UnitedHealth
Annual Report 2009

Plain-text annual report

Modernizing Health Care UnitedHealth Group Center 9900 Bren Road East Minnetonka, Minnesota 55343 unitedhealthgroup.com 2009 Summary Annual Report 100-9409 4/10 Table of contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Letter to Shareholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Responsive, Efficient Service . . . . . . . . . . . . . . . . . . . . . . . . 6 Increasing Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Containing Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Personalizing the Experience . . . . . . . . . . . . . . . . . . . . . . . 16 Strengthening the Physician-Patient Relationship . . . . . . . . . . . . . . . . . . . . . 18 Improving Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Transformative Technology . . . . . . . . . . . . . . . . . . . . . . . . 22 Business Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Foundations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 2009 Financial Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Officers and Board Members . . . . . . . . . . . . . . . . . . . . . . . 38 Forward-Looking Statements . . . . . . . . . . . . . . . . . . . . . . . 39 Investor Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Mission and Values . . . . . . . . . . . . . . . . inside back cover The names and health information for individuals included in this report have been used with their express permission. Our mission is to help people live healthier lives. Mission statement We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. We work with health care professionals and other key partners to expand access to quality health care so people get the care they need at an affordable price. We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions. Our values We serve people through a value and performance culture based on integrity, quality, innovation, diversity and social responsibility. The best way we can satisfy the millions of people we serve — our customers and members, employees, shareholders and partners — is to execute on the fundamentals of our business to the very best of our abilities, each and every day. That means as an organization, we are accountable for adding value to the health care system. For more information on how our 80,000 people work to fulfill our mission every day, please see our Social Responsibility Report at www.unitedhealthgroup.com/2009-social-responsibility-report 10% BV-COC-940655 BV-COC-940655 This annual report is printed on recycled papers certified by Bureau Veritas per FSC (Forest Stewardship Council) standards for Chain of Custody ensuring environmentally responsible, socially beneficial and economically viable forest management, and also uses reduced VOC (Volatile Organic Compounds) vegetable-based inks. UnitedHealth Group 2009 Summary Annual Report UnitedHealth Group is a leading health care company, serving more than 70 million people. Our family of companies touches nearly every aspect of health care, helping people live healthier lives. We help people find and receive the best care possible. We work to provide them with access to the quality care they need at an affordable cost. And we provide information, guidance and tools to help people make more informed decisions about their health, health care and well-being. These decisions have lifelong, sometimes life-defining, consequences. We embrace this position of trust and the critical social responsibility we have to serve people’s health care needs in the United States and worldwide. UnitedHealth Group plays a unique role in modernizing the health care system and making it work better for everyone, through innovation, advanced technology and careful stewardship of our unparalleled resources and capabilities. UnitedHealthcare provides comprehensive commercial health benefits for individuals, small- and medium-sized businesses and large national and international companies. In partnership with AARP, Ovations delivers health care services tailored to the needs of people over 50, serving one in five Medicare beneficiaries nationwide. AmeriChoice is the largest U.S. company serving low-income families through programs like Medicaid and the Children’s Health Insurance Program (CHIP). OptumHealth works with health plans, employers and the public sector to bring together information, inter- ventions and holistic solutions that help people make better decisions, achieve their health and well-being goals and finance their health care needs. Ingenix develops health information and technology that improve health system performance and stream line administration. Through Prescription Solutions we are a leader in the management of pharmacy benefits. UnitedHealth Group 2009 Summary Annual Report 1 Letter to Shareholders Dear shareholders: In 2009, the people of UnitedHealth Group delivered a strong As a result, we entered 2010 a much performance while advancing our mission to help people live stronger enterprise. We are positioned for the next generation of growth, in healthier lives, despite a very difficult economy. We demonstrated both health benefits and health services. consistency in effectively managing medical costs and continued While we cannot predict what changes ultimately will be introduced to the health to reduce our own operating costs. Our businesses again steadily care system, we understand that in any delivered in service and practical innovation. We continued to combine national scale with local responsiveness and further diversified our products, services and markets. We built stronger relationships with the people we serve across the health care setting we must combine consistent