Medicare Advantage: A focus on early detection and prevention

We believe there is an urgent need to build a health care system that focuses on early detection and disease prevention – one that is more proactive and focuses on caring for patients before they are sick and before treatable conditions get worse. Value-based care models, including Medicare Advantage (MA), are structured to encourage precisely this approach.

Instead of waiting for conditions to become serious, MA encourages early screening for conditions that could result in serious patient complications. Appropriate and complete documentation of these conditions helps us better manage patient care and ensures Medicare provides adequate resources to take care of patients based on their overall health. 

Committed to accuracy, compliance and transparency

To confirm that we are delivering this value, we take seriously our role in protecting the integrity of the MA program and are committed to maintaining accurate and compliant risk adjustment data. In all care settings, including home visits, our providers exercise independent clinical judgment in determining which screenings may be appropriate and fully diagnosing and documenting any conditions they find. The majority of diagnoses made during a home visit do not result in increased payments.

Additionally, the federal government conducts regular, strict oversight of MA. UnitedHealth Group has long supported efforts by the Centers for Medicare and Medicaid Services (CMS) to enhance MA program oversight and integrity, including through regular audits of MA plans.

CMS conducts Risk Adjustment Data Validation (RADV) audits to assess whether MA plans were overpaid. As part of this process, CMS reviews a sample of members’ medical charts to verify that reported diagnoses are supported by documentation.

Independent CMS audits confirm we are among the most accurate in the industry in our coding practices

  • We maintain robust procedures and employ certified clinical professionals to ensure our programs meet the highest standards.
  • Over a five-year period, government auditors validated approximately 90% of the conditions for which UnitedHealthcare was paid – a significantly higher accuracy rate than other large MA plans.
  • After reconciling data discrepancies across UnitedHealthcare’s contracts, CMS determined that 13 out of 15 contracts were underpaid overall.
It's also worth noting that a decade-long challenge to our Medicare Advantage business by the Department of Justice led to the Special Master’s conclusion that there was no evidence to support claims that we were overpaid or engaged in any wrongdoing.
 
Going forward, we will deploy a regular, independent third-party coding oversight and audit process to supplement our existing quality assurance program – so all stakeholders can have the same confidence in our performance and compliance that we do.

Spotlight on HouseCalls: Better access and outcomes

For UnitedHealthcare MA members, most individuals receive an annual HouseCalls visit, a yearly in-home health and wellness service that helps people stay on top of their health between regular doctor visits. These visits occur at no cost to members, ensuring they have access to preventive care that might otherwise be difficult, or even impossible, for them to access.

Millions of older adults rely on UnitedHealthcare’s free HouseCalls service, which brings important preventive care visits into their home. Our nurse practitioners spend up to an hour with patients, checking their health and helping them make connections to other social services so they can live a better, more independent life.

In 2024 alone, HouseCalls closed over 3 million gaps in care. This means health problems were caught early and resolved or monitored to prevent life-threatening and expensive health crises.

Learn more about HouseCalls

Better care, lower costs

More than half of older adults who are eligible for Medicare now choose MA plans because they provide stable, affordable benefits and high-quality, coordinated care – particularly for people with complex health needs.

What’s more, the satisfaction among MA enrollees is exceptionally high with 94% of MA beneficiaries ; satisfied with their health care coverage.

Learn more about how this program delivers real value to people while driving improvements in health quality and patient outcomes at medicareadvantage.uhc.com.

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