MMIT Payer Portrait: UnitedHealthcare

UnitedHealthcare (UHC), the health insurance unit of UnitedHealth Group, Inc., is the largest health insurer in the U.S., offering products across all sectors. Nationally, UHC is the top insurer in the group risk, administrative services only (ASO) and Medicare Advantage (MA) markets. As of March 2021, United controls a whopping 26.7% of the national MA market, and has expanded its presence significantly year over year since 2018.

UHC’s pharmacy benefits are managed by OptumRx, part of UnitedHealth’s powerhouse Optum subsidiary. Formed in 2011, Optum arguably set the trend toward increased payer-PBM integration, fueling a wave of consolidation that sparked CVS Health’s purchase of Aetna, Cigna Corp.’s acquisition of Express Scripts and Anthem Inc.’s launch of IngenioRx. In 2020, Optum boosted its portfolio with its acquisitions of Diplomat Specialty Pharmacy and DivvyDose, an Amazon PillPack competitor.

Most recently, Optum on Jan. 6 unveiled plans to acquire technology company Change Healthcare, a move that would grant UnitedHealth unprecedented access to patient, claims and payer data. While it’s been praised by equities analysts, the deal is now facing increased regulatory scrutiny following antitrust concerns raised by the American Hospital Association (AHA). “The combination of data sets would impact (and likely distort) decisions about patient care and claims processing and denials to the detriment of consumers and health care providers,” the AHA wrote in its formal complaint to the Dept. of Justice. United’s other recent initiatives include growing its Medicaid business (UHC was selected to serve Oklahoma’s new managed care program Jan. 29, 2021), expanding telehealth services amid the COVID-19 pandemic and possible re-entries into former Affordable Care Act exchange markets, according to 2020 earnings calls.

SOURCE: DHP, AIS’s Directory of Health Plans; MMIT Analytics. Subscribers can read the Health Plan Weekly article about United’s plans to acquire Change Healthcare and the American Hospital Association’s complaint here: https://bit.ly/3cQweKH; and about the company’s 4Q20 earnings here: https://bit.ly/3dBLtWZ.

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