Activity is bubbling in the healthcare payer market, as rumors of acquisitions are surfacing. One of those payers, among the big five key companies, is UnitedHealthcare.
Here are 25 things to know about UnitedHealthcare.
Company basics
1. Minneapolis-based UnitedHealthcare operates under parent company UnitedHealth Group. UnitedHealth Group was incorporated in 1974 under the name Charter Med by a group of healthcare professionals and physicians. In 1977, United HealthCare Corp. was created and became the parent of Charter Med. It wasn't until 1998 when United HealthCare Corp. became known as UnitedHealth Group, and the company launched six independent business segments, one of which was the UnitedHealthcare of today.
2. UnitedHealth Group's other service line is Optum, a health services platform that includes solutions for population health management, care delivery and clinical and operational improvement. Optum features three platforms — OptumHealth, OptumInsight and OptumRx — providing services for health management, advisory consulting and pharmacy benefit management services, respectively.
3. David Wichmann, president and CFO of UnitedHealth Group, currently oversees operations of UnitedHealthcare. He assumed these duties in February 2015, after then-CEO of UnitedHealthcare Gail Boudreaux stepped down from her position for undisclosed reasons after serving in the position since 2008. Mr. Wichmann will transition out of his role as CFO over the next six to 12 months.
4. UnitedHealth Group employs approximately 168,000 individuals in 21 countries, including Australia, Canada, China, India, Philippines, Ireland, Italy and the United Kingdom.
Financial reports
5. In first quarter 2015, UnitedHealth Group (including Optum financials) reported revenue of $35.8 billion, a 12.6 percent increase from the first quarter 2014's $31.8 billion. On its own, UnitedHealthcare's Q1 2015 revenue totaled $32.6 billion, up 11.3 percent from $29.3 billion in Q1 2014. UnitedHealth Group's profit for Q1 2015 totaled $1.4 billion, up from $1.1 billion Q1 2014.
6. In the past three years, UnitedHealthcare has nearly tripled its total value-based payments to providers, which now total approximately $37 billion. The payer expects to double that number by 2018, paying $65 billion tied to improved quality and outcomes.
Member information
7. UnitedHealthcare covers approximately 45 million individuals worldwide. UnitedHealth Group's services serve more than 6,100 healthcare facilities and 855,000 physicians and caregivers.
8. UnitedHealthcare offers health benefits to five distinct groups. In the community and state plans, the payer provides managed care solutions to state Medicaid programs. The employer and individual plans offer consumer-oriented benefits. UnitedHealthcare also offers Medicare and retirement plans for those ages 50 and above, as well as military and veterans plans to serve the needs of military service members, retirees and their family members. Additionally, UnitedHealthcare has a global presence, mainly in Brazil.
9. UnitedHealthcare offers products on 23 state exchanges, including 15 states where the payer offers Medicaid plans.
10. The payer offers health plans tailored to individuals with specific chronic diseases, such as diabetes. UnitedHealthcare launched its diabetes-specific program in 2009, making it the first-ever health plan specifically for patients with diabetes or pre-diabetes. Under the plan, there is no cost for routine diabetes care, but members in the program must adhere to preventive, evidence-based guidelines from the American Diabetes Association.
11. Research from Mark Farrah Associates indicates UnitedHealthcare's total membership was the only one out of its top competitors to see membership growth decline from fourth quarter 2013 to fourth quarter 2014. UnitedHealthcare's membership growth fell by 1 percent, while Aetna's grew 5.9 percent, Cigna's grew 2.7 percent and Anthem grew 5.2 percent, according to the findings.
Accountable care agreements
12. UnitedHealthcare plans to add an additional 250 accountable care organizations to its current list of programs, bringing the grand total to more than 720 ACOs. The payer announced in February that 11 million plan participants receive value-based care through its ACOs.
13. Some recent accountable care relationship updates of UnitedHealthcare's include plans with Downers Grove, Ill.-based Advocate Health Care to expand accountable care from 5,500 Medicare Advantage beneficiaries to more than 80,000 UnitedHealthcare members, Raleigh, N.C.-based WakeMed Key Community Care to improve care coordination for more than 175,000 beneficiaries receiving care from WKCC physicians, and Mountain View, Calif.-based Palo Alto Medical foundation to launch a new ACO for more than 63,000 beneficiaries.
