United Health Group Overview of Business

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  • 1. My daughter is seven. If she gets sick, I want to know that I can get her the care she needs at a fair price. I want the freedom and control to decide, together with my daughter’s pediatrician, which course of treatment is most appropriate for her and to have my health care company respect our decision. And I want the whole process to be simpler. I need help accessing quality care and using health care resources effectively, but I want enough control and flexibility to choose what’s best for our family. And because our lives are so hectic, our benefits have to be easy to understand and convenient to use. It’s not too much to ask. What’s right UnitedHealthcare We understand. That’s why four receiving care, assist them in Benefits and Services that drugs, which will cost them less. simple principles shape understanding and complying Value Individual Choice In addition, UnitedHealthcare UnitedHealthcare and, we with doctors’ instructions and and Control was a leader in aggressively believe, will ultimately shape medication requirements, and UnitedHealthcare wants promoting open access, which the marketplace for health care coordinate access to a broad people to be engaged and active allows individuals to schedule services. set of resources and services. participants in managing their appointments directly with UnitedHealthcare has pro- own health and well-being. The specialists without a referral Simple, Convenient Access grams that provide health edu- company designs options that from a primary care physician. to Quality Care cation, admission counseling let individuals choose what is UnitedHealthcare is making it Improved Quality of Care before a hospital stay, care best for themselves and their easier for people to get the care Through Information advocacy to help prevent families and offers incentives they need, when they need it, To help physicians make delays in accessing resources, that increase involvement in with its comprehensive Care better treatment decisions, help ensuring a safe transition treatment and buying decisions. Coordination philosophy. Care UnitedHealthcare uses Clinical from the hospital, support for UnitedHealthcare’s Coordination helps make the Profiles — data that compares a individuals at risk of needing multi-tiered pharmacy benefit use of health care services physician’s actual practices to intensive treatment, continuous program, for example, provides more effective and efficient, nationally accepted benchmarks coordination for people with access to a wide range of while helping to preserve broad for the most successful care. chronic conditions, and pre- generic and brand-name drugs. access. Health care profession- UnitedHealthcare distrib- scription drug management, Individuals can benefit by als work with individuals to help utes profiles to physicians twice which promotes safe and effec- accessing higher-priced brand- identify and prevent delays in a year, and has added physi- tive use of medications. name drugs, as well as generic 8
  • 2. for my family cians with each distribution. comes by avoiding complica- More than 70,000 physicians tions and optimizing the use of currently participate in this health care resources, which leading-edge effort. ultimately lowers costs. An enriched Web site Further, UnitedHealthcare puts in-depth information arranges access to care at consumers’ fingertips: a through more than 340,000 directory of physicians and physicians and 3,200 hospitals hospitals, reports on thou- across the United States. sands of health topics, and The consolidated purchasing soon, a health profile tailored power represented by the to individual interests. individuals we serve makes it possible for UnitedHealthcare Affordable Value to contract cost-effectively, UnitedHealthcare’s efforts to passing on savings to con- help improve quality also help sumers and employers while keep health care costs afford- providing access to broad able. Care Coordination, by convenient networks of helping connect people with the care providers. right care in a timely manner, strives to improve health out- 9
  • 3. I have a great relationship with my physician, but I know she may not be able to provide all of the services I need to maintain my total health and well-being. I need vision care and dental services. I believe many alternative therapies provide valuable benefits, and I want affordable access to services such as acupuncture and chiropractic care. And though I feel healthy today, I want to know that if I ever need special help, I will have access to quality specialized care for things like heart or cancer treatment, transplantation, behavioral health services or counseling support. Specialized care Specialized Care Services Specialized Care Services was through the business-to-busi- United States. The company’s manage psychiatric medications conceived and built to respond ness marketplace. For a wide focus on quality helps improve and, in turn, provide quality care to people’s desire for affordable set of needs — whether as a outcomes — including survival at a reasonable cost in this access to an ever broadening comprehensive package of rates — even as it lowers costs growing and sensitive area. range of specialized health and specialty services or as access an average of 35 percent. Health Information well-being resources. Its portfo- to a specific, individual service Behavioral Health Optum® helps individuals take lio of businesses connects peo- — Specialized Care Services United Behavioral Health charge of their health and well- ple with leading care providers can organize services that can provides mental health and being. For 10 years, Optum has in more specialized fields, gives help. That translates into added substance abuse services, been a leader in helping people them access to valuable infor- convenience, simplicity and employee assistance programs meet their personal health mation and educational materi- value for its customers. SM and PsychWorks , a unique needs in a confidential and pro- als, and makes these services Critical Care service that helps manage the tected manner. The company increasingly affordable. United Resource Networks is a impact of short-term disability provides information, education Specialized Care Services gateway to leading critical care due to mental illness. In 1999, and support in print, by phone, offers access to the most com- and chronic care programs at United Behavioral Health added on tape, face-to-face and over prehensive array of specialized more than 50 of the best med- specific programs that help the Internet. Optum Internet and alternative care available ical centers throughout the health care professionals services contain comprehensive to the consumer directly or 10
