As one example, MarinHealth's revenue cycle is being absorbed into Optum. Under the agreement, some of MarinHealth's employees will become Optum employees who will still work on that health system's revenue cycle operations.
A trend within the healthcare revenue cycle is that more health systems are outsourcing to companies who will run the revenue cycle for them, all the while using the health system's employees to do the day-to-day tasks.
As an example of this trend, California-based MarinHealth is the latest health system to team up with Optum on its revenue cycle operations, with an agreement that will see some of MarinHealth's employees become Optum employees who will still work on that health system's revenue cycle operations.
As part of the partnership, Optum will provide revenue cycle management services and supporting technologies to MarinHealth, as well as supply chain services.
Over the past few years, several health systems have entered into similar agreements with Optum, where their own revenue cycle employees become Optum employees.
Such arrangements allow health systems to keep their own experienced employees while using the technology, analytics, and other tools that they may not have had access to previously. In addition, Optum, "deliver[s] pre-negotiated outcomes based on an optimal future state of operation and take financial risk on that delivery," it says.
In October 2021, the midwestern health system SSM Health announced a similar deal with Optum.
That deal was preceded by ones with New York–based Bassett Healthcare Network in May 2021; Colorado-based Boulder Community Health in July 2020; and California-based John Muir Health in July 2019.
Optum is part of UnitedHealth Group, which reported full year and fourth quarter 2021 earnings last month.
Optum full-year revenues were $155.6 billion, up $19.3 billion (14.1%) year-over-year, while its full-year operating earnings of $12 billion increased $1.9 billion (19.4%) compared to the previous year.
Its data, research, and analytics arm Optum Insight (which combined with Change Healthcare earlier this year), saw its revenue backlog increase by $2.2 billion in 2021 to $22.4 billion, driven by growth in managed services, such as with these health system partnerships.
UnitedHealthcare has its tentacles all throughout the healthcare landscape, and not every one of its decisions is popular, such as its decision to retroactively deny ED claims (a policy it later said it would delay).
Such a policy not only would have possibly violated the prudent layperson standard, but it also could have steered patients to medical facilities that OptumHealth owns, such as MedExpress, which joined Optum's clinical service offerings in 2015.
"If Optum puts pressure on people not to go to the ER, but to use urgent care centers instead, it's going to drive more patients to places that they own … it keeps everything within the UnitedHealthcare ecosystem," Doug Wolfe, co-founder and partner of the Miami-based law firm Wolfe Pincavage, told HealthLeaders over the summer. "Hospitals are competing with UnitedHealthcare from the Optum provider locations, but the hospitals do not have the same power to direct patients through coverage determination."
Alexandra Wilson Pecci is an editor for HealthLeaders.
