Interview Synopsis

Envision healthcare surprise billing & in-network shift

  • Multi Asset
  • Healthcare
  • North America

With the US healthcare system facing major regulatory changes to its billing practices, Third Bridge Forum interviewed a former network contracting head at UnitedHealth Group. UnitedHealth Group is the US’s largest healthcare insurer, and the Interview’s overall focus was to discuss the outlook for US physician-based company Envision Healthcare as it brings more doctors in-network. 

Physician Company Envision Healthcare’s Response to Rising Regulatory Pressures

The former UnitedHealth head examined how the Lower Health Care Costs Act will affect the operations of Envision and other healthcare providers like TeamHealth, and what will happen to their ability to generate profit under the new regulations. 

The managed care specialist, who now works as an independent consultant, goes on to debate whether the Act will be passed despite losing momentum in Congress. The healthcare expert believes it will, but warns there are systemic problems with the legislation, including ambiguous reimbursement models that could negatively impact the industry. 

The Interview explored in detail the different billing models being considered by Congress, including benchmarking, median in-network rates and the Medicare percentage model, which could see out-of-network physicians receive a lower billing rate of 125%. 

The consultant also looked at how the bill will affect Envision and UnitedHealth’s ability to hire doctors under this model. 

With the balance billing legislation threatening to put an end to out-of-network practices, the Interview also revealed the likely impact the legislation will have on provider revenues, which the healthcare expert forecasts to be around a 3% to 5% hit. 

Finally, the Interview explored the contract disputes between Envision and UnitedHealthcare and whether Envision will continue to take a hit on its earnings, resulting in a possible streamlining of its processes. 

To access all the human insights from Third Bridge’s Envision Healthcare – Surprise Billing & In-Network Shift Interview, click below to view the full transcript.

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The information used in compiling this document has been obtained by Third Bridge from experts participating in Forum Interviews. Third Bridge does not warrant the accuracy of the information and has not independently verified it. It should not be regarded as a trade recommendation or form the basis of any investment decision.

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