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Strategic Accounts
Portraits of the
Leading Health Plans
A private, ongoing, multi-client study.
UnitedHealth Group
AUGUST 2016
1
UnitedHealth Group
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Table of Contents
Account Summary
4
Account Analysis
5
SWOT Analysis
6
Organization Overview and Structure
7
Corporate Strategy
10
Mergers and Acquisitions
13
Business Performance
15
Business Mix
20
Products and Services
22
Geographic Reach
49
Healthcare Industry Relationships
51
© 2016 Health Strategies Group. All rights reserved.
3
UnitedHealth Group
Account Summary
 UnitedHealth Group (United), the largest health insurance company in the United States, with
46.4 million medical lives as of year-end 2015, was founded in 1977 and is headquartered in
Minnetonka, Minnesota.
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United operates two divisions (UnitedHealthcare [UHC] and Optum) with four reporting segments: UHC,
OptumHealth, OptumInsight, and OptumRx.
The company’s strategy for success includes controlling specialty pharmacy costs, growing enrollment in
profitable segments, improving healthcare quality and outcomes, developing innovative technology solutions,
and moving towards a more integrated model of care.
United’s recent acquisitions expanded its Medicare, PBM, and specialty pharmacy (SP) capabilities and its walkin clinics, urgent care centers, and home infusion centers.
United’s revenues increased 20% from $130.5 billion in 2014 to $157.1 billion in 2015; net earnings increased
4% from $5.6 billion to $5.9 billion over the same period. United’s enrollment increased 3% to 46.4 million.
The company offers commercial (individual, employer-sponsored, and TRICARE), Medicare Advantage,
Medicare supplement, PDP, Medicaid, and international products for both self-funded and fully insured
clients and individuals.
— United offers flat and two-, three-, and four-tiered benefit designs for its commercial members. Three-tiered
designs account for the vast majority of lives.
— Subsidiaries OptumRx and BriovaRx Pharmacy manage most pharmacy and SP services, including
biopharmaceutical company contracting and formulary decisions. CVS Caremark provides some product
distribution and SP services.
United’s presence spans all 50 states and the District of Columbia. United is the largest health insurer by
enrollment in Nevada and New York and in the top five in 17 other states and the District of Columbia.
As of June 2016, United had 14 million members receiving care through value-based partnerships such as
accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and bundled-payment or
pay-for-performance (P4P) initiatives.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
4
UnitedHealth Group
Account Analysis
 United serves both the health benefits and the health services markets with its UHC and Optum
businesses. United is currently the largest health insurer in the United States and owns one of the
largest PBMs.
 Look for UnitedHealth Group to:
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Focus on demonstrating the value of OptumRx and BriovaRx to legacy Catamaran PBM/SP clients, many of
which are direct competitors
Pursue strategic acquisitions that expand its geographic reach and improve its expertise in growing segments
such as Medicare and Medicaid
Dedicate significant resources to developing next-generation clinical tools and data analytics capabilities through
its Optum business lines and external partnerships
Continue to invest in performance-based models and risk-sharing agreements focusing on total patient care
(e.g., ACOs and PCMHs)
Use gamification and mobile apps to increase member engagement (e.g., Baby Blocks, Health4Me,
and March of Dimes)
Participate in the Health Insurance Marketplace (exchanges) in significantly fewer states in 2017
Leverage Optum’s health analytics platform and the wealth of data it has collected over the years to identify best
practices of care, coordinate care, identify needs and treatment outcomes for its sickest members, and help
providers identify gaps in care
Increase the use of tiered provider networks and steer its members to higher-performing facilities and providers
to reduce costs and improve quality
Lower costs and improve access to care through OptumCare medical facilities and MedExpress
urgent care centers
Shift members into more four-tiered benefit designs as employers increasingly look for ways to lower their
premiums and share additional costs with their employees
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
5
UnitedHealth Group
SWOT Analysis
SWOT analysis
Strengths
 Size and scale; United operates nationwide and is among the
top five plans by enrollment in 19 states and the District of
Columbia
 Data gained through OptumRx, which enable identification of
best practices, measurement of outcomes, and efficiency
 Long-standing relationships with large national employers
 Strong provider relationships, as evidenced by its over 750
value-based contracts
 Innovation and proven track record of finding additional
revenue opportunities beyond health insurance
 Impressive growth, stemming mostly from its Optum business
which accounted for more than 40% of its revenue in 2015
Opportunities
 Growth in Medicaid, where United is strongly positioned as
more states move to managed Medicaid models
 Expansion of its Harken Health subsidiary into new markets
offers additional growth potential
 Lower costs and increased access to care through OptumCare
and MedExpress
 Leveraging of the success of its ACOs and PCMHs to identify
best practices, improve quality, and reduce costs
 Acquisition of new business as a result of possible divestitures
from the impending mergers, especially of Medicare business
as a result of the Aetna-Humana deal
 Well-positioned for future acquisitions with available cash
 Potential to gain additional external clients through its internal
PBM OptumRx
Weaknesses
 Difficulty with rapid change due to its large size and
organizational complexity
 Limited negotiating power compared to other national payers due to
strong regional focus of individual plans
 Large number of lives in less profitable fee-based contracts
 Potential difficulty in managing and communicating with regional
affiliates and providers and controlling prescribing due to size
 Highly publicized exits from the Health Insurance Marketplace,
demonstrating an inability to manage risk within these markets
 Frequent slowness of long-standing customers to adjust to changes
in benefit design, making adoption challenging
Threats
 Increased competition; Anthem will surpass United in overall and
Medicare enrollment once its Cigna acquisition is complete
 Impact of changes in government rules and reimbursement as its
Medicare and Medicaid enrollment continue to increase
 Increased specialty drug utilization and costs, especially in
Medicare, that could negatively impact finances
 Continued concerns about the profitability of its exchange business
where it continues to sell individual policies
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
6
UnitedHealth Group
Organization Overview and Structure
Organization overview
Parent organization and divisions
Market coverage
UnitedHealth Group
 United is an international organization offering comprehensive
health benefits and services to clients of all sizes.
 United operates two divisions, UHC and Optum, with four
reporting segments: UHC, OptumHealth, OptumInsight, and
OptumRx.
 UHC offers health plans through four business units:
 UHC Employer & Individual—commercial members
 UHC Medicare & Retirement
 UHC Community & State—Medicaid members
 UHC Global—international business
 OptumHealth provides care delivery and management,
wellness and consumer engagement programs, and
distribution and health financial services to 78
million individuals.
 OptumInsight provides business and technology consulting
services to United divisions and external clients.
 OptumRx and BriovaRx, United’s internal PBM and SP, deliver
PBM, mail-order, and SP management programs.
 Optum also operates Optum360 in partnership with Dignity
Health, offering revenue cycle management and simplification
of billing and administration for payers.
 Harken Health is an independent subsidiary that provides
healthcare services and offers health insurance through the
Health Insurance Marketplace in Georgia and Illinois.
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United’s U.S. operating networks include:
 1 million physicians and other healthcare professionals
 6,000 hospitals and health facilities
 67,000 retail pharmacies
United has more than 200,000 employees, including 18,500
physicians and nurses.
United offers commercial and Medicare plans in all 50 states
and the District of Columbia. It offers Medicaid plans in
23 states.
United operates more than 30 retail storefronts in 17 states and
17 Medicare stores in 13 states, all staffed with representatives
who can answer questions and provide enrollment assistance
and educational resources.
OptumRx provides PBM and SP services through BriovaRx to
more than 66 million individuals. It operates 14 SPs and seven
mail-order facilities across the United States.
Optum operates 270 OptumCare and MedExpress clinics and
urgent care centers in 26 states.
Continued on the following page.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
7
UnitedHealth Group
Organization Overview and Structure continued
Organization overview
Corporate information
Leadership
UnitedHealth Group
9900 Bren Road East
Minnetonka, MN 55343
Phone: 952-936-1300
www.unitedhealthgroup.com
www.uhc.com
www.uhcmedicaresolutions.com
www.uhccommunityandstate.com
UnitedHealth Group
Founded: 1977
Tax status: Profit / NYSE: UNH
Service area: National, with some international presence
CEO: Stephen J. Hemsley
Vice Chairman, United, and CEO, Optum: Larry C. Renfro
CEO, Amil, and Director, United: Edson Bueno, MD
EVP, Enterprise Operations: Dirk McMahon
EVP, Medical Affairs, and Chief Medical Officer: Richard Migliori, MD
EVP: William A. Munsell
EVP: Jeannine M. Rivet, RN, MPh, FAAN
SVP, Clinical Advancement: Lewis G. Sandy, MD, FACP
EVP, Chief Medical Officer, UHC: Sam Ho, MD
Chief Pharmacy Officer, UHC: Susan Maddux, PharmD
CEO, UHC Medicare & Retirement: Steve Nelson
Chief Medical Officer, UHC Retiree Solutions: Rhonda L. Randall, DO
CEO, UHC Community & State: Austin Pitman
EVP, Chief Operating Officer, Optum: John Prince
EVP, Chief Quality Officer, Optum: Karen Erickson
EVP, OptumCare: Jack Larsen
CEO, OptumRx: Mark Thierer
President, OptumRx: Timothy Wicks
VP, OptumRx Specialty Pharmacy: Michael Lonergan
CEO, OptumInsight: Bill Miller
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
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UnitedHealth Group
Organization Overview and Structure: Pharmacy
© 2016 Health Strategies Group. All rights reserved.
9
UnitedHealth Group
Corporate Strategy
 United, the largest health plan in the United States as of year-end 2015, competes primarily with
Aetna, Anthem, Cigna, Humana, and regional Blues plans.
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The company’s strategy for success includes controlling specialty pharmacy costs, growing enrollment in
profitable segments, improving healthcare quality and outcomes, developing innovative technology solutions,
and moving towards a more integrated model of care.
Corporate strategies
Goal
Control costs of
specialty
pharmaceuticals
Grow enrollment in
profitable segments
Tactic
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The company leverages its centers of excellence, Comprehensive Cancer Solution and other clinical
guidelines, product exclusion programs, biopharmaceutical company coupon bans, disease management
programs such as Cholesterol Connected Care, bundled-payment contracts for oncologists, and BriovaRx
tools, such as BriovaLive, to control specialty pharmacy costs.
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United’s successful oncology bundled-payment pilot reduced overall costs 34%, leading to partnerships with
five additional practices: Cancer Specialists of North Florida, Oncology Hematology Care, Rocky Mountain
Cancer Centers, Texas Oncology, and Tulsa Cancer Institute.
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United’s membership growth strategies focus on profitable segments, such as Medicare, Medicaid, and
employer groups. The company announced its intent to exit unprofitable exchange markets in 2017 and
