Company type | Subsidiary |
---|---|
Industry | Healthcare |
Founded | 2011 |
Headquarters | , U.S. |
Key people | Heather Cianfrocco (CEO) Andrew Witty (CEO of parent company, UHG) |
Services | Pharmacy benefit manager Health care provider |
Revenue | US$ 226.6 billion (2023) [1] |
Parent | UnitedHealth Group |
Website | www |
Optum, Inc. is an American healthcare company that provides technology services, pharmacy care services (including a pharmacy benefit manager) and various direct healthcare services.
Optum was formed as a subsidiary of UnitedHealth Group in 2011 by merging UnitedHealth Group’s existing pharmacy and care delivery services into the single Optum brand, comprising three main businesses: OptumHealth, OptumInsight and OptumRx. [2] In 2017, Optum accounted for 44 percent of UnitedHealth Group's profits. [3] In 2019, Optum's revenues surpassed $100 billion for the first time, growing by 11.1% year over year, making it UnitedHealth’s fastest-growing unit at the time. [4] [5]
In early 2019, Optum gained significant media attention regarding a trade secrets lawsuit that the company filed against former executive David William Smith, after Smith left Optum to join Haven, the joint healthcare venture of Amazon, JPMorgan Chase, and Berkshire Hathaway. [6]
Optum's three businesses, OptumRx, OptumHealth and OptumInsight focus on five core capabilities: data and analytics, pharmacy care services, population health, healthcare delivery and healthcare operations. [3] Optum serves employers, government agencies, health plans, life science companies, care providers and individuals and families offering products in data and analytics, pharmacy care services, health care operations and delivery, population health management and advisory services. [7] The Optum Serve division provides health-related services to U.S. government agencies. [8]
Since Optum's founding in 2011, the company has acquired various healthcare technology services to build out its pharmacy benefit manager and care services offerings.
This Optum-UnitedHealth model of vertical integration [19] is pointed to as having sparked a pattern of acquisition activity in the healthcare industry; most notably, mega-mergers between CVS-Aetna, Cigna-Express Scripts and Humana-Kindred. [20] "Optum's been the leader in showing how a managed care organization with an ambulatory care delivery platform and a pharmacy benefit manager all in house can lower or maintain and bend cost trend and then drive better market share gains in their health insurance business. I think they have been the impetus in the large space for the Aetna-CVS deal," Ana Gupte, managing director of healthcare services at Leerink, said in an interview with Healthcare Dive. [3]
In early 2019, UnitedHealth Group filed a lawsuit asking a U.S. District Judge Mark Wolf to stop former Optum executive, David William Smith, from working at Haven (the Amazon, JP Morgan and Berkshire-Hathaway joint-healthcare venture). [24] Optum argued that Haven is in direct competition with its business and as such, Smith's employment would be in violation of a noncompete agreement that he signed while with Optum. [25] Smith, meanwhile, asked the judge to send the parties into closed-door arbitration. Wolf rejected Optum's request and allowed Smith's, putting court proceedings on hold until the arbitration process is complete. [26]
The case garnered media attention as setting a precedent in trade secret litigation ahead of an anticipated wave of vertical integration in the healthcare industry [27] and for uncovering previously unknown details about Haven. The case has also been referred to as having shed light on the threat that pharmacy benefit managers feel to bottom lines amid mounting bipartisan pressure to control rising healthcare costs. Testimony brought by Haven chief operating officer Jack Stoddard was unsealed after a motion brought by the parent companies of Stat News and The Wall Street Journal. [28]
A 2019 study published in Science , alleges the "algorithm used to manage the healthcare of millions of Americans shows dramatic biases against black patients". Said algorithm, applied to over 200 million individuals yearly, "significantly underestimates the amount of care black patients need compared with white patients". In fact, "less money is spent on black patients with the same level of need as white patients, causing the algorithm to conclude that black patients were less sick". Optum claims "its system helps 'clinicians provide more effective patient care every day'". [29] [30]
Cardinal Health, Inc. is an American multinational health care services company, and the 14th highest revenue generating company in the United States. Headquartered in Dublin, Ohio, the company specializes in the distribution of pharmaceuticals and medical products, serving more than 100,000 locations. The company also manufactures medical and surgical products, including gloves, surgical apparel, and fluid management products. In addition, it operates one of the largest networks of radiopharmacies in the U.S. Cardinal Health provides medical products to over 75 percent of hospitals in the United States.
UnitedHealth Group Incorporated is an American multinational health insurance and services company based in Minnetonka, Minnesota. Offering insurance products under UnitedHealthcare, and health care services and care delivery aided by technology and data under Optum, it is the world's eleventh-largest company by revenue and the largest health care company by revenue.
Tenet Healthcare Corporation is a for-profit multinational healthcare services company based in Dallas, Texas, United States. Through its brands, subsidiaries, joint ventures, and partnerships, including United Surgical Partners International (USPI), the company operates 65 hospitals and over 450 healthcare facilities. Tenet also operates Conifer Health Solutions, which provides healthcare support services to health systems and other clients.
