Resources - Unlock Health

Resources

Unlock Health has deep experience in managed care consulting, revenue strategy, contract performance and negotiations, benchmarking, analytics, and strategic communications

UnitedHealth Group – The “Death Star” of U.S. healthcare

If you have attended one of our speaking engagements or read any of our thought leadership, it might be easy to think we are a little obsessed with UnitedHealth Group. Truth is, we are a little obsessed. Every other health plan in the U.S. watches United and parrots its strategy in some way. So it’s not unreasonable to think that UnitedHealth Group is, in effect, the U.S. healthcare system. I could use 10-12 emails or blog posts to unpack United’s corporate strategy and its implications for the

So much Medicare Advantage noise, so little time

Medicare Advantage (MA) plans have emerged as a pivotal component of the U.S. healthcare system, with enrollment more than doubling since 2010. These plans offer seniors an alternative to traditional Medicare. For the first time last year, more than half (51 percent) of the 65 million eligible Medicare members opted for MA plans over traditional Medicare. By 2030, more than 60 percent of eligible members are projected to enroll in an MA plan.

Three things you need to know about Medicare Advantage today

Medicare Advantage is the fastest-growing health insurance product. Enrollment has more than doubled since 2010, but it is adding to the financial headwinds for hospitals and health systems and impacting overall financial sustainability, all while we continue to see increased pressures for payor consolidations.

2023 revenue challenges: Turning the tide in 2024

While 2023 will always be celebrated as the year that Covid-19 shifted from a pandemic to an endemic state, providers across the country still faced significant financial challenges in 2023. From ongoing issues with Medicaid redeterminations and reimbursements to issues related to the huge growth of Medicare Advantage to shifting commercially insured expectations regarding care delivery, many hospitals and health systems are still fighting across multiple fronts to keep their doors open. In this

Denials by bots: Why providers need to keep an (even closer) eye on claims

Providers and payers are arguably the most important stakeholders in our healthcare ecosystem, yet the two groups have a long history of acrimony. While it’s tempting to point the finger at contentious contract negotiations, the events that occur after a contract is signed play just as big a role in perpetuating ongoing conflict as the negotiation process itself. The majority of provider organizations that we work with at Unlock Health – and our clients run the gamut from small, independent hos

Shifts in healthcare, provider hurdles, & the flywheel effect

In the “good old days” — let’s call that period pre-2008 — the majority of commercial insurance was full-risk; Increases came out of payor profitability rather than employers’ and consumers’ pockets, and patients were protected from high out-of-network/out-of-pocket costs. In 15-20 years, everything has changed. A lot. UnitedHealth Group is the poster child for this seismic shift in the underlying design of the healthcare system. At the end of the day, it’s all about leveraging your scaled asse