14. UnitedHealthcare was involved in some payer-hospital conflict this year as it worked to renegotiate its contract with Charlotte, N.C.-based Carolinas HealthCare. The contract between the two parties expired Feb. 28, 2015. It took approximately two months after their contract expired to agree upon a new one in April, but the contract is retroactive to March 1 so beneficiaries did not experience a disruption in benefits.
15. In 2009, UnitedHealthcare launched its patient-centered medical home program with primary care practices in Arizona, Colorado, Ohio, New York and Rhode Island. In this model, primary care physicians serve as individuals' coordinators of care to help reduce fragmentation across the care continuum.
Rankings and ratings
16. In 2015, UnitedHealth Group ranked No. 1 on Fortune's "World's Most Admired Companies" list in the insurance and managed care section for the fifth year in a row. Additionally, the payer received a top rating of 100 percent on the Human Rights Campaign's 2015 Corporate Equality Index and was named a Top 100 Military Friendly Employer and Military Spouse Friendly Employer in 2015 by Victory Media, which publishes G.I. Jobs and Military Spouse magazines.
17. UnitedHealthcare plans were ranked the No. 1 for member satisfaction in the Texas region, tied with BlueCross BlueShield of Texas, according to the annual J.D. Power Member Health Plan Study in 2015. The payer tied for third place with CareFirst BlueCross BlueShield in the Mid-Atlantic region, which includes Maryland, Virginia and Washington, D.C.
18. In athenahealth's PayerView 2015 report, UnitedHealthcare came in at 53 out of 166 payers. The report ranks payer performance based on accounts receivable, first-pass claim resolution rate, denial rate and provider collection burden, among other metrics.
19. As millennials enter the workforce, UnitedHealth Group is one place they want to end up. According to a survey from the National Society of High School Scholars that collected responses from more than 18,000 students between the ages of 15 and 29, UnitedHealth Group is No. 23 on the list of 25 specific companies for which millennials most want to work.
New offerings
20. UnitedHealthcare partnered with three telemedicine providers and will cover video consultations. Through the telemedicine service providers — Doctor on Demand, Optum's NowClinic and American Well — UnitedHealthcare members will be able to access a physician at any time. Currently, this coverage is only offered to self-funded employer customers, but the payer plans to extend coverage to employer-sponsored and individual plan participants in 2016.
21. In 2014, UnitedHealthcare launched its Health4Me mobile app, which allows plan participants to pay medical bills on their smartphones. The app also allows users to search for physicians, locate urgent care facilities, manage prescription claims and speak with nurses about health concerns, among other offerings.
22. Along with the AARP, UnitedHealthcare launched The Longevity Network, a digital platform offering a hub for individuals ages 50 and above. AARP and UnitedHealthcare have worked in partnership since 2008. UnitedHealthcare provides AARP members Medicare Supplement Insurance Plans.
23. In April, the payer announced a health incentive partnership with Walgreens. Through the collaboration, UnitedHealthcare members can earn Walgreens Balance Reward points for healthy behaviors and activities. When individuals log daily exercise, healthy eating and other health-positive activities on UnitedHealthcare's Health4Me mobile app, they earn extra Walgreens Balance Reward points. The program will be piloted for members in Arizona and Illinois.
UnitedHealthcare in the news
24. In May, UnitedHealthcare settled a decade-long lawsuit that alleged the payer purposefully withheld payments to meet financial goals. The N.C. Medical Society filed the lawsuit against UnitedHealthcare in 2004, alleging UnitedHealthcare "would systematically deny payments to NCMS members for medically necessary claims to achieve internal financial targets without regard for individual patient medical needs." UnitedHealthcare will settle for $11.5 million.
25. According to a Wall Street Journal report, UnitedHealth Group is discussing a takeover deal with Aetna that would be valued at more than $40 billion. News of this extended offer closely follows news that Anthem recently approached Cigna with a takeover deal valued at approximately $45 billion. Additionally, Aetna is speculated to be considering buying Humana.
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