eliminated its low-performing PDP offerings in 2016.
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Although the company will lose enrollment by exiting a number of exchange markets next year, it anticipates
membership growth in Medicare Advantage and Medicaid, and it will invest resources to continue expanding
OptumRx, OptumHealth, and OptumInsight capabilities.
In first quarter 2016, United increased its Medicare Advantage membership 9% and its Medicaid
membership 3%.
Continued on the following page.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
10
UnitedHealth Group
Corporate Strategy continued
Corporate strategies
Goal
Improve
healthcare
quality and
outcomes
Tactic
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Develop
innovative
technology
solutions and
leverage data
to reduce costs
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United’s strategies to improve quality and outcomes include ACOs, which have demonstrated improved outcomes
and lower costs. As of June 2016, United had more than 750 value-based contracts, such as ACOs, PCMHs, and
bundled-payment and P4P initiatives. The company paid $43 billion to physicians and hospitals in value-based
contracts in 2015 and projects this to increase to $65 billion by the end of 2018.
As a result of these initiatives, its ACOs take a more consistent approach in the delivery of quality care for
individual, employer-sponsored, and Medicaid members.
The UnitedHealth Premium Provider network identifies providers across 27 medical specialties that have
demonstrated high-quality care and cost efficiency. The program spans 163 markets in 43 states. Specialties
include allergy; cardiology; ear, nose, and throat; endocrinology; family medicine; gastroenterology; general
surgery; internal medicine; nephrology; neurology; neurosurgery; OB/GYN; ophthalmology; orthopedics;
pediatrics; pulmonology; rheumatology; and urology.
United also reimburses providers based on quality metrics through its P4P contracts. It evaluates providers on
Healthcare Effectiveness Data and Information Set and Medicare star rating measurements, member/patient
satisfaction, outcomes/quality improvement, and generic utilization rates to determine P4P reimbursement.
United leverages Optum’s capabilities and external partnerships to develop innovative, interactive, and state-ofthe-art tools to increase member engagement, improve outcomes, streamline processes, and enter new markets.
The company’s annual health information technology (HIT) budget is nearly $3 billion.
Recent innovations include a partnership with Qualcomm for personal fitness devices, a new Medicaid
management software for state programs, and a cancer treatment protocol program. United’s partnership
with Rally Health for an interactive weight loss program yielded positive results in nearly half of
participating members.
United subsidiary OptumRx uses data to help cut costs and guide better patient care by identifying when it may
be appropriate to switch patients to more effective treatments. Optum claims it recently saved one client more
than $70,000 in six months by changing its acne treatment coverage policies based on insights gained through
data and saved another client $110,000 when data showed attention deficit hyperactivity disorder (ADHD) drugs
were being overprescribed to adults.
Continued on the following page.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
11
UnitedHealth Group
Corporate Strategy continued
Corporate strategies
Goal
Move towards a
comprehensive
integrated care
model
Tactic
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Because of acquisitions and internal expansions, United members have access to care through United-owned
medical facilities, urgent care centers, and infusion centers, including those of Axela, MedExpress,
OptumCare, and WellMed.
United plans to aggressively expand these facilities in order to lower costs; the facilities provide the majority of
services available through emergency rooms at lower cost and increase United’s control over the services its
members receive.
Independent subsidiary Harken Health resembles a Kaiser Permanente integrated care model. Members
purchase Harken insurance and receive care at Harken facilities with no additional copay or coinsurance; all
services are included in monthly premiums.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
12
UnitedHealth Group
Mergers and Acquisitions
 United’s recent acquisitions expanded its Medicare, PBM, and SP capabilities and its walk-in
clinics, urgent care centers, and home infusion centers.
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In July 2015, United acquired Catamaran; OptumRx integrated Catamaran members during the first quarter
of 2016.
— OptumRx adopted the BriovaRx name for its SP; transition of OptumRx specialty members to BriovaRx will
conclude by the second quarter of 2016.
Year
Transaction
May 2016
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March 2016
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January 2016
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November 2015
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July 2015
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Optum acquired Wells Fargo & Co.’s health savings account (HSA) assets, estimated at $1.9 billion, for an
undisclosed sum, bringing these assets into Optum Bank.
United acquired nearly 357,000 PDP lives from Granite Creek FlexCap LLC. Granite is an Illinois-based
company offering PDPs under the Symphonix Health Insurance name in 48 states and the District
of Columbia.
OptumRx acquired Helios, a Memphis-based workers’ compensation PBM that processes approximately
7 million claims per year for health insurers and third-party administrators. The deal is valued at an estimated
$1.6-$1.7 billon; OptumRx will integrate Helios into its existing PBM business.
OptumRx acquired Kansas-based AxelaCare, a home infusion solution company with more than 30 locations
serving 44 states, to expand its home infusion services. OptumRx also benefits from AxelaCare’s proprietary
software solutions, CareLogix and CareExchange, which improve both clinical care and outcomes. Financial
details of the acquisition were not publicly disclosed.
UnitedHealth Group acquired Catamaran Corporation for approximately $12.8 billion, merging Catamaran
and BriovaRx into its OptumRx division. Transition of Catamaran’s PBM clients began in October 2015 and
ended in the first quarter of 2016.
OptumRx adopted the BriovaRx name for its SP and expects to finish transitioning all specialty members to
BriovaRx by July 2016.
Continued on the following page.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
13
UnitedHealth Group
Mergers and Acquisitions continued
Year
Transaction
April 2015
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October 2014
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September 2014
February 2014
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Optum acquired MedExpress, which operates 150 urgent care clinics in 16 markets with plans to add 25-30
new facilities in existing and new states in the near future.
Optum acquired Alere Health, an Atlanta-based health management company, for $600 million. The
acquisition strengthened United’s wellness programs, condition management, and case management.
Optum acquired MedSynergies, a physician practice management solutions company.
Optum purchased a majority stake in Audax Health Solutions. Optum uses Audax’s technological offerings to
help members manage their health and wellness. Audax’s Zensey application offers interactive health
assessments, gamified fitness, and a social environment for the betterment of health.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
14
UnitedHealth Group
Business Performance
 From 2014 to 2015, United’s revenues increased 20% from $130.5 billion to $157.1 billion due to its
acquisition of Catamaran as well as ongoing membership growth.
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Net earnings increased 4% from $5.6 billion to $5.9 billion over the same period. Losses in its Health Insurance
Marketplace business negatively impacted these earnings.
 United reported first-quarter 2016 revenues of $44.5 billion, up approximately 25% from $35.8 billion
in first quarter 2015.
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Net earnings for the first quarter were $1.6 billion, up from $1.4 billion in first quarter 2015.
© 2016 Health Strategies Group. All rights reserved.
15
UnitedHealth Group
Business Performance continued
 United reports the following revenues by segment:
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UHC reported $131.3 billion in revenue in 2015, compared to $119.8 billion in 2014 (minus $41.8 billion
and $37.1 billion in corporate eliminations in 2015 and 2014, respectively). UHC segment contributions
were as follows:
— Employer & Individual reported $47.1 billion in revenue in 2015, up from $43 billion in 2014.
— Medicare & Retirement reported $49.7 billion, up from $46.3 billion.
— Community & State reported $28.9 billion, up from $23.6 billion.
— International reported $5.5 billion, down from $6.9 billion.
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Optum reported $67.6 billion in 2015, up from $47.7 billion in 2014.
 United received the following quality scores and ratings for its plans:
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United holds numerous NCQA accreditations:
— The company has six accredited commercial HMOs, one of them rated “commendable”; seven accredited
commercial HMO/POS plans, one of them rated “commendable”; and 81 accredited commercial PPOs,
12 of them rated “commendable” and two with provisional accreditation.
— United has 20 accredited Medicaid HMOs, five of them rated “commendable” and two with interim accreditation.
— It has 40 accredited Medicare plans, including 25 rated “commendable” and one rated “excellent”; it also has 35 in
process for accreditation and seven scheduled for accreditation.
— United has 24 accredited Health Insurance Marketplace plans and 11 with interim accreditation.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
16
UnitedHealth Group
Business Performance continued
— Under NCQA’s new rating system (scores of 1 to 5, with 5 being the highest):
•
•
•
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Two commercial plans received overall scores of 4.0. Twelve received scores of 3.5, while 27 received scores of 3.0
and 11 scores of 2.5.
One Medicaid plan (Rhode Island) received a score of 4.5; two (Michigan and Nebraska) received scores of 4.0.
Five received scores of 3.5, five scores of 3.0, and four scores of 2.5.
One Medicare plan (Maine) received a score of 4.5. Seven received scores of 4.0, while 23 received scores of 3.5.
Six received scores of 3.0, eight scores of 2.5, and one a score of 2.0.
United also holds several URAC accreditations:
— UHC, UHC Life Insurance Company, and United Behavioral Health are all accredited for health
utilization management.
— OptumHealth is accredited for health call center, consumer education and support, and health
utilization management.
— OptumRx is accredited for pharmacy benefit management, drug therapy management, mail pharmacy,
and specialty pharmacy.
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OptumRx also holds Verified Internet Pharmacy Practice Sites (VIPPS) certification.
BriovaRx received the Pharmacy Benefit Management Institute’s Excellence Award in Quality Improvement for
the BriovaLive video consultation program.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
17
UnitedHealth Group
Business Performance continued
 United’s enrollment increased 3% from 45 million at year-end 2014 to 46.4 million at year-end 2015.
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The increase is attributed to Health Insurance Marketplace membership gains, Medicaid expansion efforts and
new programs (i.e., Managed Long Term Services and Supports and Nebraska’s Heritage Health program), and
new employer-group clients.
 United managed 47.7 million lives and 5 million PDP lives as of first quarter 2016.
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Enrollment increased across all segments except international and PDP; most notably, Medicare Advantage
lives increased 9%.
© 2016 Health Strategies Group. All rights reserved.
18
UnitedHealth Group
Business Performance continued
 United reported a year-end 2015 medical loss ratio (MLR) of 81.7%, up from 81.2% at year-end 2014.