Express Scripts Holding Company is a pharmacy benefit management (PBM) organization. In 2017 it was the 22nd-largest company in the United States by total revenue as well as the largest pharmacy benefit management (PBM) organization in the United States. Express Scripts had 2016 revenues of $100.752 billion. Since December 20, 2018, the company has been a direct subsidiary of Bloomfield, Connecticut-based Cigna.
WellCare Health Plans, Inc. is an American health insurance company that provides managed care services primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug plans for members across the United States.
In the United States, a pharmacy benefit manager (PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans. According to the American Pharmacists Association, "PBMs are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims." PBMs operate inside of integrated healthcare systems, as part of retail pharmacies, and as part of insurance companies.
Centene Corporation is a publicly traded managed care company based in St. Louis, Missouri, which is an intermediary for government-sponsored and privately insured healthcare programs. Centene ranked No. 25 on the 2023 Fortune 500.
CVS Health Corporation is an American healthcare company that owns CVS Pharmacy, a retail pharmacy chain; CVS Caremark, a pharmacy benefits manager; and Aetna, a health insurance provider, among many other brands. The company is the world's largest healthcare company, and its headquarters are in Woonsocket, Rhode Island. In 2023, the company was ranked 65th in the Forbes Global 2000.
Genesis HealthCare is a provider of short-term post-acute, rehabilitation, skilled nursing and long-term care services. According to data provided by the Centers for Medicare & Medicaid, as of November 1, 2023, Genesis owned or operated 290 skilled nursing facilities with 34,047 bed through 105 affiliates in 25 states in the United States. Genesis also supplies rehabilitation therapy to approximately 1,700 healthcare providers in 45 states and the District of Columbia. Genesis has approximately 80,000 employees. Genesis HealthCare is headquartered in Kennett Square, Pennsylvania.
Sir Andrew Philip Witty is a British business executive, who is the current chief executive officer (CEO) of UnitedHealth Group. He was also the CEO of GlaxoSmithKline between 2008 and 2017. He formerly held the role of chancellor of the University of Nottingham.
Catamaran Corporation is the former name of a company that now operates within UnitedHealth Group's OptumRX division. It sells pharmacy benefit management and medical record keeping services to businesses in the United States and to a broad client portfolio, including health plans and employers. Working independently of the government and insurance companies allowed it to operate as a third party verifier; the RxCLAIM online claim processing system allowed for prescription drug claims to be processed online if the customer lived in and filled his/her prescription in the United States. SXC had three separate but interrelated business segments which dealt with prescription drug programs. For 2013, 23% of company revenue came from Cigna Corporation.
Elevance Health, Inc. is an American health insurance provider. Prior to June 2022, Elevance Health was named Anthem, Inc. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Anthem Blue Cross in California, Wellpoint, and Carelon. It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2022, the company had 46.8 million members within its affiliated companies' health plans.
Amedisys, Inc. is an American healthcare company based in Baton Rouge, Louisiana. They are one of the largest home health providers and second largest hospice care provider in the United States.
SCA Health (SCA), is based in Deerfield, Illinois, with a network of 300+ ambulatory surgery centers (ASCs) in 35 states performing 1 million procedures a year. Since March 2017, the company is part of Optum.
Change Healthcare is a provider of revenue and payment cycle management that connects payers, providers, and patients within the U.S. healthcare system. The name also refers to a company founded in 2007 which subsequently became part of the current conglomerate. The company operates the largest financial and administrative information exchange in the United States.
EMIS Health, formerly known as Egton Medical Information Systems, supplies electronic patient record systems and software used in primary care, acute care and community pharmacy in the United Kingdom. The company is based in Leeds. It claims that more than half of GP practices across the UK use EMIS Health software and holds number one or two market positions in its main markets. In June 2022 the company was acquired by Bordeaux UK Holdings II Limited, an affiliate of UnitedHealth’s Optum business for a 49% premium on EMIS’s closing share price.
Teladoc Health, Inc. is a multinational telemedicine and virtual healthcare company headquartered in the United States. Primary services include telehealth, medical opinions, AI and analytics, telehealth devices and licensable platform services. In particular, Teladoc Health uses telephone and videoconferencing software as well as mobile apps to provide on-demand remote medical care.
DaVita Inc. provides kidney dialysis services through a network of 2,816 outpatient dialysis centers in the United States, serving 204,200 patients, and 321 outpatient dialysis centers in 10 other countries serving 3,200 patients. The company primarily treats end-stage renal disease (ESRD), which requires patients to undergo dialysis 3 times per week for the rest of their lives unless they receive a donor kidney. The company has a 37% market share in the U.S. dialysis market. It is organized in Delaware and based in Denver.
Haven was a not-for-profit, healthcare-focused entity created through a joint venture by American companies Amazon, Berkshire Hathaway and JPMorgan Chase. The entity's stated goals were to improve healthcare services and lower costs for the three companies' employees, while making primary care easier to access, making prescription drugs more affordable and rendering insurance benefits easier to understand. The company was headquartered in Boston, Massachusetts, with offices in New York City.
1Life Healthcare, Inc., is Amazon's chain of primary healthcare clinics. One Medical is a membership-based primary care service with in-person care and online resources, including a mobile app. In February 2023, it was acquired by Amazon.