fundamental execution with our proven ability to adapt to core market demands and continuously innovate in practical ways across the health care experience. The extraordinary, national debate over community. Our balance sheet grew stronger — our investments the future of health care in the United performed well and our leverage decreased. States serves to shine a spotlight on a key challenge: How do we modernize the health care system, in a fiscally responsible manner, to make quality health care accessible and affordable for all Americans? Finding innovative, practical and financially responsible answers to that question has been our objective for more than two decades. This annual 2 For online access: www.unitedhealthgroup.com/2009-annual-report Quite simply, we are helping to create the infrastructure and capabilities that will enable a modernized American health care system to take root and function more effectively for all participants. The changes we envision include: • Americans will become better • Common administrative standards and informed consumers of health services, enabling technology will connect and unify patients, health care providers, because there will be personalized motivations to be engaged, including health benefit plans and the entire financial incentives. health care sector. Actionable informa- • Better management of care, driven tion will be available electronically to by education, adherence to evidence- help physicians and patients make based medicine and aligned incentives better decisions together. for patients and health care providers, • Evidence-based medicine will become widely accepted and consistently practiced, improving care quality and helping to control costs. • Transparency, performance account- ability and comparative effectiveness along with supporting information and technologies, will become ubiquitous to health care, built right into the core of how medicine is practiced rather than existing as a parallel “administrative” function as it is today. will be adopted across all care services, • Health care will adopt a culture of just as they are in other sectors of the economy. prevention that promotes good health rather than simply treating illnesses as they are presented in the doctor’s office or the emergency room. report highlights just a handful of the many ways we are helping create a more modern and effective health care system. We continue to make it easier for people to get the care they need, to personalize and simplify their health care experience, to strengthen the bonds between patients and their physicians, to foster the introduction of modern technology and to find new ways to control the rising costs of health care. These advances are critically important. As we move into the next decade, we believe positive, competitive pressures and ever-growing demands from individuals and employers, physicians and medical facilities and state and federal govern ments will open the health care system to even greater change … change that will accelerate the evolution of new products and services and cost- effective new technologies, spurring even more rapid modernization of our health care system. UnitedHealth Group 2009 Summary Annual Report 3 Letter to Shareholders • There will be a new focus on the range of capabilities, market positions, As we have for a decade, we continue challenges of helping people cope capital strength and experience of to develop and enrich our three core with chronic disease, as well as the UnitedHealth Group. Our business competencies, which are the building importance of health and wellness model and philosophy are designed to blocks of a better health care system: programs that can prevent the onset align with and help enable this national of those conditions for many years path into a better health care future. • Information — to guide and lead; • Technology — to enable, simplify or a lifetime. • Health care will be purchased based on the effectiveness of achieving health outcomes, not the volume of services rendered. We are already delivering many of and modernize; and these modernizations to the marketplace. • Expertise in clinical access and We have developed and invested in management — to consistently innovative technologies that bring the deliver higher quality, lower cost and health care sector into the 21st century. consumer affordability in health care. • All health care transactions will follow We pioneered the financial services the lead of the financial industry and market for health care. We are a leader become totally electronic. in the introduction of consumer-focused • Public health plans, like Medicare benefits and services, and we have and Medicaid, will be modernized to more integrated and performance-based become more economically viable for care delivery payment relationships than the long term and enable better care. anyone else in health care. We leverage these competencies to help the health care system perform to its potential. Quite simply, we are helping to create the infrastructure and capabilities that will enable a modernized American health care system to take root and function more effectively for all participants. We will remain focused on executing on the fundamentals, prepared to further elevate our performance in medical and operating cost management and deliver an even better experience and value to the markets we serve. The modernization of Medicare is per- haps the greatest area of opportunity to positively influence health care nationally, as well as to improve our financial outlook as a nation. These changes to our health care system will promote a positive health agenda for our nation and a positive growth agenda