Thinking about jumping the ship, i have major concerns about the direction and position (not to mention the execs).
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Replacing current CTO with an AI that keeps repeating "1000x".
Having a three-way merger with Bob's Speedy Rx/Fishing Wirm Emporium and Kaiser Permanente in a desperate attempt to convince Wall Street that synergy will "improve healthcare in ways never seem before" while obscuring poor execution and generating big bonuses for C-levels.
@3gv "CPT reimbursement rates and individual insurance premiums are regulated"
This is key. If there was one schedule of reimbursement rates across payers and providers and the vast array of plans were converted into around 5-6 options it would be a game changer. Harmonizing reimbursement and coverage premiums bracketed by age cohort regardless of group size would eliminate the need for brokers and big chunks of Payers' functional purpose, saving billions.
If you took out who funds healthcare (employers, government programs, tax rebates, citizens, etc) this should have broad bipartisan appeal.
American health insurance failed financially. Healthy people opting out and an increasingly sick population. Health insurance premium tax deductibility dropped in favor of uncapped HSAs in a major blow in 2028. Many employers tired of rising costs or double digit rate hikes fund employee HSAs en masse.
In late 2030, an Amtrak-type deal was proposed by some in the National Party to bailout and nationalize the industry with a semblance of what was. Federal Socialists wanted to remove for-profit functions altogether and setup a national, government operated system of reimbursement focused on clinical outcomes like most civilized countries.
Seeing both as overreach and something the downsized Federal Ruling Council couldn't afford, regulations were changed: individual mandate that allowed catastrophic and med-share plans was eliminated, hospitals could refuse any service including emergency cases without pre-pay, the requirement to accept Medicaid (only a handful of states still offer following the distribution of national debt to the states by population) and Medicare was outlawed. This and the elimination of business taxes for incomes below $250,000 that boosted self employment was also part of the downfall of insurance with more self-pay.
UHC and other Payers are paper-pusher AI agents selected to administer a plan operated by Palantir - thank UHG for the data that made this possible - where CPT reimbursement rates and individual insurance premiums are regulated at the state level. Many states agree to a common schedule, making the task even less AI-intensive. The average American has new faith in the system - in fact the leveling of costs between large employers and the self employed is seen to actually increase insurance sales.
Health insurance profits are heavily regulated. Proceeds over a threshold fund Trump Baby Bonds and the Neo Natalist Bureau of Reproduction which finances births for citizens whose IQ level and marital status qualify.
Most of Optum as a business has largely disappeared. It's no longer needed. PBMs, while never outlawed, are no longer necessary as AI/crypto handles dr-g distribution. Harmonized, simplified reimbursement and premium design has completely transformed healthcare. Folks who can afford healthcare actually like the system. Providers, too. Those who can't afford it join new worker communities created to staff manufacturing returning from places like SE Asia. Some describe these a blend of Antebellum plantation and Na-i concentration camp with a hint of Great Wolf Lodge. Under new CEO, Dr. Oz, OptumHealth plays a leading role as a provider for millions now residing in worker communities.
sc--wed up like it is today. different players at the top but the game shall continue
In my past, I see it as a place I used to work...
hopefully a thriving independent healthcare technology and operations consulting company making a real difference in improve lives with a global workforce and client base (read: not just cheap labor PH-IN or tax haven IE countries) serving providers, life science, and more.
i think very much like this poster:
I see it being exactly what it is today, albeit with different leaders.
Acquired by AMAZON
No way we stay in current form. It's not sustainable. Epic, something similar, or a consulting firm free from dated leadership+Payer will lead innovation.
You could cut the cr-p (and a ton of bloat) if there was one reimbursement schedule for the whole country and one clinical recommendation system and then the tech bro "facilitators" that can do it with apps and AI and/or better service will blow away old health insurance.
As long as the govt isn't running/paying for it, Trump, RFK, etc would support it because it "cuts the middleman" and reduces social programs.
I see it with more management from India, spawning a BIG investment in deodorant and toothpaste - a halitosis company.
