60 essential things to know about the 'Big 6' payers

Six payers dominate the health insurance landscape in the United States, but each has taken dramatically different paths that define their approaches to the industry today. 

Here are 60 essential things to know about the 'Big 6' payers:

UnitedHealth Group

1. Minnetonka, Minn.-based UnitedHealth Group was founded by a group of healthcare professionals and physicians in 1974 as Charter Med. Three years later, United HealthCare Corp. was created and became the parent of Charter Med.

2. The company significantly realigned its operations in 1998 to include five independent businesses — UnitedHealthcare, Ovations, Uniprise, Specialized Care Services and Ingenix. As a result, United HealthCare Corp. was renamed to UnitedHealth Group.

3. Andrew Witty leads UnitedHealth Group as CEO. Formerly the CEO of Optum, Mr. Witty later served as UnitedHealth's president in 2019 and later as a company director. He became CEO in 2021 after taking over from David Wichmann, who retired.

4. UnitedHealth Group employs about 340,000 people worldwide.

5. Through its UnitedHealthcare and Optum arms, UnitedHealth Group provides medical benefits to people in all 50 U.S. states and more than 150 other countries.

6. The company processed nearly $1 trillion in global gross billed charges and managed over $250 billion in aggregate healthcare spending in 2020.

7. UnitedHealth Group reported revenues of $72.3 billion in the third quarter of 2021, a year-over-year increase of 11 percent. The growth was characterized by double-digit development from both UnitedHealthcare and Optum and the decreased influence of COVID-19 on finances.

8. UnitedHealthcare is the insurance arm of UnitedHealth Group and the largest single health carrier in the U.S. The payer is led by Brian Thompson, who began to oversee UnitedHealthcare's domestic and international businesses in April 2021. He previously served as the company's CEO of government programs, including Medicaid and Medicare.

9. UnitedHealth Group also operates Optum, a health services platform that includes solutions for population health management, care delivery and clinical and operational improvement. Optum features three core platforms — OptumHealth, OptumInsight and OptumRx — providing services for health management, advisory consulting and pharmacy benefit management services, respectively.

10. UnitedHealth Group is ranked No. 8 on the 2021 Fortune Global 500 list. It also ranked No. 5 in the U.S. 500 list based on 2020 revenue. 

Centene

1. Centene was founded in Milwaukee as a nonprofit Medicaid plan in 1984. The plan's original name was Family Hospital Physician Associates. 

2. In 1995, the company named Michael Neidorff as president and CEO during its expansion into Indiana. Mr. Neidorff, who is still CEO, would go on to expand the payer into every U.S. state. 

3. Family Hospital Physician Associates was rebranded as Centene in 1997, which is also when it moved its headquarters to its current location in St. Louis. The company went public in 2001. 

4. Mr. Neidorff is retiring from Centene in 2022, so its future leadership is uncertain. The board of directors has implemented a succession planning initiative to find his successor. 

5. Centene covers 26.5 million members, translating to about 1 in every 15 Americans. The payer operates in all 50 states as well as in Spain, the United Kingdom and Central Europe. 

6. Centene currently employs about 76,000 workers. 

7. Centene reported $32.4 billion in 2021 third quarter revenue, indicating an 11 percent year-over-year increase. 

8. Centene's largest acquisition was a $17 billion deal to purchase WellCare Health Plans in early 2020, bringing 22 million members in 31 health plans under one roof. More recently, Centene moved to purchase behavioral health insurer Magellan Health for $2.2 billion.

9. After settling with six states for allegedly using its pharmacy benefit managers to overcharge state Medicaid programs, Centene announced its decision to outsource its PBM business after its current in-house contract expires in 2023. That would mean PBMs would compete for a contract that includes $30 billion in annual drug spending. 

10. Centene is ranked 24th on the 2021 Fortune 500 list, jumping up from 42 in 2020. The payer ranks 207 on Fortune's Global 2000 list. 

Aetna

1. Aetna was founded under the leadership of its first president, Eliphalet Bulkeley, in 1853 and has its roots as an annuity fund to sell life insurance. Around 1985, Aetna was the largest insurer in the country, and the payer began to seriously develop its HMOs, PPOs and other products.

2. Aetna is currently under the leadership of Karen Lynch, who was the first woman to serve as the company's president in its 160-year history when she took over in 2015. Ms. Lynch is now the president and CEO of CVS Health, which owns Aetna.

3. In 2018, CVS Health, under the leadership of President and CEO Larry Merlo, closed a $70 billion acquisition of Aetna. The payer maintained its leadership and structure, operating as a stand-alone unit. 

4. Today, Aetna insures about 39 million people total through medical, pharmacy, dental, Medicare, Medicaid, behavioral health and management coverage. It provides medical coverage to 23.7 million people. 

5. Aetna directly owns five subsidiaries. However, since its acquisition by CVS Health, the payer taps CVS services, like its pharmacy benefits manager, Caremark. 

6. CVS Health's healthcare benefits segment, which includes Aetna, reported $20.5 billion in revenue in the third quarter of 2021 — up $1.8 billion, or 9.5 percent, year-over-year.

7. On the horizon, Ms. Lynch said CVS Health is focusing further integration between Aetna and its other healthcare offerings. One example may be encouraging Aetna members to use CVS MinuteClinics over competitors. 

8. As payers quickly adopted virtual-first health plans throughout 2021, Aetna led the pack. The payer was the first to launch a national virtual-first plan with virtual primary care, mental health counseling, dermatology and more. 

9. Aetna is also reentering the ACA marketplace in 2022 after leaving the space four years ago, according to Forbes. It will sell individual coverage as Ms. Lynch cited stronger market conditions.

