UnitedHealth Finds Success in Las Vegas With Sierra Health Plan Model.

HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that while health insurance premiums are rising in Las Vegas and across the country, UnitedHealth Group’s unique, integrated structure in Las Vegas has enabled the insurer to keep premiums lower than other health plans in this market. Following its 2008 purchase of Sierra Health Services, UnitedHealth leads the market in managed care enrollment and also owns the area’s largest multispecialty physician group, Southwest Medical Associates.

According to the recent Las Vegas Market Overview, UnitedHealth has achieved this dominance by maintaining plan models Sierra had in place prior to the merger that include its affiliated physician group. For instance, with its Health Plan of Nevada HMO, even though the insurer does not limit its network in the Las Vegas market to its own facilities, or charge a higher in-network rate to members who choose non-affiliated care, most members do choose Southwest Medical for their care, which enables UnitedHealth to manage costs through integrated patient care.

UnitedHealth can also control drug costs with the aid of Southwest Medical’s electronic medical record system, including its extensive use of electronic prescribing, which enables UnitedHealth to track physician prescribing.

“It’s not unusual for UnitedHealth to be an influential player in a market, but its dominance in Las Vegas as the result of owning a large physician group is rare for the insurer. Additionally, UnitedHealth has maintained Sierra’s model following the merger, changing little about how plans are run. This has not typically been its strategy in other markets. For example, when it acquired PacifiCare in California, the plan was integrated into the UnitedHealth model,” said Taylor Holliday, analyst with HealthLeaders-InterStudy. “With its own physician group making up the core of its physician network, UnitedHealth operates almost like a staff-model HMO in Las Vegas. It appears to be a model that is working because UnitedHealth is looking to open Southwest Medical locations in Arizona, as well as expand this delivery model to other markets.”

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HealthLeaders-InterStudy, a Decision Resources, Inc. company, is the authoritative source for managed care data, analysis and news. For more information, please visit www.HL-ISY.com.

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Source: HealthLeaders-InterStudy

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