United Healthcare 2015 Annual Report Download - page 11

OptumHealth
OptumHealth is a diversified health and wellness business serving the physical, emotional and health-related
financial needs of more than 78 million unique individuals. OptumHealth enables population health management
through programs offered by employers, payers, government entities and, increasingly, directly with the care
delivery system. OptumHealth products and services deliver value by improving quality and patient satisfaction
while lowering cost. OptumHealth builds high-performing networks and centers of excellence across the care
continuum, by working directly with physicians to advance population health management and by coordinating
care for the most medically complex patients.
OptumHealth offers its products on a risk basis, where it assumes responsibility for health care costs in exchange
for a monthly premium per individual served, and on an administrative fee basis, under which it manages or
administers delivery of the products or services in exchange for a fixed monthly fee per individual served. For its
financial services offerings, OptumHealth charges fees and earns investment income on managed funds.
OptumHealth sells its products primarily through its direct sales force, strategic collaborations and external
producers in three markets: employers (which includes the sub-markets of large, mid-sized and small employers),
payers (which includes the sub-markets of health plans, TPAs, underwriter/stop-loss carriers and individual
market intermediaries) and government entities (which includes states, CMS, DoD, the Veterans Administration
and other federal procurement agencies). As provider reimbursement models evolve, care providers are emerging
as a fourth market for the health management, financial services and local care delivery businesses.
OptumHealth is organized into two primary operating groups: OptumCare and Optum Consumer Solutions
(OCS).
OptumCare
• OptumCare partners closely with care providers to improve both the health of the populations they serve and
the efficiency and cost-effectiveness of local care systems. Through networks comprised of employed,
managed and contracted physicians, advanced practitioners and other providers, OptumCare assists care
providers in adopting new approaches and technologies that improve collaboration and coordination among
everyone involved in patient care. OptumCare also enables care providers’ transition from traditional, fee-
for-service care delivery to performance-based delivery and payment models that put patient health and
outcomes first, such as those emerging through accountable care organizations (ACOs) and local care
provider partnerships. OptumCare builds partnerships with care providers who share its focus on creating
strong and sustainable new approaches to care delivery and works with them to develop and deliver services
around the spectrum of patient and community needs.
• Mobile Care Delivery. OptumCare’s mobile care delivery business provides occupational health, medical
and dental readiness services, treatments and immunization programs. These solutions serve a number of
government and commercial clients, including the U.S. military.
OCS.
• Population Health Management Services: OCS serves people through population health management
services that meet both the preventative care and health intervention needs of consumers across the care
continuum - physical health and wellness, mental health, complex medical conditions, disease management,
hospitalization and post-acute care. This includes offering access to proprietary networks of provider
specialists in many clinical specialties, including behavioral health, organ transplant, chiropractic and
physical therapy. OCS engages consumers in managing their health, including guidance, tools and programs
that help them achieve their health goals and maintain healthy lifestyles.
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