UnitedHealth Group (Part 2)

This is Part 2 of The Guardian’s investigation into UnitedHealth Group.

To reduce residents’ hospital visits, UnitedHealth has offered nursing homes a variety of “financial sweeteners.” Over the last seven years, the company has produced “Premium Dividend” and “Shared Savings” payments that boost nursing homes’ bottom lines. UnitedHealth offered a larger cut to nursing homes’ from its “Quality and Shared Risk” that drove down medical spending, but in the end, threatened to take back money from those that didn’t.

Additionally, UnitedHealth was obsessed over APK, “Admits Per Thousand.” APK measured the rate that nursing homes sent their residents to the hospital, while under the “Premium Dividend” program, a high APK meant that nursing homes received nothing. A former national UnitedHealth executive, who worked on the initiative involving nursing homes, spoke on the confidential contracts on the condition of anonymity.

“APK drove everything” and “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.” 

These revelations emerge during a crisis for UnitedHealth, like the fatal December shooting of executive Brian Thompson and the arrest of Luigi Mangione. This incident reignited concerns over the “healthcare giants” Medicare profits and care denials. Still, the details of cost-cutting practices in nursing homes have not previously been disclosed, despite government and media investigations into UnitedHealth’s company conduct.

These secret bonuses were just one of many loopholes and maneuvers that UnitedHealth used to track and cut expenses in its nursing home initiatives.