Profile: UnitedHealth Group Inc (UNH)
17 Feb 2017
UnitedHealth Group Incorporated, incorporated on July 1, 2015, is a diversified healthcare company. The Company operates through four segments: UnitedHealthcare, OptumHealth, OptumInsight and OptumRx. The Company conducts its operations through two business platforms: health benefits operating under UnitedHealthcare and health services operating under Optum. UnitedHealthcare provides healthcare benefits to a range of customers and markets through its UnitedHealthcare Employer & Individual, UnitedHealthcare Medicare & Retirement, UnitedHealthcare Community & State, and UnitedHealthcare Global businesses. Optum is a health services business serving the healthcare marketplace, including payers, care providers, employers, governments, life sciences companies and consumers, through its OptumHealth, OptumInsight and OptumRx businesses.
The Company's UnitedHealthcare Employer & Individual offers a range of consumer-oriented health benefit plans and services around the country for national employers, public sector employers, mid-sized employers, small businesses, individuals and military service members in the TRICARE west region. UnitedHealthcare Employer & Individual provides access to medical services for approximately 30 million people on behalf of its customers and alliance partners. This includes over 190,000 employer customers across approximately 50 states. Through its risk-based product offerings, UnitedHealthcare Employer & Individual assumes the risk of both medical and administrative costs for its customers in return for a monthly premium, which is a fixed rate per individual served for a one-year period. When providing administrative and other management services to customers that elect to self-fund the healthcare costs of their employees and employees' dependents, UnitedHealthcare Employer & Individual receives a fixed monthly service fee per individual served. These customers retain the risk of financing medical benefits for their employees and employees' dependents, while UnitedHealthcare Employer & Individual provides services, such as coordination and facilitation of medical and related services to customers, consumers and healthcare professionals, administration of transaction processing and access to a contracted network of physicians, hospitals and other healthcare professionals, including dental and vision. UnitedHealthcare Employer & Individual also offers a range of insurance options for purchase by individuals, including students, which are designed to meet the health coverage needs of these consumers and their families.
UnitedHealthcare Employer & Individual has relationships with network care providers that integrate data and analytics, implement value-based payments and care management programs. UnitedHealthcare Employer & Individual is also participating in select multi-plan exchanges that are structured to encourage consumer choice. UnitedHealthcare Employer & Individual's diverse product portfolio offers a continuum of benefit designs, price points and approaches to consumer engagement, which provides the flexibility to meet the needs of employers of all sizes, as well as the needs of individuals shopping for health benefits coverage. UnitedHealthcare Employer & Individual offers its products through affiliates that are licensed as insurance companies, health maintenance organizations (HMOs) or third-party administrators (TPAs). UnitedHealthcare Employer & Individual's product families include traditional products, which include a range of medical benefits and network options from managed plans, such as Choice and Options PPO, to traditional indemnity products; consumer engagement products, which couple plan design with financial accounts to increase individuals' responsibility for their health and well-being, and clinical and pharmacy products, which offers a range of clinical and pharmacy benefits management products. Traditional products also offer a range of covered services, including preventive care, direct access to specialists and catastrophic protection. Consumer engagement products include consumer-driven benefit plans, which include health reimbursement accounts (HRAs), health savings accounts (HSAs) and consumer engagement services, such as personalized behavioral incentive programs and consumer education.
UnitedHealthcare Employer & Individual's clinical programs include wellness programs, decision support, utilization management, case and disease management, complex condition management, on-site programs, including Know Your Numbers (biometrics) and flu shots, incentives to reinforce positive behavior change, mental health/substance use disorder management, and employee assistance programs. UnitedHealthcare Employer & Individual also delivers dental, vision, life and disability product offerings through an integrated approach, including a network of over 22,000 vision offices and over 80,000 dental offices, in private and retail settings. UnitedHealthcare Military & Veterans provides managed care support services, provider networks, medical management, claims/enrollment administration and customer service. UnitedHealthcare Military & Veterans is the provider of healthcare services for approximately three million active duty and retired military service members and their families in over 20 states under the Department of Defense's (DoD) TRICARE Managed Care Support contract.