10. CVS Health is currently ranked No. 4 on Fortune's U.S. 500 list and No. 7 on its international 500 list. 

Cigna

1. Cigna was founded in 1792 as the Insurance Company of North America, the country's first marine insurer and its oldest stockholder-owned payer. Cigna was formed by a merger between Connecticut General Corp. (CG) and the Insurance Company of North America (INA). Its new name comes from a combination of the parties' abbreviated names.

2. The payer is led by CEO and Chair David Cordani, who stepped into his role in 2009. 

3. Cigna operates globally in over 30 countries and territories. The payer reaches 180 million people through all of its services, which include health insurance, pharmacy benefit management and more. 

4. The insurer has Medicare prescription drug plans in all 50 states and Medicare Advantage plans in 16 states. 

5. Cigna had a total of 17 million medical customers worldwide, comprising 13.8 million U.S. commercial members, 1.5 million government members and 1.7 international members as of 2021's third quarter. The company also had nearly 40 million behavioral care customers. 

6. Cigna reported $44.3 billion in revenue during 2021's third quarter, representing 8.6 percent year-over-year growth. 

7. Cigna has grown its mental and behavioral healthcare provider network by 70 percent since 2016. Its network includes more than 175,000 providers to date. 

8. In 2018, Cigna moved to purchase pharmacy benefit manager Express Scripts for $67 billion. The Express Scripts acquisition closed in December 2018, bringing the pharmacy benefit manager's 85 million customers under Cigna's roof. 

9. Evernorth CEO Eric Palmer said in October 2021 that the subsidiary's priorities included promoting affordability amid rising specialty pharmacy spending, connecting pieces of its business portfolio and continuing to promote innovation.

10. Cigna is ranked No. 13 on Fortune's U.S. 500 list and No. 28 on Fortune's global 500 list. 

Anthem

1. Anthem is the largest publicly traded Blue Cross Blue Shield affiliate, operating as a Blue Cross or Blue Cross Blue Shield plan in 14 states. The payer also offers Medicaid plans in 23 states as well as Washington, D.C., and Puerto Rico, and Medicare plans in 24 states and Puerto Rico. 

2. Anthem covers 45 million members through its health plans. About 1 in 8 Americans are covered by Anthem. 

3. Between health coverage and healthcare services offered throughout its portfolio, Anthem serves 117 million people. 

4. Gail Boudreaux has led Anthem as its president and CEO since 2017. named her the 16th most powerful woman in the world on its top 100 list. 

5. The payer employs 90,201 associates and is focused on workforce diversity. Over 76 percent of its employees are women and nearly half are people of color. 

6. Anthem reported $35.8 billion in revenue in the third quarter of 2021, representing 15 percent year-over-year growth. The payer also posted $1.51 billion in profit in the third quarter of 2021, up 579.7 percent year over year.

7. Over the past 10 years, Anthem's notable acquisitions include ocular product company 1-800 CONTACTS in 2012, managed care company Amerigroup, Florida-based managed care companies Simply Healthcare Holdings, Florida-based Medicare Advantage plan and network Health Sun, and home-based nursing company myNexus.

8. Anthem attempted to acquire Cigna for $54.2 billion in 2015. The move aimed to bring a total of 53 million members under Anthem's roof. However, after years of legal struggles, the deal would eventually be blocked in 2017 following a judge's ruling

9. In recent moves, Anthem joint venture Hydrogen Health — a partnership between the payer, investment firm Blackstone and digital primary care company K Health — launched its virtual primary care offering across the U.S. in December. The joint venture seeks to expand its membership by 10 million in 2022. 

10. Anthem is ranked No. 23 on Fortune's U.S. 500 list and No. 50 on Fortune's global 500 list.

Humana

1. Humana was founded as Extendicare in 1962 by attorneys David Jones Sr. and H. Wendell Cherry, who partnered to open a nursing home in Louisville, Ky. Through 1969, the company developed 50 nursing homes, developing Extendicare as one of the largest nursing home companies in the country. 

2. Humana entered the insurance market after one of its Arizona hospitals lost a contract with a health maintenance organization. It would eventually go all-in on insurance in 1993 after shifting its hospital ownership business to another company, Galen Health Care. 

3. Bruce Broussard, former McKesson Specialty/US Oncology CEO, leads Humana as its president and CEO. He joined the company in 2011. 

4. The payer covers nearly 5 million individual Medicare Advantage members, 560,000 group Medicare Advantage members, 3.6 million Part D members and 909,000 state-based contract members. 

5. Humana employed 49,600 workers as of the end of 2020, including 900 medical personnel.

6. At the end of 2021, Humana reported $83.1 billion in revenue. However, the payer's profits dipped 27.1 percent year over year to $3.4 billion. 

7. In the same report, the payer pledged to kickstart a $1 billion value creation initiative through 2022. The plan includes a review of strategic initiatives, streamlining workforces, reducing third-party spending, shoring up real estate investments, and shifting toward digital processes.

8. Humana made headlines at the start of 2022 for nearly halving its outlook for 2022 Medicare Advantage enrollment. The payer anticipated adding between 325,000 and 375,000 new Medicare Advantage members in 2022, but cut the range down to between 150,000 and 200,000 new members. 

9. Humana closed its acquisition of Kindred at Home in August 2021 by purchasing its unowned 60 percent stake in the company for $5.7 billion. The acquisition will merge the at-home care provider with Humana's payer-agnostic CenterWell brand. 

10. Humana is ranked No. 41 on Fortune's U.S. 500 list and No. 110 on Fortune's global 500 list.

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