The company issued rebates totaling $62.8 million in 2015 for not meeting 2014 MLR requirements.
— Individual members received nearly $1.1 million, small-group members received $34.8 million, and large-group
customers received $26.9 million.
 United reported a first-quarter 2016 MLR of 81.7%, up from 81.1% in first quarter 2015.
© 2016 Health Strategies Group. All rights reserved.
19
UnitedHealth Group
Business Mix
 UHC offers commercial (individual, employer-sponsored, and TRICARE), Medicare Advantage,
Medicare supplement, PDP, Medicaid, and international products for both self-funded and fully
insured clients and individuals.
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United includes its approximately 3.0 million TRICARE lives (6% of its total enrollment) in its commercial
fee-based lives.
© 2016 Health Strategies Group. All rights reserved.
20
UnitedHealth Group
Business Mix continued
 United’s overall enrollment increased 3% to 46.4 million members in 2015, due primarily to
individual membership growth in the Health Insurance Marketplace and employer-client wins
and renewals.

Enrollment increased across all segments except global, which has seen steady declines since United’s
Amil acquisition.
 In first quarter 2016, United’s overall enrollment increased 3% over year-end 2015.

Commercial risk-based and Medicare supplement membership increased 4%, Medicare Advantage membership
9%, Medicaid membership 3%, and commercial fee-based membership 2%. PDP and international enrollment
declined approximately 1% each.
Business mix and enrollment
Market segment
Enrollment YE2015
Enrollment YE2014
Change from 2014
Share of business
Commercial fee-basedᵃ
21,445,000
21,245,000
1%
46%
Commercial risk-based
8,285,000
7,505,000
10%
18%
Medicaid
5,305,000
5,055,000
5%
11%
International
4,090,000
4,425,000
-8%
9%
Medicare supplement
4,035,000
3,750,000
8%
9%
Medicare (MA-PD)
3,235,000
3,005,000
8%
7%
46,395,000
44,985,000
3%
100%
Total
ᵃIncludes approximately 3.0 million TRICARE lives in YE2015 and 2.9 million TRICARE lives in YE2014.
Note: United (through OptumRx) provides pharmacy coverage to approximately 25.9 million lives including 5.1 million PDP lives.
Source: Managed Markets Insight & Technology, UnitedHealth Group.
Accessed May-June 2016 from corporate and subsidiary websites and public reports; Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
21
UnitedHealth Group
Products and Services
 United offers a wide range of health insurance products, including HMO, PPO, consumer-directed
health plan (CDHP), Medicare Advantage, Medicare supplement, Medicaid, and PDP products.


United also offers accidental death and dismemberment, critical illness, dental, disability, hospital indemnity,
life, and vision products.
The company’s CDHPs include high-deductible health plans (HDHPs) with flexible spending accounts (FSAs),
health reimbursement accounts (HRAs), and HSAs.
— United reports that its CDHPs cover an estimated 7 million members, including 3 million with HSAs.

United’s customers include individuals, employer and union groups, government entities, and Medicare and
Medicaid beneficiaries.
— Employer-group plans are based on size: National Accounts (3,000 or more employees), Large Business (1002,999 employees), and Small Business (1-99 employees).
— United serves more than 190,000 employer groups across the United States. In 2015, nearly 35,000 of these,
including approximately 400 large self-insured groups, purchased HDHPs paired with HSAs or HRAs.

United’s traditional product lines include Choice, Choice Plus, Choice PPO, and Options PPO. The company
also offers value-based and wellness-based products such as Catalyst, FlexPoint, Navigate, Navigate Plus,
Optimum Choice, Simply Engaged, Simply Engaged Plus, and Tiered Benefits.
— Catalyst products (available in eight states and the District of Columbia) are high-deductible, open-access plans
with flexible benefits and a range of employee cost sharing. Deductibles are $3,000-$5,000, and coinsurance
options are 80% / 60% or 70% / 50%. Employers can choose the level of network access.
— FlexPoint products offer premium savings, a national network, and 50% coverage of out-of-network services.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
22
UnitedHealth Group
Products and Services continued
— Navigate and Navigate Plus products focus on patient-centered care. Members must choose a primary care
physician (PCP) to “navigate” all aspects of their health care. The plans cover preventive care; laboratory, X-ray,
and diagnostic services; urgent care and emergency room visits; inpatient hospital, rehabilitation, and skilled
nursing facilities; and mental health services.
— Optimum Choice products also focus on patient-centered care. Members must choose a PCP and obtain referrals
for specialist visits and hospital care. The products can be paired with HSAs.
— SimplyEngaged products encourage healthy behaviors by rewarding members for participating in
worksite wellness programs, completing health assessments, and using online and telephone wellness
coaching services.
— Tiered Benefits products offer employers and employees lower monthly premiums and cost sharing via a tiered
provider network. Providers offering lower-cost, quality care are on the first tier; referrals are not needed for
specialists. Preventive care is covered with no copay or deductible.

United also offers regionally based tiered-network products.
— UHC North Shore–LIJ Advantage is available in three New York counties: Nassau, Suffolk, and Queens.
•
North Shore physicians and facilities are on the first tier; providers in United’s Choice Plus national
are on the second. Services from non-network providers are not covered.
— Charter, available in the Houston market, is an employer-sponsored plan offering access to Kelsey-Seybold
physicians and providers at 19 locations.
— Neighborhood Health Partnership plans are available in southern Florida. They include HMO, POS, and
HSA/HRA options.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
23
UnitedHealth Group
Products and Services continued

The UnitedHealth Premium program evaluates providers in 43 states across the 27 specialties accounting for
80% of medical spend. First-tier providers have demonstrated improved outcomes and lower costs.
— EDGE products offer lower premiums and copays for using first-tier physicians.

United’s Multi-Choice employer-defined exchange offerings are available in 26 states to businesses with
1-100 employees.
— Employees may choose from employer-selected plans, which include traditional HMO/PPO plans and consumerdriven products paired with HSAs.
— Participants also have access to United’s wellness and disease management programs and online tools and to
OptumHealth’s NurseLine.


United participates in several private exchanges, including Aon Hewitt, HPOne, DirectHealth,
HealthInsurance.com, Mercer, and Willis Towers Watson.
UnitedHealthOne, the company’s individual product line, includes four plan types:
— Copay Select products are available on and off the Health Insurance Marketplace with multiple copay/deductible
options. Deductibles range from $1,000 to $6,000. Silver, gold, and platinum plans include a multitiered pharmacy
benefit; bronze plans offer 30% coinsurance after the deductible is met.
— Bronze HSA 100 and Silver HSA 100 feature deductibles of $6,500 and $4,000, respectively. Prescription drugs
are covered at 100% after the deductible is met.
— The Select Saver catastrophic coverage plan, available for individuals under 30, offers lower monthly premiums
and higher deductibles than Copay Select. It covers all services at 100% once the deductible is met. It also offers
three in-network PCP visits per year at $35 each.
— Short Term Medical offers three options (Value, Plus, and Plus Elite) with varying copays, deductibles, and
pharmacy coverage. All plans can be purchased for one to 11 months.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
24
UnitedHealth Group
Products and Services continued
 New products:

In 2016, United began offering products through the Health Insurance Marketplace in 11 new states, for a total of
34—up from 23 in 2015.
— As of March 2016, the company enrolled approximately 795,000 members through the exchanges.
— In April 2016, it announced its withdrawal from the majority of states due to profitability concerns. The company
reported losses of $475 million in 2015 and projects losses of up to $650 million in 2016.
— For 2017, United will participate in three states: Nevada, New York, and Virginia.
•

The company requested a 46% premium rate increase for its individual plans in New York.
Subsidiary Harken Health, which began offering individual plans through the Health Insurance Marketplace
in Atlanta and Chicago in 2016, has applied to participate in Florida, offering plans in the Miami/
Fort Lauderdale area.
— Harken members receive care through Harken medical facilities at no cost beyond their premiums.
— Harken plans to add six new locations in Chicago, two in Atlanta, and 12 in South Florida by January 2017 to
accommodate membership growth.
— United does not report Harken membership in its total enrollment.

