United Healthcare 2008 Annual Report Download - page 16

treatment protocols to support care management. AmeriChoice operates advanced and unique pharmacy
administrative services, including benefit design, generic drug incentive programs, drug utilization review and
preferred drug list development to help optimize the use of appropriate quality pharmaceuticals and concurrently
manage pharmacy expenditures to levels appropriate to the specific clinical situations. For state customers, the
AmeriChoice Personal Care Model means increased access to care and improved quality for their beneficiaries,
in a measurable system that reduces their administrative burden and lowers their costs.
AmeriChoice considers a variety of factors when determining in which state programs to participate and on what
basis. They include a state’s consistency of support for service innovation and funding of its Medicaid program,
the population base, the commitment of the physician/provider community to the AmeriChoice Personal Care
Model, and the presence of community-based organizations that can partner with AmeriChoice to meet member
needs. AmeriChoice launched Medicaid programs in two new markets and expanded its presence and program
offerings in several existing markets during 2008.
OptumHealth
OptumHealth serves approximately 60 million individuals with its diversified offering of health, financial and
ancillary benefit services and products that assist consumers in navigating the health care system and accessing
services, support their emotional health, provide ancillary insurance benefits and facilitate the financing of health
care services through account-based programs. OptumHealth seeks to simplify the consumer health care
experience and facilitate the efficient and effective delivery of care. Its capabilities can be deployed individually
or integrated to provide comprehensive, consumer-focused health and financial well-being solutions.
OptumHealth’s simple, modular service designs can be easily integrated to meet varying health plan, employer,
payer, public sector and consumer needs at a wide range of price points. OptumHealth offers its products on an
administrative fee basis where it manages and administers benefit claims for self-insured customers in exchange
for a fixed fee per individual served, and on a risk basis, where OptumHealth assumes responsibility for health
care in exchange for a fixed monthly premium per individual served. For its financial services offerings,
OptumHealth charges fees and earns investment income on managed funds.
OptumHealth’s products are distributed through the three strategic markets: the employer market for both
UnitedHealth Group customers and unaffiliated parties; the payer market for Health Care Services health plans,
independent health plans, third-party administrators and reinsurers; and the public and senior markets for
Medicare and state Medicaid offerings through partnerships with Ovations, AmeriChoice and other
intermediaries. Approximately 50 percent of the consumers that OptumHealth serves receive their major medical
health benefits from a source other than UnitedHealth Group.
OptumHealth is organized into four major groups: Care Solutions, Behavioral Solutions, Specialty Benefits and
Financial Services.
Care Solutions. Care Solutions serves approximately 40 million people through personalized health management
solutions that improve the health and well-being of members, improve clinical outcomes and work force
productivity, and reduce costs for customers. It delivers its services through the use of evidence-based best
practices and technology. Its clinically focused product portfolio includes programs focused on disease
management, care advocacy, wellness and complex condition management, such as cancer, solid organ
transplant, infertility and congenital heart disease. To support its complex condition management programs, Care
Solutions negotiates competitive rates with medical institutions that have been designated as “Centers of
Excellence” based on their satisfaction of clinical standards, including patient volumes and outcomes, medical
team credentials and experience, and patient and family support services.
Care Solutions also provides benefit administration and clinical and network management for chiropractic,
physical therapy, occupational therapy and other complementary and alternative care services through its national
network consisting of approximately 23,000 chiropractors, 15,000 physical and occupational therapists and 7,000
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