- http://www.kaiserhealthnews.org/stories/2012/april/29/conflicts-arise-as-hospitals-diversify.aspx
- http://www.washingtonpost.com/health-insurance-companies-push-to-diversify-raises-concerns/2012/04/27/gIQAWoSkoT_story.html
List date(s) this work was published or aired.
4/29/2012
Provide a brief synopsis of the story or stories, including any significant findings.
The story recounts the numerous conflicts of interest caused by UnitedHealth’s move to diversify out of the insurance business and purchase businesses whose interests are directly opposed to those of United’s insurance wing. While some of these had been reported, the story focused on one that hadn’t gotten attention and which illustrated the conflicts in a striking way: The purchase by United, a health insurance company, of Executive Health Resources, a hospital consultant whose job is to fight against health insurers.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
Web research and documents from competitors — EHR’s marketing documents, hospital memos etc. — showed the lengths to which Executive Health Resources and UnitedHealth go to hide their common ownership. One hospital told its medical staff that EHR was “physician owned.”
Explain types of human sources used.
I was tipped to the story by the spouse of an Executive Health Resources employee. Extensive interviews with hospital executives and competitors of Executive Health Resources, in addition to those with academics and UnitedHealth officials. Confirmed that EHR pays the American Hospital Association a fee to be its preferred claims-denial protest contractor — for AHA to promote EHR to its hospital members.
Results:
With luck hospitals hiring and thinking about hiring EHR and other UnitedHealth affiliates will have a better idea of who they’re dealing with.
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No.
Advice to other journalists planning a similar story or project.
Diversification is one of health care’s megatrends. Everybody’s trying to hedge bets. Hospitals are starting insurance companies. Doctors are selling out to hospitals. Insurers are buying consultants and doctors. Everybody (except for most for-profit hospitals) is starting ACOs. So there are lots of stories even when the combos don’t pose a conflict of interest, which they often do. To see all arms of the octopus, for publicly traded companies, see SEC form 10K. They usually give only the names of the corporate entities and you’ll have to do more research, but it’s a start. For nonprofit hospitals, of course the 990s are one resource, but there is richer data in what they have to send to bondholders — certified financial statements and the like. You can get the bondholder disclosures through the EMMA database. In any case, you need regular reporting. The best sources are those whose interests are potentially harmed by health mergers — independent competitors, clients who feel bought-out vendors are compromised, etc.