Update: UnitedHealthcare Sues Department of Defense Over Tri-Care Contracts–They Said They Would Do This – Is This A Case Of My Algorithms Are Better Than Yours?

You have to read the press release and keep in mind this was put out by United HealthCare, so thus I ask the question in the title, do they feel their algorithmic formulas are better and they have more IT infrastructure?  Tri-Care has the same problems that Medicare has with low reimbursements and there are areas where patients have problems finding a physician who takes the coverage.  Many doctors do it on the same grounds as they do for Medicare patients, to take care of the patient, which everyone appreciates and they don’ expose patients to the garble and contract negotiations that take place all the time. 

UnitedHealth Loses Tri-Care Protest Again With Contract Awarded to Humana in the South-Now Protesting Contracts Awarded In Both the South and the Western States

So many MDs that I run across tell me United is the lowest payer on their list and one hospital in Orange, won’t take any employer provided United patients, they will see private and other contracts but the ones converted from the old Pacificare they say are too low for reimbursement.  Below were my comments on the first post last week.  The wording here, again, “Tri-Care going down the same risky path” again looks a bit political in nature when describing the DOD decision.  One other thing to think about too when changing contracts is the disruptions that occur, so maybe the incumbent is not the absolute top of the line but then also not the bottom feeder of all carriers so I think weighing the impact on all Tri-Care members may have fit into this decision too, again my speculation as it is disruptive with what everyone has going on in their lives today to make another whole bunch of changes.  This is just the straight talk of the numbers being discussed here at the Medical Quack once more:)  BD

“This contracting and bidding situation has been going on since 2009 and yes it’s taking forever, but in the north Healthnet kept their contract and in the south United contested twice and here’s the latest with Humana staying in place.  It’s pretty gutsy when United said that Tri-Care misevaluated the proposals a second time.  According to this article they still have not given up and are reported to be looking at some other methodologies, like maybe pulling some algorithmic reports?   They own enough companies to do all the analytics that one could desire I think and even said they would not stop short of legal action.  The Tri-Care contract for the south includes Alabama, Arkansas, Florida, Georgia, part of Kentucky, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee and most of Texas.”

MINNETONKA, Minn.--(BUSINESS WIRE)--UnitedHealthcare today filed suit with the U.S. Court of Federal Claims over the Department of Defense’s (DoD) handling of the TRICARE South Region contract.

“The stakes for military families are simply too high, and the deficiencies in the contracting process too significant, for the Department of Defense to proceed with implementing this contract as it stands,” said Lori McDougal, CEO of UnitedHealthcare’s military health division. “The Pentagon disregarded its own stated goals for this contract, and military families’ access to quality health care in the South will be put at risk as a result.

“UnitedHealthcare is committed to serving military members and their families with the best possible access to quality doctors, specialists and health care facilities,” McDougal said. “We will continue to pursue that mission and are prepared to do our part to help members of our nation’s uniformed services gain access to the health care they need and deserve.”

Also in 2009, the Defense Department awarded the TRICARE West Region contract to the incumbent, which has held the contract since 1996. UnitedHealthcare, which competed for that contract, filed a protest with the Department of Defense, based on a number of issues with the review and selection process.

In early 2011, UnitedHealthcare won that agency protest and the Pentagon agreed to reevaluate the TRICARE West contract proposals. However, the Pentagon has indicated that it will go down the same risky path it chose in the South Region by inviting offerors to guarantee cuts in payments to doctors and hospitals in the TRICARE West network. The Department will re-open the contract solicitation, but the negative long-term implications for TRICARE members in the West are clear if the same network discount guarantees that threaten health care access in the South are put in place in the West.

UnitedHealthcare Sues Department of Defense over TRICARE South Region Contract | Business Wire

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