The same it is today and just like it was 5 years ago, unless it’s forced change based on Congress decisions.
@fj We don't need Single Payer to ki-l health insurance, the system will implode on itself.
We can outsource 90%, save for 30+/ELT, but it won't bring costs anywhere close to OECD countries especially with hundreds of duplicative private payers (with their own 30+/ELT) adding cost and complication to the aggregate system.
Reimbursement based on severity, retrospective billing, bundling, all the tricks etc are/will be under pressure. GOP is cutting social programs and will save corporations from paying for health insurance. Add to that more "freedom alternatives" to health insurance, and we end up with a whole lot fewer customers.
If the industry embraced single payer around ACA negotiations (heck or with Hillarycare), we might have a future managing the programs. Instead, the number of uninsured is going to skyrocket.
Was that thesis from AI?
Single payer in this country ain't happening. To think so is a liberal wish ... To much money in play.
Had fun with this. Perhaps investors piling into the stock due to the Growth to Value shift read this.
DOJ limits PBMs due to cost pressure and Trump hates middlemen. Arkansas is making it illegal for PBMs to own pharmacies which led CVS to sell off their small retail pharmacy footprint. Other states may follow. This goes Federal. The ultimate blow is to restrict Payer+PBM combo.
First: ORX is forced to spin off. This invariably makes UHG a smaller business – less “too big to fail” and easier to be chopped up. Old guard shows hubris – we're more focused on patients than ever, we'll keep growing!
Second: Trump Admin has 3+ years (at least). Cuts to MA, Mcaid. Parts of ACA that require coverage, limit deductibles/out of pocket, and substitution of non-health insurance (eg indemnity plans/Aflac) are impacted. Stronger tax breaks for religious health cost share programs and employer stipends for direct care. Admin is pro-employer/anti-labor. Millions of fewer members buying standard commercial health insurance or using government programs.
Result: flat revenue, smaller margins for UHC and a hit to Optum’s Payer clients. UHG is reluctant to let Optum focus exclusively on Provider because of support for UHC, optics, misguided belief that USA for-profit/private Payer system will recover, and provincial attitude around international growth. External pressure mounts for UNH to spin off UHC (or at least exit MA) and focus on Optum which is seen as having potential if it had new leadership.
Third: Optum Health continues to struggle as fewer patients are covered, practitioners turnover due to pressure to focus on profit over clinical outcomes, and reimbursement falls as Congressional limits on severity-based billing “that’s been gaming the system” kick in. The drag on UNH leads even UHG-sponsored talking heads in the media call for a Provider spinoff.
Fourth: The walls crack. Layoffs are no longer necessary as attrition reaches historic highs. Offshoring and outsourcing peak at 80% of staff as customer feedback hits a nadir. It’s clear that “innovation” around VBC logically leads to a national Single Payer system - an outcome more distant than ever. The idea that UHG would “take over” US healthcare is an old man’s dream.
Private equity circles, gobbling up health techs and the healthcare services arms created by other Payers as they shed assets to stay independent. Grumblings about removing Directors. Eventually, an offer is too good. Outsiders demand Steve & Co accept an LBO for Optum to consolidate the non-provider business elsewhere.
Fifth: UHC absorbs OH, consolidating it with other Provider functions and rebrands as a new, one-stop PayVider, marketing directly to large employers who've instituted major RTO programs. The hope is to sell a new direct care service with a capitation model as the exclusive care provider (read: no out of network coverage, including emergency) to the largest USA employers. This is the penultimate evolution of VBC - short of public Single Payer. The latest plan is to lobby the government to ensure new tax-advantaged direct care stipends are limited to large companies (like UHC).
Coda: if we survive the Trump administration and its successor(s), eventually Single Payer that's taken hold in Blue states will be instituted nationally. UHC gradually shrinks as its Payer footprint falls off state-by-state and it's left as a low-rated Provider. Cost constraints spur heavy taxes on for-profit providers in favor of more regulated, nonprofit ones. At last, the great HMO that Steve built, is gone.
I see it being exactly what it is today, albeit with different leaders.