Look from Optum commercial insurance integration trend of medical service

by:Celecare     2020-07-14
On April 16th, as the Unitedhealth integration brings higher returns for medical services, domestic insurance giants in recent years have also entered the medical service market. However, with the United States is given priority to with business insurance payer market is different, the Chinese medical service market is the national health care is given priority to, this leads to the commercial health insurance more focus in the field of heavy disease risk class life insurance, weak influence on medical service, difficult to through to the service integration to promote the development of the system itself. From the point of the American market, the development of commercial insurance of medical services there are two goals: to push its control ability and find a new growth point. First, to promote their own ability to control cost. Commercial insurance has part of the service side, when price negotiations with medical services to occupy the initiative. For example, in February 2020, with prices not compromise and Unitedhealth will large group Mednax doctors out of their own health care network. Although Unitedhealth have large user base, but in terms of price discount for, still is not very well to get some strong medical services high discount. However, because of Unitedhealth has acquired some mature doctors group, can be part of uncompromising service out, so as to maintain their price system, to control the cost growth. Due to the commercial health insurance is given priority to with group, in the face of rising health care costs, the enterprise control the will of the stronger, the group price growth is flat. This transmission to the insurance company will have further suppress the service price rise quickly. But over the past few years the massive influx of capital medical service industry, especially for a specialist group acquisition speed, push prices for the medical services, especially the specialized service faster, resulting in insurance companies, and the contradiction between the hospital and the doctor group, rose. As America's biggest insurance company, Unitedhealth talks with its powerful dimension to and services to cut the price. In general, American medical service fee based on Medicare health insurance company price is 200% higher than the benchmark - 400%. In recent years, due to price increases faster, both sides of the negotiating room for shrinking. In order to advantage in the negotiation, the insurance company to buy medical services such as also accelerated. Unitedhealth Mednax play network is also due to their own medical group. Other insurance companies on the acquisition of doctors group also is relatively slow, the price negotiation on slightly weak. Although Unitedhealth contract only account for 2% of the $3. 5 billion Mednax revenue, but the vibration is great, news, stock price is declining rapidly, the superposition of the outbreak, Mednax shares in more than a month has been halved. It also reflects the service party once a crackdown by the payer, services in the capital market will be very passive. Second, through the development of medical service to find new sources of growth. Senior health insurance business income is 183. 5 billion yuan, up 12% from a year earlier. Optum's total income is 101. 3 billion yuan, up 11% from a year earlier. Unitedhealth's Optum Health income is 24. 1 billion yuan, accounting for more than 24%, accounting for bibi increased by 3% in 2015. On Optum three piece of business growth, OptumHealth fastest growth, in 2017, up 22% from a year earlier, in 2018 year-on-year growth has reached 18%. Thus, service has become the main growth point of the insurance company, and the traditional insurance business growth was only 12%. With high medical service business, senior drugs, found a new growth point. In 2018, although the PBM business OptumRx still account for 68% of Optum income, but the proportion has declined each year since 2015, growth is also maintain in single digits. At the end of 2017, Optum announced by $4. 9 billion to buy DaVita Medical Group, its 300 clinics, clinics of services in more than 1. 7 million people a year. This 300 clinics are included in the basic medical clinics, emergency medical center and operation center. For Optum, the move that increases its offline clinic and expanded its basic medical service network, especially the surgery center. Optum following the acquisition of Surgical Care after Affiliates, plus DaVita six operation center, its operation center has more than 200. And for DaVita Optum for more than 300 payer ( Including commercial insurance, self-preservation payer enterprise and the government) To provide services, become members of the family of Optum let DaVita have access to a wider range of customers. It is difficult to imitate the American market of insurance companies in China. Type business is weak, on the one hand is its own claims not to affect the medical service, medical services cannot be as an effective auxiliary control fee; On the other hand, is a private medical services by continuous extrusion of public medical service, it is difficult to rely on medical services be on a par with main business in the new growth point. Large insurance company's intention to expand medical services, however, the determination of did not change. This is because the large insurance company core business of the ultimate goal or feedback, great input to the medical service is mainly in order to find with insurance service mode, this also is the future development of Chinese market main imaginary space.
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