  • 4. at my fingertips information, including interac- create value for individual tive features for personalized consumers or for health care information. organizations. Dental Care Life and Accident Benefits Dental Benefit Providers offers Unimerica Life and Accident is convenient access to afford- a single convenient source for able dental care with the life and accident benefits that broadest benefits portfolio, align with other health and spe- demonstrated cost advantages cialty coverages and benefits. and extensive networks that allow maximum accessibility. Vision Care Coordinated Vision Care facilitates each step in the delivery of vision services and products, helping to enhance quality and control costs to 11
  • 5. I’m not a kid anymore, and I love it. I’ve worked hard all my life, and now I have time to be myself, enjoy my grandkids, travel with my wife and hit the bike trails. I recognize my needs and opportunities are changing. My health concerns are increasing. I need to understand my health care choices, whether I have enough money, what coverage Medicare will provide, and what supplemental coverage I will need. I want information and services tailored to my needs — family, health and fitness, travel and recreation, home and work. After all, I intend to enjoy the second half of my life, not worry about it. Services to meet my Ovations Ovations serves the needs Indemnity insurance to more that provides a hospital network Knowledge About Health and aspirations of people in than 3.7 million AARP members. and 24-hour access to health and Well-Being the second half of life, using Recently, Ovations introduced care information from nurses. Ovations Knowledge Group UnitedHealth Group capabili- AARP Eye Health Services to provides useful information for Healthy Lifestyles ties and buying power to offer affordable eye exams, making health and lifestyle In nearly every person’s life, develop products and services complimentary glaucoma decisions. The Ovations Press there comes a time when around the distinct health and screenings and discounts on is developing books designed thinking about where to live is life-stage needs of people eyewear. Ovations’ Medicare to improve understanding of influenced by health and family age 50 and older. Supplement Pharmacy Service complex questions faced in life. considerations. Ovations is addresses one of the most sig- The first books provide guides Affordable Health Care shaping a distinctive service nificant cost problems facing to financial planning, caring Americans are caught between that will respond to the older Americans — prescription for your heart, forgetfulness, the soaring cost of health care complex health, housing drug costs. These services memory loss and Alzheimer’s and pressure on Medicare to and well-being needs of older saved AARP members nearly disease, and wills, trusts and remain viable by reducing Americans. This integrated $60 million in 1999. Ovations’ estate planning. costs. Ovations is responding set of services will leverage AARP Division also developed a through a 10-year partnership Ovations’ and UnitedHealth valuable offering with lower cost with AARP, offering Medicare Group’s capabilities to serve Medicare Supplement coverage Supplement and Hospital the unique needs of this market. 12
  • 6. changing needs Eldercare among the top reasons for Through the EverCare® net- hospital admissions among work, on-site nurse practition- elderly individuals. In its first ers collaborate with physicians year, the pneumonia early to enhance care to the elderly treatment and detection through improved timeliness, program helped individuals disciplined continuity and served by EverCare receive coordination of care. EverCare timely access to services to has innovative programs to treat their illnesses, helping detect and treat common them avoid the trauma of conditions — such as hospitalization, and lowering pneumonia and other infec- hospital admissions for tions, congestive heart failure, pneumonia by 10 percent. hip fractures and medication side effects — which are 13
  • 7. To run a world-class business, you need to recruit and retain world-class employees. That’s why it’s so important to me to be able to offer my employees and their families competitive benefits that are distinctive in how they combine quality, convenience and affordability. I want to align with an organization that makes it easy for my company to offer a set of employee services that delivers maximum value to our people. And as my business needs change, I want a technologically advanced, progressive partner with the initiative to continually strive to develop and deliver superior solutions. Benefits that run as well as Uniprise Uniprise offers the most or diverse global enterprise, Consumer Focus applying advanced technology. advanced and comprehensive or an insurance company, a Uniprise serves more than In this effort, Uniprise is looking set of employee services and provider network or health care one-fourth of the Fortune 500 beyond the historic health care technologies in the entire company seeking an outsourc- companies, including many of services industry and emulating spectrum of health care ing solution, Uniprise can the most progressive compa- the best consumer services benefits. Uniprise services fit respond with a set of services nies in the world. In 2000, companies, regardless of seamlessly into any business appropriate for your needs. Uniprise will handle more than industry. In 2000, Uniprise will environment and serve the Uniprise works with clients 350 million transactions with expand these investments needs of employees and their to develop a strategic plan that