UnitedHealthcare Medicare & Retirement provides health and well-being services to individuals with approximately 50 years of age and older, addressing their needs for preventive and acute healthcare services, as well as services dealing with chronic disease and other specialized issues common among older individuals. UnitedHealthcare Medicare & Retirement offers a selection of products that allow people to obtain the health coverage and services they need as their circumstances change. For those who prefer traditional fee-for-service Medicare, UnitedHealthcare Medicare & Retirement offers both Medicare Supplement and Medicare Prescription Drug Benefit (Medicare Part D) prescription drug programs that supplement their government-sponsored Medicare by providing additional benefits and coverage options. Beneficiaries with special needs are served through UnitedHealthcare Medicare & Retirement Dual, Chronic and Institutional Special Needs Plans (SNPs) in various markets.
UnitedHealthcare Medicare & Retirement's product categories include Medicare Advantage, Medicare Part D and Medicare Supplement. UnitedHealthcare Medicare & Retirement provides healthcare coverage for seniors and other eligible Medicare beneficiaries mainly through the Medicare Advantage program administered by Centers for Medicare & Medicaid Services (CMS), including Medicare Advantage HMO plans, preferred provider organization (PPO) plans, Point-of-Service plans, Private-Fee-for-Service plans and SNPs. Under the Medicare Advantage program, UnitedHealthcare Medicare & Retirement provides health insurance coverage in exchange for a fixed monthly premium per member from CMS plus, in some cases, consumer premiums. UnitedHealthcare Medicare & Retirement offers care management, disease management and other clinical programs, integrating federal, state and personal funding through its continuum of Medicare Advantage products. For high-risk patients in certain care settings and programs, UnitedHealthcare Medicare & Retirement uses automated medical record software that enables clinical care teams to capture and track patient data and clinical encounters, creating a set of care information that bridges across home, hospital and nursing homecare settings.
UnitedHealthcare Medicare & Retirement provides Medicare Part D benefits to beneficiaries throughout the United States and its territories through its Medicare Advantage and Medicare Part D plans. UnitedHealthcare Medicare & Retirement offers two Medicare Part D plans: the AARP MedicareRx Preferred and the AARP MedicareRx Saver Plus plans. Each of the plans includes the majority of the drugs covered by Medicare and provides varying levels of coverage to meet the diverse needs of Medicare beneficiaries. UnitedHealthcare Medicare & Retirement is serving over four million seniors around the country through various Medicare Supplement products in association with AARP.
UnitedHealthcare Community & State's customers oversee Medicaid plans, Children's Health Insurance Programs (CHIP), SNPs, integrated Medicare-Medicaid plans (MMP), and other federal, state and community healthcare programs. UnitedHealthcare Community & State serves people through Medicaid expansion programs in over 10 states. The main categories of eligibility for the programs served by UnitedHealthcare Community & State and its participation are temporary assistance to needy families, primarily women and children in over 20 markets; CHIP in over 20 markets; aged, blind and disabled (ABD) in approximately 20 markets; SNP in 10 markets; Medicaid expansion in over 10 markets; long-term services and supports (LTSS) in over 10 markets; childless adults programs for the uninsured in over three markets; other programs (such as developmentally disabled, rehabilitative services) in over six markets, and MMP in over two markets. These health plans and care programs offered are designed to address the needs of the populations they serve, including the chronically ill, those with disabilities and people with a risk of medical, behavioral and social conditions. UnitedHealthcare Community & State coordinates resources among family, physicians, other healthcare providers, and government and community-based agencies and organizations to facilitate continuous care.
UnitedHealthcare Global participates in international markets through national in country and cross-border strategic approaches. UnitedHealthcare Global's cross-border healthcare business provides health benefits, care management and care delivery for multinational employers, governments and individuals around the world. UnitedHealthcare Global provided medical benefits to over four million people, principally in Brazil, but also residing in over 120 other countries. Amil provides medical and dental benefits to over five million people. Amil operates hospitals and specialty, primary care and emergency services clinics across Brazil, principally for the benefit of its members. Amil's patients are also treated in its contracted provider network of over 26,000 physicians and other healthcare professionals, approximately 2,100 hospitals and over 8,000 laboratories and diagnostic imaging centers. Amil offers a diversified product portfolio with a range of product offerings, benefit designs, price points and value, including indemnity products. Amil's products include various administrative services, such as network access and administration, care management and personal health services and claims processing.
