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A new STAT investigation: How UnitedHealth squeezes profits out of patients

July 25, 2024
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Morning Rounds Writer and Podcast Producer

Good morning, happy Thursday! It's the end of the Morning Rounds week for me, as you know. Catch this afternoon's episode of the Readout LOUD edited by me. And tomorrow, you'll hear from a new voice in the MRU (Morning Rounds Universe, obviously): STAT's Brittany Trang!

Brittany will be taking over as your trusted Friday guide for the next few months while our colleague Nalis is out on maternity leave! We're sending love to Nalis and the family, and excited to read Brittany's take on the newsletter. 

a stat investigation

Inside UnitedHealth's doctor empire

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Physician Susan Baumgaertel spent 25 years working in internal medicine at a large, multispecialty group in Seattle. But after UnitedHealth took over in 2018, she said, the company pressured her and her colleagues to code patients for certain conditions, including some that they didn't think applied. "We were not truly caring for patients anymore," said Baumgaertel, who quit in 2021. "We were just micromanaging their care to bring in money. It just felt so unconscionable."

UnitedHealth Group started out as a small health insurance company, but it has turned into a colossus. The group's clinics and outpatient centers provide care for about 103 million Americans. Almost 1 in 10 of all U.S. doctors either work for UnitedHealth or are under its influence. A STAT investigation reveals the untold story of how the company has become so powerful and profitable, turning medicine into an assembly line in communities across the country. 

Read the first story in this impressive series from my colleagues Bob Herman, Tara Bannow, Casey Ross, and Lizzy Lawrence in STAT+. And don't miss Hyacinth Empinado's video explainer on how insurers use the coding system to increase profit.


mortality

U.S. infant mortality rose 3% in 2022, per CDC

Infant deaths were up 3% in 2022 from 2021, according to new CDC data published today in its National Vital Statistics Report. The rate was 5.61 deaths per 1,000 live births overall, but varied widely by race. Black women lost babies at the highest rate, at 10.9 per 1,000. White women lost babies at a rate of 4.52 per 1,000.

Infant mortality rates measure the number of babies that die before they reach their first birthday. The 3% increase is the first statistically significant increase in two decades, the authors of a provisional report on the numbers said late last year. The number has generally been decreasing over the years, so despite the increase, 2022's rate is still below where it was back in 2002.

The leading causes of death for infants were the same in 2022 as 2021: congenital malformations and disorders related to short gestation and low birth weight. But there was one cause of death that became more common. Infant deaths due to maternal complications from pregnancy jumped from 30.4 to 33.1 deaths per 1,000 live births.


big names

The scientist who made CRISPR-edited babies has a new job

You might not know the name Jiankui He, but you probably know his work: He is a Chinese scientist who sparked a global uproar in 2018 after he created the first gene-edited children. After spending three years in prison for "illegal medical practices," He was ready to attempt a comeback in the scientific community.

The community wasn't quite ready for him, though. He has spent the past two years shuffling around China trying unsuccessfully to get a foothold. STAT's Megan Molteni has the exclusive news on his latest job located on an island that's home to an ongoing experiment in medical tourism. Read more in STAT+



cardiovascular health

Vigorous exercise didn't raise risk in people treated for a heart rhythm disorder

Silhouettes of a person dunking and two people in the background, all against the evening sky in saturated blue and light orange

JORG CARSTENSEN/DPA/AFP via Getty Images

For many people, sudden cardiac arrest comes out of nowhere, the first sign of heart disease they never knew they had. For others, family history or unexplained fainting might prompt an ECG that reveals a heart rhythm disorder that could cause dangerously chaotic heartbeats. Medications and implantable cardiac defibrillators can help, and a new study out today in Circulation suggests people who depend on them face a similar risk during vigorous exercise — even competitive sports —  as others on the same treatments whose exercise was limited to walking, gardening, or none.  

After three years, the rates of adverse cardiac events among the 1,400 participants treated for abnormal heartbeats in long QT syndrome were low: 2.7% overall and similar for both groups. That's in line with previous American Heart Association guidelines saying sports could be considered for athletes with defibrillators. 

"This is actually very powerful information," said Patrice Desvigne-Nickens of NIH's National Heart, Lung, and Blood Institute, which funded but did not conduct the study. "This is not about you should do this or you should do that, but rather, this is what happened: Here are the averages, discuss this with your physician. It may be that exercise is right for you, that it's a tolerable risk for you, especially considering the benefits that you seek."  —Liz Cooney


mental health

CDC will finally collect data on disordered eating in youth

The CDC will include a question about binge eating in its nationally-representative Youth Risk Behavior Surveillance System questionnaire in 2025. It's been more than a decade since the survey, given to high school students every other year, included any questions about disordered eating habits like purging or fasting. Without nationally representative data, researchers have had to rely on smaller localized surveys and datasets, which make it difficult to understand national trends.

Ariel Beccia is a postdoctoral research fellow at Boston Children's Hospital who has been advocating for the CDC to include disordered eating questions on the YRBS questionnaire since 2021. She and colleagues in a working group focused on the issue were asked by CDC which of two proposed questions they would prioritize if only one were to be selected, Beccia told me in an email. The team suggested one that asks about the frequency of eating "an unusually large amount of food in a short period of time." Binge eating is the most prevalent disordered eating behavior among youth and disproportionately affects marginalized groups like queer youth and kids of color, "so we wanted to prioritize this item from an equity perspective," Beccia wrote.


first opinion

Psychotherapy needs to be regulated. Can the FDA do it?

Tom Insel wasn't surprised when an FDA advisory committee voted "no" on MDMA-assisted psychotherapy for PTSD. On top of other barriers, psychotherapy is like a bug to the FDA, not a feature, writes the former director of the National Institute of Mental Health in a First Opinion essay. 

The FDA doesn't regulate psychotherapy. In fact, there's no federal agency reviewing the effectiveness or safety of psychological interventions or enforcing the safe and appropriate provision of that care. That needs to change, Insel argues. "Just as the FDA was formed over more than a century ago to help the public distinguish medicine from snake oil, a regulatory process is needed today that defines the effectiveness and safety of psychological treatments," he writes. Read more.


More around STAT
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What we're reading

  • A disease that makes children age rapidly gets closer to a cure, New York Times

  • Key disability civil rights law will get a big refresh under Sen. Bob Casey's new bill, STAT
  • RFK Jr. wants to send people on antidepressants to government "wellness farms," Mother Jones
  • Sponsored genetic testing programs are under fire, further complicating life for people with rare diseases, STAT

Thanks for reading! More tomorrow,


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