United responded to more than 20 Medicaid requests for proposals in 2015; recent contract wins include
Nebraska, several new counties in New York, and two California counties.
— Enrollment will take place throughout 2016 and into 2017.

For 2016, United expanded its Medicare Advantage offerings in Philadelphia, Pittsburgh, Savannah (Georgia),
and Toledo (Ohio).
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
25
UnitedHealth Group
Products and Services continued
 Government business: Medicaid

United’s Medicaid membership increased 5% from nearly 5.1 million in 2014 to more than 5.3 million in 2015.
Medicaid business accounts for 11% of United’s medical membership and 22% of its revenues.
— United anticipates continued growth as new contracts begin enrollment in 2016 and 2017, including Medi-Cal
services in San Diego and Sacramento counties, Nebraska’s new Heritage Health program, and five additional
New York counties (making 43 total).
— United offers Medicaid products in 23 states; 16 of these elected to participate in Medicaid expansion.

The company participates in dual-eligible demonstrations in New York, Ohio, and Texas, leveraging its ACO
expertise to manage these lives.
— In May 2016, United reported that Medicaid members receiving care through ACOs have 16% fewer hospital
admissions, 14% fewer hospital readmissions, and 21% more primary care visits than non-ACO members.

OptumRx manages nearly 500,000 Medicaid fee-for-service lives in Indiana and Nevada. It also provides other
pharmacy administrative services for Georgia, Indiana, and Nevada Medicaid programs.
— OptumRx provides services for Medicaid members under PBM contracts with other health plan clients (primarily
legacy Catamaran clients).
— Optum currently provides Medicaid clinical, analytical, consulting, data, and technology solutions to 37 states and
the District of Columbia.

Optum Medicaid Management Services (OMMS), launched in May 2015, supports states' Medicaid management
information systems. OMMS is a software-as-a-service and business-process-as-a-service model that enables
Medicaid agencies to purchase only needed services.
— The product leverages Trizetto's claims and administrative platform, Facets, and Medecision's population health
management tool, Aerial.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
26
UnitedHealth Group
Products and Services continued
 Government business: Medicare

United offers Medicare Advantage HMO, PPO, POS, private fee-for-service, and special needs plans, as well as
PDPs. It is the nation’s largest Medicare provider, managing 3.2 million Medicare Advantage and 5.1 million PDP
lives at year-end 2015.
— United’s partnership with AARP accounts for nearly 6.4 million total Medicare lives (1.9 million MA-PD and 4.5
million PDP lives).
— United anticipates a 5% increase in Medicare Advantage enrollment by the end of 2016, primarily due to improved
star ratings.
— The company projects declines in its PDP membership through 2016 due to strategic product eliminations but
anticipates growth in 2017.

United’s overall star rating increased from 3.4 in 2015 to 3.8 in 2016 (weighted by enrollment). The company
projects that 65% of its Medicare members will be enrolled in a plan with 4 or more stars by 2017 and 80%
by 2018.
— Star ratings for United’s PDPs declined on three of its five contracts; none are eligible for bonus payments.
— United participates in several private exchanges offering Medicare and retiree plans, including Aon Hewitt’s
Retiree Health Exchange, DirectHealth, HPOne’s ClearChoice Exchange, Mercer, and Towers Watson’s
OneExchange.

The company offers a wide variety of health and wellness programs for its Medicare members,
including SilverSneakers, HouseCalls (in-home visits for seniors), and medication therapy
management programs.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
27
UnitedHealth Group
Products and Services continued

The company operates 17 year-round Medicare stores in 13 states; stores are staffed with representatives to
answer questions and provide enrollment assistance. United also opens stations or kiosks inside stores and
malls nationwide during open enrollment.

Most United MA-PDs and PDPs offer five-tiered benefit designs; one MA-PD, UnitedHealthcare Connected for
MyCareOhio (a Medicare-Medicaid plan), has three tiers.

United offers Medicare members a $0 copay when they purchase 90-day supplies of first- or second-tier drugs
through OptumRx mail order.
— Members also have access to lower copays through 21,000 retail pharmacies in United’s Preferred Retail
Pharmacy Network.


One of United’s four largest plans, UHC GroupMedicare Advantage (PPO), with approximately 441,000 lives, is
employer-sponsored; detailed benefit design information is not publicly available.
Three of the company’s most popular plans based on enrollment are:
Enrollment
(as of April 2016)a
Monthly
premiums
Prescription drug
cost-sharing amounts by tierb
AARP MedicareRx Preferred (PDP)
1,234,813
$19-$71
$1-$5 / $3-$15 / $20-$36 / 40%-50% / 25%-33%
AARP MedicareRx Saver Plus (PDP)
1,234,813
$21-$50
$1 / $2-$3 / $15-$28 / 30% / 25%
385,837
$0-$27
$2-$3 / $8-$12 / $45 / $93-$95 / 25%-31%
Plan design
AARP MedicareComplete Plan 1 (HMO)
aIndividual plan enrollment from Centers for Medicare & Medicaid Services.
30-day supply at preferred pharmacy; premiums and cost sharing vary by region.
Source: Centers for Medicare & Medicaid Services, UnitedHealth Group.
Accessed May-June 2016 from corporate and subsidiary websites and public reports; Health Strategies Group, Strategic Accounts, August 2016.
bFor
© 2016 Health Strategies Group. All rights reserved.
28
UnitedHealth Group
Products and Services continued
 Government business: TRICARE

United submitted bids to continue offering TRICARE services under the new Department of Defense (DoD)
contract beginning April 1, 2017. The new contract will include two regions instead of three.

On July 21, 2016 the DoD removed United from the TRICARE program effective in 2017, consolidating the
number of health insurer contracts from three (Centene/Health Net, Humana, and United) to two
(Centene/Health Net and Humana).

At year-end 2015, United manages approximately 3 million lives through its TRICARE West contract which
began in April 2013.
— United manages lives in 21 states: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excluding the Rock
Island Arsenal area), Kansas, Minnesota, Missouri (excluding the St. Louis area), Montana, Nebraska, Nevada,
New Mexico, North Dakota, Oregon, South Dakota, portions of Texas (including El Paso), Utah, Washington,
and Wyoming.
— United provides managed care support services, provider networks, medical management, claims/enrollment
administration, and customer services under the contract, which includes five one-year option periods.
•

Benefit enhancements include Convenience Care Clinics, urgent care centers, the UnitedHealth Premium Program
network, centers of excellence, and telemedicine.
The DoD carves out TRICARE members’ pharmacy benefits to Express Scripts.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
29
UnitedHealth Group
Products and Services:
Biopharmaceutical Management
 United offers flat and two-, three-, and four-tiered benefit designs for its commercial
members. Three-tiered designs account for the vast majority of lives; enrollment in
four-tiered benefit designs increased from approximately 5% in 2014 to approximately
8% in 2015.



Approximately 50% of United’s commercial lives are subject to a pharmacy deductible, which varies by product
and region. Employers may customize their employees’ cost-sharing amounts.
The company anticipates a continued shift in enrollment to four-tiered benefit designs with coinsurance as
employers seek to increase member cost sharing and awareness of drug costs.
United may launch a five-tiered benefit design for its commercial members in the next two to three years to
remain competitive and meet employers’ demands for lower premiums and increased member cost sharing.
Commercial pharmacy benefits and formulary
Commercial plan design
Percentage membership
enrolled
Flat or two-tiered
<1%
Three-tiered
~92%
Four-tiered
~8%
Most common
cost-sharing amountsa
$10-$15
$10-$15
$10-$15
$35-$45
$35-$45
$25-$40
$35-$70
$60-$65
20%-45%
aFor 30-day supply at preferred pharmacy.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
30
UnitedHealth Group
Products and Services:
Biopharmaceutical Management continued
 OptumRx and BriovaRx manage most pharmacy and SP services for United members, including:

Biopharmaceutical company and wholesaler contracting, formulary decisions, product distribution, patient
education, device support/education/training, disease/case management, home care distribution/administration,
claims processing, rebate management, SP and mail-order services, and compliance and persistency programs.

CVS Caremark provides some administrative functions, including some product distribution and SP services.
Walgreens Specialty Pharmacy provides some product distribution and care management.
Biopharmaceutical management
2015 drug spend
$74 billion (for OptumRx)
2015 commercial pharmacy benefit PMPM cost
~$52 (varies by region)
2015 commercial pharmacy cost trend
~12% (varies by region)
Percentage of insured lives with
pharmacy coverage
OptumRx manages pharmacy benefits for approximately 25.9 million United lives,
including nearly 5.1 million PDP lives. TRICARE and international lives are
carved out.
Primary PBM
OptumRx (internal), Walgreens and CVS Caremark for some product distribution
Coverage of in-office and self-injectable
pharmaceutical products
100% of in-office injectable and infused products are covered under the medical
benefit; nearly all self-injectables are covered under the pharmacy benefit.
Generic utilization rate
75%-88%; 80%-90% projected for 2016 (varies by region)
Mail-service utilization rate
10%; 10%-15% projected for 2016 (varies by region)
2015 specialty pharmacy PMPM cost
Information not available
2015 specialty pharmacy cost trend
Information not available
Primary SP
BriovaRx (internal), Walgreens and CVS Caremark for some SP services
Source: Managed Markets Insight & Technology , UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
31
UnitedHealth Group
Products and Services:
Biopharmaceutical Management continued
 United’s national P&T committee, comprising internal and external physicians and pharmacists,
reviews new and existing medications, provides clinical guidance, and recommends formulary and
pharmacy management strategies to the Prescription Drug List (PDL) Management Committee.