industry-leading levels of and continue to advance its families — from simplified takes them from where they are timeliness and quality. consumer-focused agenda. benefits design with broad today to wherever they want to During the past 24 That is what the marketplace network access to world-class go — and gets them there fast. months, Uniprise has invested desires, and it defines a great Internet connectivity to That’s why, in 1998 and 1999, more than $100 million in infra- future for Uniprise. consumer-friendly services Uniprise grew more than any structure enhancements aimed Advanced Technology and experiences. other enterprise in its market- at improving the consumer Uniprise has aggressively Whether you represent place, and has retained more experience by strengthening expanded its Internet tech- a large domestic company, than 98 percent of its customers service quality and accuracy, nology. Already among the university, government agency over the past three years. simplifying operations and most connected, Internet- 14
  • 8. my business capable companies in all of institutional outsourcing health care, Uniprise has relationships with insurers, invested heavily to enhance providers and other health service features, speed and care industry participants. functionality even further, so 2000 will be a defining that ease of use and speed year for Uniprise as the of service is optimized. company continues to apply innovative solutions to its deep Comprehensive Outsourcing understanding of the needs Through Uniprise, clients can of large employers. What seamlessly access all of the will emerge is an ever more services and features within consumer-centered operating the domain of UnitedHealth environment that opens new Group, as well as products opportunities and enhances and services from providers service for clients and their in any location outside of employees or customers. UnitedHealth Group, if that works best for their situation. Uniprise is rapidly expanding 15
  • 9. How are new technologies changing care protocols and costs? Who provides the best care? What should I expect in terms of duration, recovery and total costs for a given procedure? Health care is too important for guesswork. I want information I can use — evidence — to improve outcomes and help control costs. Knowing the cost of a single procedure or the result of one patient’s experience with a treatment just isn’t enough. To draw meaningful conclusions, I need information that helps me understand broad trends, evaluate what works and doesn’t work, consider results and costs over a longer period of time, and learn from the experience of large populations. Knowledge that Ingenix Whether you represent a corpo- improve health care operations With access to massive The Source for ration trying to better under- and address critical issues, databases, Ingenix can identify Health Information stand and shape health care such as rising medical costs, physicians with the necessary As a leader in health informa- benefits for its employees, a quality of care and new experience for a certain study tion, Ingenix offers one-stop pharmaceutical manufacturer therapies and compounds. and establish data sets for shopping to meet business- seeking to bring a new product broad populations. As demon- to-business health care The Source for to market, a health insurer or strated in its work on clinical information needs. Pharmaceutical Services payer trying to understand trials, Ingenix’s ability to From the beginning, Ingenix conducts clinical costs, or a health care provider organize physician and patient UnitedHealth Group has used research and studies to help trying to improve coding and populations advances the information to study and make develop new therapeutic billing disciplines, Ingenix has search for better treatments advances in care, the reim- agents, evaluate medical out- the health care informatic data- and cures. Its access to bursement process, population comes and consider economic bases and expertise to help. UnitedHealth Group’s deep, risk management and cost impacts. Ingenix helps devise Ingenix combines the power of rich base of care and outcomes management. Now, with a research protocols, identify and information and technology to data aids in trial design and growing arsenal of advanced train investigators, and assist guide better clinical, technical enables Ingenix to identify information technologies, with recruitment. The company and financial decisions. Through treatment patterns and out- including increasingly sophisti- also provides data manage- its information, analysis, comes, as well as pinpoint cated analytic tools, Ingenix is ment, biostatistics, regulatory research and consulting servic- factors that contribute to poised to help solve the most services and overall project es, Ingenix can help customers adverse effects or other challenging operational issues management services. problems. and make breakthroughs in 16
  • 10. drives results the treatment of today’s most conducted using Ingenix data serious health problems. and software products. • Data and Software • Publishing. Ingenix busi- Products. Ingenix helps ness-to-business publications companies streamline, inter- deal with coding and reim- pret and manage activities by bursement information. These providing data services and publications are used by virtu- software to support bench- ally all providers and payers in marking, pricing, cost manage- America to understand the use ment, utilization, regulation, of health benefits more clearly. reporting, coding, claim review • Consulting. In the United and provider contracting. States and abroad, Ingenix UnitedHealthcare’s Clinical advises providers, insurance Profiling, which encourages companies and government improvement in clinical programs on their health care performance by comparing operations. an individual physician’s practices to local peer group and national standards, is 17
