedHealth had threatened nursing homes. They threatened to freeze payments if the homes didn’t reach certain spending goals. The insurer utilized a metric known as “admits per thousand” (APK) to track hospital admissions and enforce these financial incentives. This move struck fear into the hearts of healthcare providers. They felt that the new focus on doing everything cheaper put positive patient outcomes increasingly at risk for our most vulnerable populations.
The program provided substantial monetary incentives, such as “Premium Dividend” and “Shared Savings” payments to facilities that reached specific targets. This made the nursing homes more financially secure. It also raised ethical concerns about the relationship between profit and patient care.
Incentives and Pressure on Healthcare Providers
The conquest of UnitedHealth’s insurance arm has deepened, gobbling up more of the Medicare Advantage seniors than any other giant. Optum, one of the company’s three subsidiaries, fuels the majority of this growth. It uses or collaborates with 100,000-plus healthcare professionals. This large pipeline has resulted in their exercising of outsized influence over essential healthcare decisions for nursing home residents.
Those reports show that UnitedHealth’s nurse practitioners experienced immense pressure. They were pressured to persuade Medicare Advantage enrollees to adjust their “code status” to DNR (do not resuscitate). This directive frequently ran counter to patients’ stated desire to get everything that could be treatment.
“They’re pretending to make it look like it’s in the best interest of the member.” – current UnitedHealth nurse practitioner
Healthcare stakeholders often reminisce about the times when nursing professionals would call doctors due to misgivings about sending patients seeking critical treatment. Equals were telling them to step in and stop those moves.
“A lot of times the nurses want to send people out and we have to go in and try to stop it.” – current UnitedHealth nurse practitioner
Nurse practitioners are under enormous pressure, extending far past the code of ethics. If not, they may be subject to disciplinary actions for failure to follow corporate directions.
“And if we don’t, it’s on us. They take us out onto the carpet.” – current UnitedHealth nurse practitioner
Allegations of Negligence and Legal Challenges
The effects of these intimidation tactics are already being seen. Blatant violations are not hard to find, with patients enduring delayed transplants and lack of quality care as a result. A classic example was a patient who presented with stroke symptoms. In spite of this, the suggested plan of care included only bloodwork and aspirin.
“That’s not useful when it might be a stroke.” – former UnitedHealth doctor
A confidential nursing home incident log, along with video and photos, revealed a disturbing reality. One patient ultimately sustained permanent brain damage due to a transfer that was delayed. In these cases, playing the primary role of cost control instead of ensuring immediate access to critical care has been proven deadly.
Maxwell Ollivant, an ex-NP, recently spoke out against some alarming practices. He entered and filed a False Claims Act lawsuit that charged UnitedHealth with denying necessary services to nursing home patients. This lawsuit was notably attention-grabbing. The suit began to encounter obstacles when the Department of Justice announced that it would not intervene, leading Ollivant to pull out his suit in early 2023.
“How many of those people were further harmed because they never received the care that they needed?” – Maxwell Ollivant
Investigations and Ongoing Concerns
Call for justice
Despite these increasing allegations, investigations into UnitedHealth’s practices have not resulted in any significant accountability. Former and current employees describe disappointment with the lack of internal scrutiny about long-term damage to patients in the system.
“No one is truly investigating when a patient suffers harm. Absolutely no one.” – current UnitedHealth nurse practitioner
Critics say that the company’s obsession with lowering hospitalization rates still doesn’t tell the whole story about whether patients are actually doing better.
“When you just look at the percentage reductions in hospitalizations, it doesn’t say anything about patient outcomes.” – Maxwell Ollivant
Many advocates and critics have warned that economic incentives have warped clinical care into a more predatory business approach that lacks a focus on patient care. A former national UnitedHealth executive stated,
“You gain profitability by denying care, and when profitability suffers for the shareholders, that’s when people get crazy and do things that are not appropriate.”