ABOUT THIS EPISODE
Most doctors I talk to think of UnitedHealthcare as an insurance company. The insurance arm is the least profitable part of what it actually is. I recorded this one live from a conference in Chicago, the second round of Saturday Morning Coffee with Matt, the morning after a welcome reception full of chiropractors and physical therapists telling me they don't know how much longer they can hang on. So I treated UnitedHealth Group the way we treat a company in business school, as a case study in how you take control of a market.
I walk it through Betty. Her insurance card says UnitedHealthcare. Her longtime doctor now works for Optum. Her prescription runs through Optum Rx, the nurse who visits her living room comes through a program run by her insurer, and the claims run through Change Healthcare, which Optum also owns. If an independent physician owned a piece of the surgery center and the rehab facility he referred into, the self-referral rules would stop him. When one corporation owns all of it, the doctor is an employee and the structure stands. Then I follow the money from the premium cap on the insurance side to the payments that move between divisions, and into the research comparing what UnitedHealthcare pays its own practices with what it pays independents for the same work. Medicare Advantage adds another layer, because it pays more for a patient with more diagnoses on the chart. Federal inspectors have called billions of dollars in those diagnosis payments questionable. No court has found fraud, and the company says its practices are appropriate.
Then we get to you. If you own your practice, look up what your biggest payer pays the practice it owns down the street. Rank your payers and look hard at the ones that pay least and slowest. Build services your patients pay you for directly, something you want to be great at, and once you're outside the insurance model, you get to design the patient journey around the patient. I expect the fix to come one practice and one patient at a time, from doctors who stop waiting on Washington.
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About the Host:
Matthew Gillogly is the host of Out of the System and the founder and CEO of the Mavrix Profit System. He is not a doctor, and he treats that as the advantage. While physicians were learning anatomy, he was learning business anatomy, and he brought it into medicine as an operator. He ran three clinics in North Carolina under a management arrangement built by the letter of the law, where the doctor owned the practice and made every clinical call. His company handled the business side, and those clinics became the number-one provider of men's sexual health solutions in their market before he sold them.
He built Mavrix to hand that playbook to physicians who want out of insurance-dependent care, and he and his team have worked with hundreds of doctors on cash and direct-pay models. He spends most of his time making the case that the system works exactly as it was designed to, and that the people it works worst for are the ones who trained the longest.
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