  • 11. UnitedHealth Group At A Glance Business Description Customer Base (as of Jan. 31, 2000) Market Opportunity UnitedHealth Group Focused on forming and operating orderly, Not applicable $1.1 trillion in aggregate U.S. efficient markets for the exchange of high health care spending, and further quality health and well-being services through potential in worldwide activities five distinct businesses operating in strategic in various markets. alignment across separate market segments. UnitedHealthcare 7.4 million individuals from small and Approximately $150 billion in Network-based health and well-being services, • mid-sized employers small and mid-sized employer including commercial, Medicare and Medicaid group, Medicare and Medicaid products for locally based employers and 412,000 Medicare-eligible individuals • spending across the individuals in six broad regional markets. 485,000 Medicaid-eligible individuals • UnitedHealthcare markets. Ovations 3.7 million individuals served through About $20 billion of spending in Health and well-being services for people in • the AARP Division supplemental Medicare and the second half of life and their families. hospital indemnity products; 16,000 individuals served through • about $18 billion in eldercare EverCare® services; additional revenue opportunity in emerging businesses, such as health and housing, and knowledge and information services. Uniprise Network-based health and well-being services, 218 large organizations, including More than $100 billion in • business-to-business transactional infrastructure 131 Fortune 500 companies, aggregate spending each year by services, consumer connectivity and service, representing 6.3 million individuals U.S. employers with more than and technology support for large employers, 5,000 employees through either health plans, and other payers. fee-based or risk--sharing business models; further opportunity to manage infrastructure for other payers in the marketplace. Specialized Care United Behavioral Health serves more More than $200 billion in total Portfolio of specialized health and well-being • Services than 15 million individuals payer, employer and consumer companies, each serving a specialized market spending across the spectrum of need with a unique blend of benefits, provider United Resource Networks serves • specialized benefits and networks, services and resources. 1,400 clients representing more than products; purchases made on 41 million individuals both a fee basis as well as on Optum® services are available to more • partially or fully insured terms. than 16 million individuals Dental Benefit Providers serves more • than 2 million individuals Ingenix More than 200,000 health care providers More than $40 billion in Two primary business unit divisions — • worldwide spending on pharmaceutical services and health 2,000 payers • pharmaceutical research and information — providing a comprehensive 100 Fortune 500 companies • development; an additional line of health care knowledge and information Most major pharmaceutical manufacturers • $13 billion in data, software products and services to pharmaceutical and health business information companies, health insurers and payers, care services. providers, large employers and governments. 18
  • 12. Competitive Strengths 1999 Operating Highlights • Strategically aligned, market-facing business model • Revenues increased nearly 13% to $19.6 billion • Deep, talented and motivated management team • Earnings per share grew by 22% • Entrepreneurial roots • More than 40% of operating income contributed from outside of our health plan business • Advanced technology capabilities • Cash flows from operations well exceeded $1 billion for the second consecutive year • Return on equity rose to 14.1% • Stock price increased 23% Flexible, access-oriented products Revenues reached $13.9 billion, an increase of 16% • • Pro-consumer philosophy Introduced Care Coordination process to help enhance health outcomes • • SM Local orientation What works for you? campaign and branding initiatives launched • • Simplicity, quality and affordability of services Added 160,000 net new fee-based commercial individuals • • Strong underwriting capabilities • Focus on health care providers as central participants in the system • Exclusive focus on needs of people 50 and older Revenues increased 1% to $3.6 billion • • Nation’s largest Medicare Supplement insurance offering with AARP, Enhanced the AARP Medicare Supplement product offerings for • • including unique services to address affordability and quality of health care individuals, improving membership trends EverCare®, one of the nation’s largest eldercare Expanded EverCare® membership and revenues 47% with improving • • companies clinical and operational performance EverCare’s award-winning nurse practitioner model Created total consumer savings of $60 million through Medicare • • Supplement Pharmacy Service offering Depth of research and information through the Ovations Knowledge Group • New operational processes created medical savings of more than $50 million • Launched publishing enterprise • Focused commitment to this market segment Revenues increased 15% to $1.9 billion • • Consumer orientation Added 30 new major corporate employers as clients • • Advanced technology Processed 300 million transactions • • Scalable infrastructure serving 1.5 million members covered Achieved customer retention rate of 98.7% • • by other health insurers Electronic claim submission hit 46% and claim auto-adjudication • Comprehensive outsourcing for employee services rate exceeded 65% • Financial accuracy measured 99% • Developing new customer service solutions leveraging the Internet • Most complete offering of access to specialized health care services Revenues increased 17% to $726 million • • in America Added dental, vision, life and accident product capabilities • Premier behavioral health offering • Enhanced behavioral health, catastrophic care and information-based • service offerings Largest center of excellence critical care program in the nation • One of top consumer health information services • One of largest managed dental services companies • Vision care services that help improve quality and control costs • Unique, proprietary data sets Revenues reached $258 million, an increase of 40% • • Therapeutic clinical expertise Enrolled 13,000 physicians in clinical investigator network • • Commercialized medical cost and utilization knowledge and Increased clinical trials business sixfold • • information in business-to-business sector 19