OptumRx’s Business Implementation Committee works with United’s P&T committee to develop the company’s
formulary to allow access to a wide range of medications while controlling healthcare costs.
The P&T committee reviews the overall clinical value of specific medications—comparing those in the
same category—to balance members’ need for flexibility and choice with clients’ need for affordable
pharmacy benefits.
— The committee monitors high-impact drugs prior to FDA approval and conducts an expedited review process.
— Regional plans communicate directly with their local provider groups to contribute additional insight to the P&T
process on a quarterly basis.

The PDL Management Committee, comprising senior United leadership, physicians, pharmacists, and clinical
experts, makes tier decisions based on clinical, economic, and other factors.

When a generic becomes available, the P&T committee evaluates the tier statuses of the brands and the generic
based on overall healthcare value. Typically, it does not change the PDL during the first six months of exclusivity
but moves the generic to a low-copay tier and the brands to a high-copay tier once the generic is multisource. In
rare instances, contracted prices allow brands to compete with generic options on a low-copay tier.

New product launches are normally reviewed within six to nine months.

United uses site of administration to determine whether the medical or the pharmacy benefit covers a product.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
32
UnitedHealth Group
Products and Services:
Biopharmaceutical Management continued

United is moving to a single national formulary for all regions to maximize negotiating ability with
biopharmaceutical companies. However, regional plans will retain some autonomy to adjust benefit designs and
formularies based on local needs, prescribing patterns, and state regulations.
 United’s primary pharmacy management tools include biopharmaceutical company contracting (for
pricing and rebates), pharmacy network management, formulary design, product exclusions
(exclude at launch and strategic exclusions), SP and mail-order requirements for certain products,
and member cost-sharing incentives.

United also uses quantity limits, duration-of-therapy limits, maximum-daily-dose limits, and age or gender
restrictions to ensure patient safety and lower costs.

In the next two years, United may increase the use of front-end deductibles and coinsurance, increase copay
differentials among tiers to encourage generic use, adopt generic-focused or generic-only formularies in classes
with an available generic, increase the number of specialty products outsourced to an SP/PBM for management,
and expand prior authorization (PA), step therapy, and quantity/duration limits to additional categories.

United’s Refill and Save program encourages medication adherence by offering a copay or coinsurance discount
of $20 for a 30-day supply and $50 for a 90-day supply. The program includes Advair, Dulera, and Breo Ellipta
for asthma and Pristiq for depression.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
33
UnitedHealth Group
Products and Services:
Biopharmaceutical Management continued
 United has two national PDLs, Advantage and Traditional, both with three- and four-tiered options.

Advantage places the lowest-cost products on the lowest tiers, regardless of generic or brand status.
— Products may be moved to a lower tier any time during the year; products may be moved to a higher tier if a
generic becomes available. Products are moved to higher tiers or excluded semiannually based on new products
or information.

Traditional is a more conventional, less aggressive formulary.
— Products may be moved to a lower tier any time during the year; products may be moved to a higher tier if a
generic or lower-cost equivalent becomes available. Products are moved to higher tiers annually based on new
product availability; products are excluded semiannually based on new products or information.

United also uses PDLs specific to the Health Insurance Marketplace, Medicare, and Medicaid, as well as several
state-specific PDLs.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
34
UnitedHealth Group
Products and Services:
Biopharmaceutical Management continued
 Generic promotion programs:

United reports a 75%-88% generic utilization rate for 2015 and projects an increase to 80%-90% for 2016; the
rate varies by region.
— To increase generic utilization, United covers generics on the lowest tier, uses pharmacy management tools (e.g.,
PA, step therapy, generic mandates), requires members to pay the cost difference when a brand is chosen over
an available generic, and implements copay waiver programs. It also leverages member communication and
outreach and provider P4P/contracting incentives.
— Members have access to cost calculators to help them determine the lowest-cost options, whether
generic or brand.

OptumRx reports a generic utilization rate of 84.4% for 2015. The PBM launched a Generic-Centric formulary
and projects a 90% generic utilization rate for 2016.
— The Generic-Centric formulary is OptumRx’s most restrictive. It is closed, and the majority of drugs are generics;
however, it does includes some brands in categories with limited generic options.
•
The formulary requires quantity limits and PA for specialty drugs.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
35
UnitedHealth Group
Products and Services:
Biopharmaceutical Management continued
 Management of specialty products:

BriovaRx handles the majority of SP functions, including biopharmaceutical and wholesaler contracting,
formulary decisions, patient education, device support/education/training, disease/case management, and home
care distribution/administration.
— BriovaRx dispenses specialty pharmaceuticals to member homes, physician offices, or alternate sites of
administration through 14 URAC-accredited SPs in 13 states.
— Members may receive up to 30-day supplies of specialty medications.
— BriovaRx’s specialty drug list includes over 300 products and 35 therapeutic areas.
— United recommends that its providers use BriovaRx, CVS Caremark, or Walgreens Specialty Pharmacy for
product acquisition.

Management of specialty products is a high priority for the company due to their high cost, the launch of multiple
new products, and the robust pipeline of costly treatments.
— United’s specialty pharmacy cost trend varies significantly by region.
•
Therapeutic categories impacting specialty PMPM cost include asthma, autoimmune inflammatory conditions, and
multiple sclerosis (MS).
— To control specialty pharmacy costs and manage utilization, United limits the number of products available in
classes with multiple products; uses pharmacy management strategies such as PA and step edits; and has
increased member cost sharing through coinsurance for specialty products.
•
United also leverages biopharmaceutical company contracting for prices and rebates, OptumRx’s exclude-at-launch
program, and prohibitions on biopharmaceutical company copay coupons.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
36
UnitedHealth Group
Products and Services:
Biopharmaceutical Management continued


United publishes a list of 39 specialty products covering 13 therapeutic areas for which its network pharmacies
will not accept biopharmaceutical company coupons. Targeted products are:
— Actemra, Adcirca, Astagraf XL, Aubagio, Bravelle, Cellcept, Copegus, Cosentyx, Enbrel, Extavia,
Follistim AQ, Ganirelix Acetate, Genotropin, Gilenya, Humatrope, Kineret, Menopur, Myfortic, Neoral, Neulasta,
Norditropin, Olysio, Omnitrope, Orencia, Otezla, Ovidrel, Prograf, Rebif, Repronex, Revatio, Ribapak, Saizen,
Sandostatin, Somavert, Technivie, Tyzeka, Viekira Pak, Xeljanz, and Zomacton
Through OptumRx and BriovaRx, members have access to specialized care programs.
— OptumRx’s hemophilia management program includes clinical management, aggressive contracting with
biopharmaceutical companies, utilization management strategies, a contracted network of hemophilia treatment
centers and a dedicated call center.
— The Clinical Management Programs provide members with a single contact for personalized, one-on-one support
on disease education, financial resources, and provider coordination/outreach, as well as for telephone
consultations. It also provides 24/7 support.
•



Conditions covered include ankylosing spondylitis, cancer, hemophilia and related bleeding disorders, hepatitis C,
HIV/AIDS, juvenile idiopathic arthritis, MS, psoriatic arthritis, rheumatoid arthritis (RA),
and transplants.
In anticipation of PCSK9s, OptumRx launched its Cholesterol Connected Care program to connect patients,
health benefits coordinators, specialty pharmacists, and care teams to ensure only the appropriate members
have access to these high-cost products.
— Other supportive programs include behavioral care, disease management, wellness programs, adherence
programs, and education.
— In December 2015, United selected Praluent as its preferred PCSK9 inhibitor.
In January 2015, United announced that Harvoni would be its preferred hepatitis C treatment.
United conducts preliminary reviews prior to the launch of biosimilars, but it does not make final decisions until
FDA approval. It places biosimilars on the second or third tier and may or may not prefer them over the brands,
depending on pricing. The company also uses provider/member education tools to increase awareness of lowercost biosimilars when applicable.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
37
UnitedHealth Group
Products and Services: Therapeutic Areas of Focus
 The company’s class management priorities for 2016 include the following:

Agents for asthma, dyslipidemia, hepatitis C, MS, psoriasis, and RA, as well as anticoagulants, antidepressants,
antipsychotics, antiretrovirals, hypoglycemics, insulins, oncolytics (office-administered, oral, and self-injectable),
and opioids
 United uses a variety of management tools to ensure appropriate use, improve formulary
compliance, and lower costs. Its most effective management tools are:

Clinical pathways/guidelines, evidence-based guidelines, disease management, member cost sharing, generic
substitution, member and provider education, mandatory generics for new starts in classes where generics are
available, online step therapy, PA, and quantity limits
— Common therapeutic areas subject to PA include antidepressants, antiemetics, antipsychotics, antiretrovirals,
erythropoietins, hypoglycemics, insulins, oncolytics (office-administered, oral, and self-injectable), and opioids, as
well as agents for Alzheimer’s, anemia, benign prostatic hyperplasia (BPH), chronic obstructive pulmonary
disease (COPD), dyslipidemia, epilepsy, hepatitis C, irritable bowel syndrome (IBS), MS, neuropathic pain,
osteoporosis, psoriasis, RA, and sleep disorders.
— Categories subject to step therapy include anticoagulants, antidepressants, antipsychotics, antiretrovirals,
hypoglycemics, insulins, opioids, and oral oncolytics, as well as agents for Alzheimer’s, asthma, BPH, COPD,
dyslipidemia, epilepsy, hepatitis C, migraines, MS, neuropathic pain, psoriasis, and RA.
— Common therapeutic areas subject to quantity/duration limits include antibiotics, anticoagulants, antidepressants,
antihypertensives, antipsychotics, antiretrovirals, erythropoietins, hypoglycemics, oncolytics (oral and selfinjectable), ophthalmics, and opioids, as well as agents for ADHD, Alzheimer’s, anemia, asthma, COPD,
dyslipidemia, epilepsy, hepatitis C, IBS, migraines, MS, neuropathic pain, osteoporosis, RA, and sleep disorders.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
38
UnitedHealth Group
Products and Services:
Therapeutic Areas of Focus continued

United uses evidence-based clinical guidelines from nationally recognized sources for many common chronic or
high-cost conditions, such as asthma/COPD, cancer, cardiovascular disease, chronic pain, diabetes, hepatitis C,
mental health disorders, osteoporosis, RA, and substance abuse, as well as preventive services.
— In the next two years, the company may adopt clinical guidelines for additional therapeutic areas, such as
epilepsy and HIV/AIDS.
 United partners with industry stakeholders to improve healthcare quality and conduct research.

United’s Advocate4Me program provides members with one-on-one representatives to help them address
their health needs from the beginning to the end of care. The program currently supports approximately
25 million members.
— Representatives can access detailed information on the member’s plan and benefits to assist with financial
resources; involve specialists in areas such as clinical care, emotional health, and pharmacy; and leverage
Optum’s data analytics and technology platforms to help identify solutions.

UHC and several health systems operate SharedClarity to conduct independent studies on the long-term
effectiveness of implanted medical devices across several therapeutic areas, including cardiology,
imaging/radiology, ophthalmology, orthopedic and spinal surgery, urology, and vascular surgery.
— This collaboration also includes group purchasing that identifies best practices to reduce costs
and improve outcomes.
— Partners include Advocate Health Care, Baylor Scott & White Health, Dignity Health, and McLaren
Health Care.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
39
UnitedHealth Group
Products and Services:
Therapeutic Areas of Focus continued
 United also leverages Optum’s capabilities to improve member health and control costs.

Clinical Management Programs provide support to members with ankylosing spondylitis, cancer, hemophilia
and related bleeding disorders, hepatitis C, HIV/AIDS, juvenile idiopathic arthritis, MS, psoriatic arthritis,
RA, and transplants.
— The programs include phone consultations with pharmacist or nurse specialists, individualized care plans and
follow-up, case management, educational support, refill reminders, and 24/7 access to care teams.

The Specialty Care Management Program includes utilization management (case review, PA management,
dose review and optimization, copay assistance, and drug utilization reviews), personalized case reviews,
collaborative fulfillment, condition management education, and medication compliance and clinical management
programs for over 35 therapeutic areas and 400 drugs.

Optum Comprehensive Cancer Solution provides treatment selection support, network strategies, and
specialized case management programs to lower cancer treatment costs.
— Optum’s treatment library includes approximately 1,700 treatment regimens for more than 120 different cancer
types and provides access to more than 10,000 federally registered clinical trials.

OptumHealth’s centers of excellence are located in all 50 states and include specialized provider/care networks
for members with serious or complex conditions.
— The centers specialize in bariatric surgery, cancer, chronic kidney disease, congenital heart disease, high-risk
pregnancy, infertility, neonatal services, spine and joint solutions, and transplant management.
— The Oncology Centers of Excellence network includes 37 cancer centers across the United States.

Optum provides remote monitoring for heart failure and COPD.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
40
UnitedHealth Group
Products and Services:
Therapeutic Areas of Focus continued
Wellness initiatives and disease management
Wellness
initiatives











Through the 24/7 NurseLine, registered nurses help members determine the appropriate site of care; schedule
appointments; identify symptoms, treatment options, and available case or disease management programs; access
health information; and improve health through lifestyle coaching.
Bridge2Health for employer groups integrates health and wellness through a holistic, data-driven, and proactive
methodology to educate and support members.
A Health and Wellness site engages employer-group members in healthy lifestyles through health assessments
and personal health records and trackers, personalized management tools and action plans, a health library, and
incentives for completing healthy behaviors. Programs include preventive care, back pain, exercise and nutrition,
pregnancy, stress management, tobacco cessation, and weight management, as well as disease management
programs for asthma, cardiovascular health, diabetes, and high blood pressure.
The Family Health Web portal includes health information specific to various age groups—infants and toddlers;
children; teens and young adults; and adults in their 20s and 30s, 40s, 50s, and 60s—as well as information on
men’s health, preventive care, and caregiver support.
The Healthy First Steps and Baby Blocks maternity programs provide support on nutrition, fitness, and safety and
include supplies such as breast pumps for nursing mothers as well as incentives for healthy behaviors.
The Healthy Mind Healthy Body monthly e-newsletter offers information on health issues; members can preselect
topics such as BodyWorks (back health), heart health and cancer awareness, nutrition, children’s health and
parenting, disease-specific topics, and emotional well-being.
The Healthy Savings program, available to employer-group members in Illinois and Indiana, offers discounts on
healthy foods at select retailers. The website provides participating locations, recipes, and weekly promotions.
Home Care includes post-discharge care coordinators, equipment and supplies, meal deliveries, and nurse visits.
JOIN for ME, a family-centered program on childhood obesity, engages parents and their children in group
sessions. The program focuses on achieving healthier weights through healthier food choices, increased activity,
and lifestyle improvements.
The LiveandWorkWell website assists members with stress, anxiety, depression, or other mental issues.
The Source4Women website provides information for women and their families on topics such as family health,
fitness, nutrition, and healthy recipes, as well as online seminars and a blog.
Continued on the following page.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
41
UnitedHealth Group
Products and Services:
Therapeutic Areas of Focus continued
Wellness initiatives and disease management
Wellness
initiatives



UHC Motion, launched in March 2016 in partnership with Qualcomm, provides a no-cost fitness device and
financial rewards of up to $1,460 for meeting fitness goals.
United’s Health and Wellness website offers information on common health topics such as Alzheimer’s disease,
arthritis, birth control, cancer, depression/anxiety, diabetes, eating disorders, emotional health, endometriosis, eye
health, fibromyalgia, heart health, high blood pressure, infertility, menopause, MS, osteoporosis, pregnancy,
sexually transmitted diseases/HIV/AIDS, stress management, strokes, urinary incontinence, and the Zika virus.
In 2012, Optum and Mayo Clinic launched Optum Labs, an open, collaborative research and development facility
based in Cambridge, Massachusetts. The facility seeks to improve treatment for serious conditions such as
chronic myelogenous leukemia and hepatitis C, while developing comprehensive assessments of patient
diagnoses, disease progression, and comparative treatment outcomes. Optum Labs includes more than 20
organizations; its newest partner is the U.S. Department of Health and Human Services.
 In August 2015, Mayo Clinic became a center-of-excellence provider for complex and rare conditions.
Disease
management
programs


United offers internally developed disease management programs for acute myocardial infarction, asthma,
cancer, chronic heart failure, COPD, coronary artery disease, diabetes, hemophilia, high-risk pregnancy, and
kidney disease. Program availability varies by region.
Case management programs address serious and complex medical conditions such as asthma, cancer,
congestive heart failure, diabetes, emphysema/COPD, heart disease, hemophilia, high-risk pregnancy, HIV/AIDS,
kidney failure, and sickle cell anemia.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
42
UnitedHealth Group
Products and Services: Distribution Strategy
 Mail-service promotion programs:

United’s mail-order utilization rate was approximately 10% in 2015; this is projected to increase to
10%-15% in 2016. The rate varies by region and customer type.
— The company uses copay structure/benefit design (i.e., discounted copays), member communication (e.g.,
outreach via letter/phone), provision of cost calculators to demonstrate savings, expedited shipping, employer
outreach to encourage use among employees, and online ordering capabilities to increase mail-order utilization.
•
•
•
Members can receive 90-day supplies through mail order for the equivalent of two or two and a half copays,
depending on plan and region.
The company reports that members using home delivery have a 13.4% higher medication adherence rate than those
purchasing 90-day supplies at retail pharmacies.
This study included diabetics as well as members using beta blockers, calcium channel blockers or other
antihypertensives, or statins.
— With the acquisition of Catamaran, OptumRx now operates mail-order facilities in California, Florida,
Illinois (2), Kansas, and Ohio. All facilities are URAC and VIPPS accredited.
— Mail Service Member Select automatically transfers maintenance medication prescriptions to mail order
after two refills; however, employees may opt out of the program and continue to receive retail fills at
their normal copay.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
43
UnitedHealth Group
Products and Services: Distribution Strategy continued
 United members have access to multiple programs and services through Optum.