The Company's OptumHealth is a diversified health and wellness business serving the physical, emotional and health-related financial needs. OptumHealth enables population health management through programs offered by employers, payers, government entities and, increasingly, directly with the care delivery system. OptumHealth builds networks and centers of excellence across the care continuum, by working directly with physicians to improve population health management and by coordinating care for the medically complex patients. OptumHealth sells its products through its direct sales force, strategic collaborations and external producers in over three markets: employers, payers and government entities. OptumHealth is organized into approximately two operating groups: OptumCare and Optum Consumer Solutions (OCS).
Through networks consisting of employed, managed and contracted physicians, practitioners and other providers, OptumCare assists care providers in adopting approaches and technologies that improve collaboration and coordination among everyone involved in patient care. OptumCare also enables care providers' transition from traditional, fee-for-service care delivery to performance-based delivery and payment models that put patient health and outcomes first, such as those emerging through accountable care organizations (ACOs) and local care provider partnerships. OptumCare builds partnerships with care providers who share its focus on creating new approaches to care delivery and works with them to develop and deliver services around the spectrum of patient and community needs. OptumCare's mobile care delivery business provides occupational health, medical and dental readiness services, treatments and immunization programs. These solutions serve a number of government and commercial clients, including the United States military.
OCS serves people through population health management services that meet both the preventative care and health intervention needs of consumers across the care continuum-physical health and wellness, mental health, complex medical conditions, disease management, hospitalization and post-acute care. This includes offering access to networks of provider specialists in various clinical specialties, including behavioral health, organ transplant, chiropractic and physical therapy. OCS engages consumers in managing their health, including guidance, tools and programs. The distribution business provides sales and services through digital, phone and in-person interaction to assist individuals in selecting and understanding their benefits. OCS provides contact center support, multimodal software, data analysis and licensed sales agents that help clients acquire, retain and service populations of healthcare consumers. The financial services business provides a range of healthcare financial products for individuals, employers, healthcare professionals and payers. OCS is a provider of consumer healthcare accounts. OCS also offers electronic claims payment services to care providers through Optum Bank, a subsidiary, with over 3.8 million accounts.
OptumInsight provides services, technology and healthcare capabilities to participants in the healthcare industry. Hospital systems, physician practices, commercial health plans, government agencies, life sciences companies and other organizations that comprise the healthcare system depend on OptumInsight to help them improve performance, meet compliance mandates and improve their core operating systems to meet the changing needs of the health system. OptumInsight provides capabilities targeted to the needs of over four market segments: care providers (physician practices and hospital systems), payers, governments and life sciences organizations. OptumInsight provides capabilities that help drive financial performance, meet compliance requirements and deliver health intelligence. OptumInsight brings a range of solutions to help care providers, with a focus on clinical performance and quality improvement, population health management, data management and analytics, revenue management, cost containment, compliance, cloud-enabled collaboration and consumer engagement. OptumInsight is also helping payer clients adapt to market models, including health insurance exchanges, consumer-driven healthcare and engagement, pay-for-value contracting and population health management.
OptumRx provides a range of pharmacy care services to over 60 million people in the United States through its network of over 67,000 retail pharmacies and multiple home delivery facilities throughout the country. OptumRx's pharmacy care services deliver pharmacy benefit through retail network contracting, including rebate management and clinical programs, such as step therapy, formulary management, drug adherence and disease/drug therapy management programs. OptumRx's whole-person approach integrates demographic, medical, pharmaceutical and other clinical data and then applies analytics to drive clinical care insight to support care treatments and compliance, benefiting clients and individuals through services and cost trend management.
The Company competes with Aetna Inc., Anthem, Inc., Centene Corporation, Cigna Corporation, Health Net, Inc., Humana Inc., Kaiser Permanente, CVS Health Corporation, Express Scripts, Inc. and Prime Therapeutics LLC.
UnitedHealth Group Inc
9900 Bren Rd E
HOPKINS MN 55343-9664
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