UnitedHealthcare is considering participation in CMS’ voluntary “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” model, according to UnitedHealth Group’s April 21 earnings call.
BALANCE involves negotiated lower GLP-1 prices for Medicaid programs and Medicare Part D plans, along with lifestyle-oriented initiatives. Beyond UnitedHealthcare, other insurers have not directly addressed the possibility of joining.
“We’ve been in good active dialogue with both CMS and [the Center for Medicare and Medicaid Innovation] on that front. We’d like to find a path to ‘yes’ there on coverage over time, but there are some notable challenges and outstanding questions with the currently planned structure,” Bobby Hunter, UnitedHealthcare’s CEO of government programs, said in response to a question about the model. “We’re still working through that process internally. … We’ve provided some specific recommendations that we believe would serve all stakeholders really well.”
CMS announced the model in December, but questions remain regarding implementation, adherence and regulatory issues, a March KFF analysis found.
Mr. Hunter said UnitedHealthcare will participate in the Medicare GLP-1 Bridge demo that begins in July.
“I think we’ll learn a lot about the best way to advance this priority through that experience,” Mr. Hunter added.
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