Optum operates 270 OptumCare and MedExpress clinics and urgent care centers in 26 states and plans to open
100 or more facilities to increase access and lower cost of care. Current centers include:
— AppleCare, Monarch, OptumCare Medical Group, Primary Care Associates, PrimeCare, and Valley Physicians
Network in California
— Optum Clinic+Urgent Care facilities in Houston; Dallas; and Overland Park, Kansas
— ProHEALTH Urgent Care locations in the New York City area (there are expansion plans for New Jersey)
— Southwest Medical Associates in Nevada
— WellMed in Florida and Texas

Optum HealthAllies Basic and Enhanced programs offer 10%-50% discounts on out-of-pocket costs for health
and wellness purchases and services.
— The Basic program includes alternative care; dental, hearing, and vision care; fitness clubs; long-term care
services; smoking cessation programs/products; and health supplies.
— The Enhanced program includes all of these plus medical care, prescription drugs, and behavioral
health services.

Optum Bank helps members with HSAs manage their accounts and track their healthcare dollars.

Optum CarePlus offers nurse practitioners to assist members who are in nursing homes or need specialized inhome care.


OptumRx’s Prescription Savings program offers discounts to individuals lacking health insurance or drug
coverage and includes Medicare-excluded products.
NowClinic improves access to care by allowing members to communicate with providers via the Internet, phone,
or mobile device.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
44
UnitedHealth Group
Products and Services: Distribution Strategy continued

OptumRx acquired AxelaCare in November 2015, gaining more than 30 home infusion centers serving 44 states.
— United contracts with several regional and national infusion centers to provide services to its members, including
BioScrip, Carepoint Partners, Critical Care Systems, Heartland Healthcare Services, Infusion Solutions, Option
Care, and Walgreens.

OptumRx announced a partnership with Walgreens in March 2016.
— Beginning in January 2017, commercial members may purchase 90-day prescriptions at Walgreens retail
pharmacies for mail-order copays and will have 24/7 access to Walgreens pharmacists. Employers must opt into
the program for their employees.
— Walgreens operates 8,200 retail pharmacies and over 400 clinics and employs more than 27,000 pharmacists. Its
pending merger with Rite Aid will add 4,500 retail pharmacies.
 In April 2016, United opened an Asian Resource Center in Fullerton, California, staffed with
Chinese-, Korean-, and Vietnamese-speaking customer service representatives to provide Medicare
enrollment information to an estimated 70,000 Asian American residents of the area.
 In February 2016, UHC partnered with Chicanos Por La Causa to open a myCommunity Connect
Center in Phoenix to improve access to social services and community programs.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
45
UnitedHealth Group
Products and Services: Technology Offerings
 United views information technology as highly important to its overall success; the company
spends approximately $2.9 billion on technology and innovation and processes more than 500
billion digital transactions annually.


United’s current HIT capabilities include electronic medical records (EMRs); e-prescribing; online step therapy
and PA; data analysis to measure quality, outcomes, and cost; and gap analysis to identify quality and/or cost
improvement opportunities.
Approximately 465,000 physicians currently use Link, United’s cloud-based provider system, to streamline
administrative functions and improve care. Services/tools include:
— Electronic payments and statements, training and education, patient reporting (e.g., gaps in care), electronic
claims, and PA submissions and tracking.

United provides telehealth services to employer-group members in 47 states and the District of Columbia
through Optum’s NowClinic, Doctor on Demand, and its partnership with American Well’s Amwell.
— Members pay approximately $40-$50 per virtual visit and can access the program through United’s Health4Me
mobile application on smartphones and tablets or home computers.

United partners with Rally Health to offer personalized, interactive tools to improve member health through
fitness, nutrition, and development of healthy habits.
— As of January 2016, approximately 23 million consumers gained access to the program.
— Rally and United launched the Real Appeal diabetes management and weight loss program in July 2015. As of
January 2016, nearly 1 million members have used the program; nearly half of them achieved a 5% weight loss
within 16 weeks.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
46
UnitedHealth Group
Products and Services: Technology Offerings continued
 Through www.myuhc.com, United’s secure online portal, members can view and pay claims,
access claims forms, view and print ID cards, access HSA/HRA/FSA account balances, create and
view personal health records, locate providers, and access other tools, such as the following:


The myHealthcare Cost Estimator search tool helps members make educated healthcare decisions by providing
costs of treatments and procedures based on United’s actual contracted rates with providers and hospitals.
Through United’s Health4Me mobile application, members can locate providers, pharmacies, urgent care
facilities, and emergency rooms; view and share ID card information; contact a registered nurse 24/7; check
deductible, out-of-pocket, and HSA/HRA/FSA balances; and estimate costs for common procedures and drugs.
— Some features of the application are available to non-United members through guest access.

Through myClaims Manager, members can view claims data and explanations of benefits; pay healthcare
providers; view HSA/HRA/FSA account balances; and export detailed reports on claims history and payments.

The DocGPS mobile application allows members to locate network physicians, clinics, and hospitals within a
100-mile radius based on their specific plan.
— TRICARE members can also locate authorized civilian providers within a 100-mile radius.


United’s Health Care Lane is an interactive video-based website that offers information on healthcare topics,
United products, health insurance options, pharmacy benefits, and wellness programs.
United also offers multicultural websites focused on topics of interest and health issues related specifically to the
Latino, African American, and Asian populations.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
47
UnitedHealth Group
Products and Services: Technology Offerings continued
 Optum offers members and providers additional programs and services.

HealtheNotes and HealtheNotes Reminders provide members and providers with messaging on health risks and
reminders of preventive screenings.

Through the Optum One health analytics platform, providers can access EMRs and claims information to identify
gaps in care, coordinate care, and compare outcomes and costs of treatment options.
— Optum One includes population and risk analyses, patient engagement, and care coordination applications.


The Optum360 Revenue Cycle Management platform simplifies billing, increases cost transparency, and
streamlines administrative functions for hospitals, providers, and payers.
OptumRx’s mobile application allows members to manage their drug benefits, order refills of mail-pharmacy
prescriptions, track mail orders, locate pharmacies, view prescription history, and search the formulary.
— My Medication Reminders allows members to set up personal text message medication reminders; options
include refills, renewals, transfers (retail to mail), and order shipment notifications.

BriovaCommunity is a video library for patients with hepatitis C and MS; it provides information on the diseases,
medications, and treatment, as well as statements from other patients and experts in each disease area.

BriovaLive is a video consultation service that connects patients and their caregivers with a BriovaRx pharmacist
as soon as they receive the first dose of a new medication. Pharmacists provide step-by-step injection guidance,
disease information, and medication therapy management for patients with multiple medications.
— The program, launched in April 2014, is available for patients with MS, RA, and hepatitis C.

BriovaRx On the Go, a mobile application for members, provides personalized and comprehensive
disease/condition information, treatment plans, and medication regimens.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
48
UnitedHealth Group
Geographic Reach
 United is the largest health insurer by enrollment in Nevada and New York and in the top five in 17
other states and the District of Columbia.

United’s TRICARE contract (not included on map) spans 21 western and midwestern states.
© 2016 Health Strategies Group. All rights reserved.
49
UnitedHealth Group
Geographic Reach continued
 United’s enrollment increased in all but seven states in 2015; the largest increases occurred in
Florida, Iowa, Mississippi, and New Jersey.
Plan presence by state
State
Enrollment
State
New York
Florida
California
New Jersey
Texas
Nevada
Arizona
Tennessee
Illinois
Wisconsin
Louisiana
Washington
Pennsylvania
Ohio
Mississippi
Michigan
North Carolina
2,422,127
1,122,286
857,366
823,136
747,252
703,729
630,458
575,007
431,873
373,914
358,341
348,739
330,481
328,753
326,150
306,825
305,290
Georgia
Iowa
Maryland
Missouri
Kansas
Colorado
Indiana
South Carolina
New Mexico
Delaware
Connecticut
Nebraska
Rhode Island
Virginia
Alabama
District of Columbia
Utah
Enrollment
301,468
279,124
236,701
173,839
160,781
156,178
145,865
130,994
108,718
102,474
101,769
90,950
76,576
72,311
68,835
66,970
65,136
State
Kentucky
Hawaii
Arkansas
Oklahoma
Massachusetts
Oregon
Idaho
New Hampshire
Maine
Vermont
West Virginia
Wyoming
Minnesota
Montana
South Dakota
North Dakota
Alaska
Enrollment
63,977
61,899
59,053
54,169
45,182
40,811
14,230
11,023
10,753
8,031
4,995
4,877
2,748
745
257
92
73
Note: State enrollment breakdown is partial and represents only full-risk enrollment. It does not include approximately
8 million National Accounts lives not attributed to a state; approximately 3 million TRICARE members; or PDP lives.
Source: AIS’s Directory of Health Plans: 2016, UnitedHealth Group.
Accessed May-June 2016 from corporate and subsidiary websites and public reports; Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
50
UnitedHealth Group
Healthcare Industry Relationships
 As of June 2016, United had more than 750 value-based contracts, such as ACOs, PCMHs, and
bundled-payment or P4P initiatives.

United reports 1%-6% lower overall medical costs for the 14 million members receiving care through these
value-based partnerships.

