Feb 12, 2020 - Health

Where UnitedHealth is making its money

Data: Company documents; Chart: Axios Visuals

UnitedHealth Group is mostly known as one of the country's largest health insurance carriers, but the massive conglomerate is increasingly making its money from things that have nothing to do with health insurance.

The bottom line: UnitedHealth doesn't just want to be your health insurer. It wants to be your doctor, your outpatient surgery center, your mail-order pharmacy and your drug price negotiator.

By the numbers: UnitedHealthcare is still UnitedHealth's most profitable unit, generating more than $10 billion in operating earnings in 2019 as a major carrier of employer and Medicare Advantage plans.

  • But UnitedHealth's Optum subsidiaries are close behind. Optum collected more profit in the fourth quarter of 2019 ($3 billion) than UnitedHealthcare ($2.1 billion). And that's not new: Optum has had a stronger Q4 than UnitedHealthcare in each of the past five years.
  • The last three months of the calendar year are usually the worst for health insurers. They pay out more for medical claims as more people reach their deductibles and out-of-pocket maximums.

Between the lines: The most profitable segment within Optum is OptumRx, which is part of the pharmacy benefit manager oligopoly that controls how drugs are paid for and which drugs are covered.

  • Rebates negotiated from drug companies, and other behind-the-scenes fees, have turned OptumRx into a cash cow — often at the expense of employers and their workers.
  • Optum's other units also are growing. They include a bank for health savings accounts, physician practices, urgent care clinics, surgery centers and almost any conceivable piece of technology and consulting used in health care.
Data: Company documents; Chart: Axios Visuals

Go deeper: UnitedHealth's political and financial heft just keeps growing

Go deeper

Insurer-owned clinics are taking on hospitals and physicians for patients

Illustration: Axios Visuals

Insurer-owned clinics are increasingly competing with hospitals and physicians for patients, the Wall Street Journal reports.

The big picture: Doctor groups and hospitals have invested heavily in purchasing physician practices, and are worried about insurers steering patients toward their own clinics.

Go deeperArrowFeb 24, 2020 - Health

Surprise billing may be about to get worse

Illustration: Lazaro Gamio/Axios

The problem of surprise medical billing — which Congress failed to solve last year — is about to get worse, thanks to a feud between an insurance giant and a company that employs thousands of doctors.

The big picture Parents who have babies in intensive care, women with high-risk pregnancies and people who need anesthesia could receive unexpected bills in the mail as a result of the fight between Mednax, the physician-staffing firm, and UnitedHealth Group.

Go deeperArrowFeb 21, 2020 - Health

Health care prices still rising faster than use of services

Photo: Ricky Carioti/ The Washington Post via Getty Images

Employers, workers and families continued to spend a lot more on health care in 2018, but that wasn't because people used more services, according to the latest annual spending report from the Health Care Cost Institute, which analyzes commercial health insurance claims.

The bottom line: Higher prices remain the main culprit for exploding spending among those with private health insurance.

Go deeperArrowFeb 14, 2020 - Health