CMS urges DOI to strengthen United-RMHP agreement

Wednesday, January 11, 2017 08:15 AM
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Bob Yakely, MD

On Jan. 10, CMS President-elect Robert Yakely, MD, testified before the Colorado Division of Insurance (DOI) to provide comments and recommendations on UnitedHealth Group’s proposed acquisition of Rocky Mountain Health Plans (RMHP).

Physicians and patients throughout Colorado and especially on the Western Slope are understandably concerned with the acquisition, specifically about long-term consequences it will have on patient care and how it will affect the long-standing relationships between RMHP and physicians that have been a model for the nation. As Yakely explained to the insurance commissioner, “The historical record of industry mergers demonstrate that whatever savings are realized through scaling efficiencies are not passed on to patients or their physicians. They simply give the health plans a bigger stick that exacerbates the already dangerous imbalances in physician-health plan business relationships, and clinical determinations.”

Understanding that the acquisition is proposed because RMHP’s board of directors believes it is the best path forward to advance the company’s mission of community-based and coordinated care, the CMS board of directors voted to examine this transaction and its real-world impact on physicians and patients to determine opportunities to enhance the agreement and expand collaboration with the merged companies if approved by state regulators.

Based on extensive discussion and evaluation, including numerous listening sessions and outreach to Western Slope physicians, CMS strongly urged the insurance commissioner to strengthen the acquisition agreement in the following ways.

  1. Protect patients by prohibiting the merged company from passing on acquisition costs to patients or other Colorado consumers in the form of higher premiums, as was a condition in United’s acquisition of PacifiCare in California.
  2. Establish a Physician Advisory Committee comprised primarily of actively practicing Western Slope physicians to provide input during the transition and on any far-reaching management or medical policy changes.
  3. Require the merged companies to offer a professionally facilitated dialogue to each Western Slope and mountain-region IPA currently served by RMHP to enhance patient and community benefits.
  4. Ensure continuity in leadership by guaranteeing employment of RMHP management, especially those who are involved in medical policy and physician relations.
  5. Define “study, learn and apply” as United has said it will employ to implement RMHP best practices to the Front Range and around the country, and hold United accountable to this commitment to ensure positive outcomes.

This acquisition is unique in that both plans have been open and forthcoming with information about the transaction and plans for the future, Yakey said in his testimony. CMS urges the DOI to accept these recommendations to ensure, if approved, that Western Slope patients and physicians continue to benefit from innovative health plan practices and collaboration.

Click here to listen to a recording of the Jan. 10 hearing. Go to the Proposed Mergers and Acquisitions page of the DOI website and navigate to the section for UnitedHealthcare/Rocky Mountain Health Plans. Clicking the links will download the audio files.

Click here to read written testimony by CMS President Katie Lozano, MD, FACR, submitted to DOI on Jan. 3. Contact Dr. Lozano at to share additional thoughts or concerns.

Posted in: ASAP | Practice Evolution | Payment Reform | Interacting With Payers


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