Optum Buys NY-Based Crystal Run

This article summarizes the buyout of Crystal Run Healthcare, a New York-based Medical Group by Optum.

History of Optum Buyouts of Clinics & Medical Groups

Optum has long performed a buyout strategy of developing their own HMO model where they buy physician groups of 100-1,000 physicians within a geographical area and assumes partial or full control over delivering care and its referral networks. Optum’s most publicized 2022 buyouts were as follows:



• Refresh Mental Health previously owned by equity firm Kenso & Co. based out of Jacksonville Beach, FL, has over 300 outpatient sites across 37 states, and over 1500 employees. 
• Lafayette, LA.-based, LHC Group has 30,000 employees, operates in 37 states, and has over 500,000 lives, for a whopping $5.4 Billion.
• Kelsey-Seybold Clinic in Texas has 55 specialties across 24 locations, and 500+ physicians, and is expanding to 50+ locations by 2026. Optum purchased both Kelsey-Seybold and its Medicare Advantage Plan, KS Plan Administrators. 
• Optum bought Massachusetts-based Atrius Health for $236 million which has 645 physicians primarily administering and focusing on primary care and internal medicine.
• In Oregon, Optum acquired two companies; Oregon Medical Group and GreenField Health. Combined these companies have 11 facilities and over 120 physicians. 
• It is estimated that Optum spent almost $8 Billion in acquisitions in 2022 alone.
  

History of New York's Crystal Run Healthcare

Crystal Run Healthcare focuses on coordinated care stemming from primary care physicians (PCPs) working hand in hand with local specialists, urgent cares, and hospitals in 15 different locations throughout New York. By placing all providers within the same EMR/EHR platforms to avoid the delays that occur from differing software solutions. Offering a wide array of laboratory services and surgery centers, it aims to keep patient care within a set schedule of billing and provider networks, thus reducing out of pocket costs for providers outside the patient network. This business model made it very lucrative for Optum to buy controlling shares and implement an Optum payer limitation thus enclosing the network even further and expediting care.

Decreased Write-Offs and Increased Collections

One of the easiest ways to increase your EBITDA for your clinics is to decrease the denials and increase your monthly collections. By speeding up your collection process and avoiding write-offs and/or the $25-$40 cost or more per denial is to adopt a simple medical coding scrubber for your billing and coding team. So whether you elect to boost your profitability for a potential sale or you are battling to avoid a buyout, PCG is here to help your clinic and medical group by implementing a HIPAA-compliant medical coding scrubber, iVECoder. Click here for more information. IVECODER LINK

Increased Medical Group, MSO, and IPA Profitability

When Optum, CVS, or any large entity comes knocking at your door, they are also looking at acquiring the Manage Services Organizations (MSOs) and/or Independent Physicians Organizations (IPAs) that help manage these clinics as well. To ensure that you have the highest profitability and the least amount of erroneous claims being paid, you should consider a claims auditing software that will enable you the highest transparency in the claims adjudication. If you need a resource that can tell you what providers are providing the most errors, which codes and modifiers are erroneously being used and approved, PCG’s Virtual Examiner is the perfect fit. To learn more about VE, Click VE.

Conclusion

At PCG we hope that independent organizations remain strong and we’ve built software that enables your clinic, your MSO, and your IPA to remain independent. However, if you are in a state where an acquisition needs to occur in the next 2-3 years… Please be cognizant of the impact of further inclusion of your network. Selling to a large entity like Optum will restrict your resources of referrals, clinical decision-making, and ultimately your ownership of patient care. The choice is yours and PCG is here to help guide you through whatever decision you do decide to make.