The company paid $43 billion to physicians and hospitals under value-based contracts in 2015 and expects to
pay $65 billion by the end of 2018.
 Recent announcements, updates, and results include the following:
Industry relationships—accountable care and PCMH initiatives
Organization
Brown & Toland
Physicians
Camden
Coalition ACO
Cancer Specialists of
North Florida (CSNF)
Description of relationship



In January 2016, Brown & Toland and United announced an accountable care program benefiting
more than 15,000 employer-sponsored members in Northern California. Brown & Toland includes
1,500 physicians in Alameda, Contra Costa, Marin, San Francisco, and San Mateo counties.
In June 2015, United, Horizon BCBS of New Jersey, and the Camden Coalition launched a three-year
Medicaid ACO demonstration project impacting 37,000 Camden, New Jersey, beneficiaries. The
coalition includes three hospitals, 11 primary care practices, four behavioral health organizations, and
several community organizations.
United expanded its successful oncology bundled-payment program designed to improve care and
reduce treatment costs. CSNF and four other oncology practices joined the program, focused on
integrated care, quality, and outcomes measures, in September 2015.
Continued on the following page.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
51
UnitedHealth Group
Healthcare Industry Relationships continued
Industry relationships—accountable care and PCMH initiatives
Organization
Description of relationship
CMS’s Comprehensive
Primary Care Initiative



Delaware Valley
Accountable Care
Organization (DVACO)
Esse Health
Florida Accountable Care
Services (FACS)



United is one of nine insurers participating in the Colorado program, which comprises 72 primary care
practices with 360 providers caring for approximately 451,000 individuals, including more than 86,000
Medicare and Medicaid beneficiaries.
It is one of four insurers in the New Jersey program, which comprises 63 primary care practices with
230 providers caring for approximately 302,000 individuals, including more than 43,000 Medicare and
Medicaid beneficiaries.
It is one of eight insurers in the Ohio/Kentucky program, which comprises 75 primary care practices
with 290 providers caring for nearly 478,000 individuals, including approximately 46,000 Medicare
and Medicaid enrollees.
United and DVACO announced a partnership in March 2016 benefiting more than 17,000 employersponsored members in southeastern Pennsylvania. DVACO—owned by Doylestown Health, Holy
Redeemer Health System, Jefferson Health, Magee Rehabilitation Hospital, and Main Line Health—
includes 670 primary care physicians (PCPs).
In January 2016, United and Esse Health implemented an accountable care relationship benefiting
approximately 300,000 employer-sponsored members in the St. Louis, Missouri, area. Esse includes
38 locations and more than 100 physicians.
In February 2016, UHC and FACS partnered for an accountable care program benefiting more than
20,000 individual and employer-sponsored members in central Florida. FACS includes 300 PCPs and
700 specialty physicians.
Continued on the following page.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
52
UnitedHealth Group
Healthcare Industry Relationships continued
Industry relationships—accountable care and PCMH initiatives
Organization
Hill Physicians
Medical Group
Illinois Health Partners
(IHP)
Integra Community
Care Network
Integrated Health
Network of Wisconsin
(IHN)
Loudoun Medical
Group
Memorial Hermann
Health Systems
Description of relationship






United and Hill Physicians Medical Group launched an accountable care agreement benefiting
approximately 20,000 employer-sponsored PPO members in Northern California. The medical group
includes more than 3,800 physicians and providers.
In December 2015, United and IHP launched an accountable care relationship effective January 2016.
IHP’s 1,600 physicians and specialists provide care to more than 36,000 employer-sponsored
Illinois members.
United announced a Medicaid ACO partnership with Integra in April 2016 as part of its participation in the
State of Rhode Island Accountable Entities Pilot program. Integra includes Rhode Island Primary Care,
PC, Care New England, and South County Hospitals and their employed and affiliated physicians.
In December 2015, United and IHN reported improved quality in the first year of a three-year accountable
care relationship. Approximately 60,000 employer-sponsored members received care in 2014. Results
included 7% more breast cancer screenings compared to 2012 clinical data, 5% more colorectal cancer
screenings, 4% more diabetes screenings, 4% fewer emergency room visits, and 2% more generic
drug utilization.
United announced an accountable care agreement with Loudoun in March 2016 benefiting approximately
11,000 employer-sponsored members. Loudon employs more than 250 providers spanning 35 medical
and surgical specialties at 112 Virginia locations.
In June 2016, United announced an accountable care partnership with Memorial Hermann benefiting
more than 120,000 employer-sponsored members in the Houston area. Memorial Hermann includes 14
hospitals and 5,500 affiliated physicians.
Continued on the following page.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
53
UnitedHealth Group
Healthcare Industry Relationships continued
Industry relationships—accountable care and PCMH initiatives
Organization
Oncology Hematology
Care (OHC)
Rocky Mountain Cancer
Centers
Saint Francis HealthCare
Partners (SFHCP)
Description of relationship

OHC’s Cincinnati facility and four other oncology practices joined United’s oncology bundled-payment
program in September 2015.

Rocky Mountain Cancer Centers and four other oncology practices joined United’s oncology bundledpayment program in September 2015.

In December 2015, United and SFHCP formed an accountable care relationship benefiting more than
8,500 United and Oxford employer-sponsored members in Connecticut.
Sharp HealthCare

Texas Oncology

Texas Oncology and four other oncology practices joined United’s oncology bundled-payment
program in September 2015.
Tulsa Cancer Institute

Tulsa Cancer Institute and four other oncology practices joined United’s oncology bundled-payment
program in September 2015.
University of Texas MD
Anderson Cancer Center
Wake Forest Baptist
Medical Center
WellMed



In January 2016, Sharp HealthCare and United launched an accountable care partnership benefiting
more than 20,000 employer-sponsored members in San Diego.
In December 2014, UHC and MD Anderson announced a three-year pilot bundled-payment program
to improve care and reduce costs for head and neck cancers. The program prioritizes improvement of
integrated care, quality, and outcomes measures.
In March 2016, United and Wake Forest Baptist Medical Center launched an ACO benefiting more
than 25,000 Medicare members in North Carolina.
In March 2016, United and WellMed (owned by United’s Optum division) launched an accountable
care program benefiting more than 10,000 employer-sponsored members in Alamo City, Texas.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports;
Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
54
UnitedHealth Group
Healthcare Industry Relationships continued
 Through additional partnerships, United enhances the products and services it offers.
Industry relationships—others
Organization
Description of relationship
AARP

American Well
Cardinal Health
ChildServe
CoverMyMeds, LLC
Dignity Health
The Health Care Cost
Institute (HCCI)







LabCorp

United partners with AARP to market MA-PDs and PDPs. AARP offers bonuses if United hits
benchmarks that demonstrate improved member health and quality of life. The partnership includes
health and wellness services from Optum and runs through 2020.
United contracts with American Well for telehealth services.
Cardinal is OptumRx’s contracted supplier of brand drugs for mail-order and specialty pharmacy.
United partnered with ChildServe in April 2016 to provide residential and community services to
children covered by Medicaid in Ames, Des Moines, and Johnston, Iowa.
Providers can submit electronic PAs through CoverMyMeds.
Optum partners with Dignity Health in Optum360 to develop tools to simplify billing, increase cost
transparency, and modernize administrative functions for hospitals, providers, and payers. Dignity
Health, a 21-state network of 11,000 physicians and 300 care sites, also participates in the
SharedClarity program.
United, several other health insurers (Aetna, Assurant Health, Harvard Pilgrim, Health Net, Humana,
Kaiser, and Partners HealthCare), and CMS provide information for HCCI’s healthcare transparency
tool, Guroo, which provides consumers with no-charge access to healthcare price and quality
information to help them make educated choices.
The database includes information compiled from claims data collected on 40 million anonymous
individuals on approximately 70 common healthcare services, such as childbirth, imaging, and knee
surgery. The group plans to expand the database as more insurers join; it also plans to launch a
Spanish-language version in the near future.
United contracts with LabCorp to provide genomic testing and serve as the national laboratory for
United members until 2018.
Continued on the following page.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports; Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
55
UnitedHealth Group
Healthcare Industry Relationships continued
Industry relationships—others
Organization
Description of relationship
The Leapfrog Group
March of Dimes


Medecision

Medtronic
ProHealth Physicians
Qualcomm
Rally Health
Regeneron / Sanofi
The Rhode Island
ICU Collaborative






Trizetto

Walgreens

United participates in Leapfrog’s hospital quality and safety practices.
In June 2016, United announced a partnership with the March of Dimes to develop a healthy
pregnancy program in Tennessee. United provided $700,000 to fund the program, which is expected
to launch in the fourth quarter of 2016. The program will include Web-based tools and social media
features to educate and support expectant mothers and reduce preterm births.
Medecision, along with Trizetto, supports Optum’s new Medicaid Management Services software
product for state Medicaid agencies.
Medtronic is United’s preferred provider of insulin pumps for commercial and Medicaid members.
In December 2015, ProHealth announced it would use Optum’s clinical, administrative, and
technology solutions to improve its ability to provide accountable and collaborative care.
Qualcomm supports United’s Motion program providing fitness devices to members.
Rally supports United with interactive wellness tools on its myuhc.com member portal. Rally has
offices in Chicago, San Francisco, and the District of Columbia.
In December 2015, United selected Praluent as its preferred PCSK9 inhibitor.
United supports this collaborative in partnership with the Rhode Island Quality Institute, Quality
Partners of Rhode Island, the Hospital Association of Rhode Island, and BCBS of Rhode Island. The
collaborative promotes sharing of best practices and outcomes reporting.
Trizetto, along with Medecision, supports Optum’s new Medicaid Management Services software
product for state Medicaid agencies.
In March 2016, OptumRx and Walgreens announced a partnership to integrate OptumRx’s
pharmacy care services solutions with Walgreens’ drugstore services to reduce pharmacy costs
and improve outcomes.
Source: UnitedHealth Group. Accessed May-June 2016 from corporate and subsidiary websites and public reports; Health Strategies Group, Strategic Accounts, August 2016.
© 2016 Health Strategies Group. All rights reserved.
56
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