for a company with the 4 UnitedHealth Group is ready to help make health care more accessible and affordable, and take a leading role in our nation’s efforts to modernize health care. Over the next year, you will see our The U.S. health care market will move benefits businesses become even more forward and grow, driven by the need integrated within a more streamlined of our society for sustainable care, for organization with razor-sharp cost and even more effective cost controls and price sensitivities. Our benefits offerings for better overall system performance. will become more tightly aligned behind UnitedHealth Group is ready to help And as we help lead and adapt to change, we are meaningfully deepening our culture as a company to better serve the vital social needs of health care. This is apparent in externally measured satisfaction levels among key stakeholders and in the trust we continue to build with those we touch in the health care community. Engagement among our employees the strong UnitedHealthcare brand name, make health care more accessible and increased significantly in 2009, on top while the businesses themselves remain affordable, and take a leading role in of substantial gains in 2008. Set against distinct, market-facing organizations, our nation’s efforts to modernize health the challenging business and political dedicated to the differing needs of the care. In the years to come, it will be climate this year, this is a testament to benefit markets we serve — commercial, our progressive adaptability that will the spirit and commitment of our people senior and public benefits. translate into high performance and to our mission. In 2010 we plan to further strengthen concentrate on helping the whole health Our health services businesses will fully distinctive value for our customers and our shareholders. and diversify our competitive capabilities system modernize and perform better. Sincerely, to deliver more consistent organic growth These businesses have been expanding and further market expansion across our to address the needs of the care delivery businesses. We will remain focused on side over the past two years. We expect executing on the fundamentals, prepared the pace of this expansion will accelerate. Stephen J. Hemsley President and Chief Executive Officer to further elevate our performance in medical and operating cost management and deliver an even better experience and value to the markets we serve. UnitedHealth Group 2009 Summary Annual Report 5 Responsive, Efficient Service Service you can trust – transplant patient says, “One call … and I never worried again” For virtually his entire life, Afterward, his doctors told him his heart David Reoch suffered from problems were primarily caused by diabetes. Diagnosed at age 7 complications of diabetes, and referred after he fell into a coma, David him for pancreatic transplant surgery to has been through more medical eliminate the diabetes and halt further procedures than he can remember. progression of the many complications His friends jokingly call him the he was already experiencing. Because “Bionic Man.” Several years ago he visited the doctor because he was feeling increasingly fatigued. David says that his physician had him take a cardiac treadmill test. After about 30 seconds the doctor asked if David carried nitroglycerin. David said, “No, why?” The doctor of the seriousness of his condition, he moved quickly through the preparations for possible transplant surgery. But then David switched jobs and his health care coverage changed to UnitedHealthcare. David worried that this change might slow his progress toward, or perhaps even block, the transplant. replied, “Well, get off the treadmill and He called UnitedHealthcare’s toll-free put this pill under your tongue, because number to review his coverage with you’re about to have a heart attack.” an employee who assists customers Subsequent tests showed that David had recently suffered a mild heart attack, and he had more blockages in his heart. He required immediate bypass surgery. with questions about benefits and health coverage. Within a day, he received a call from a registered nurse at UnitedHealthcare who conducted Within a day, he received a call from a registered nurse at UnitedHealthcare who conducted an interview. She told him everything would be taken care of. 6 Melissa and David Reoch UnitedHealth Group 2009 Summary Annual Report 7 Responsive, Efficient Service an interview. She told him everything As David recovered, the next year Consumer call centers continued to would be taken care of. Confused, was perhaps the most difficult in deliver excellent results. Call center accu- David sheepishly asked, “I’m not sure I his life, but his nurse specialist from racy remains strong. All UnitedHealthcare understand you correctly. Am I going to UnitedHealthcare was in constant customer service call sites are located in have coverage with UnitedHealthcare?” contact with him, asking what she could the United States. With 14 service sites “Yes,” he was assured. “It’ll be fine.” do to help address his health care needs. across the nation, employees can easily David jokes that UnitedHealthcare was support unexpected surges in call volume “I thought for sure I’d have a stack of checking on his progress almost as or site outages. Satisfaction scores in papers in the mail the next day to fill out, frequently as the transplant team. 2009 rose to 92.7 percent with the but it was pretty much one phone call, a return phone call from UnitedHealthcare and I was done, and I never worried about it again,” said David. When people ask David how he got through major transplant surgery, he has a simple answer, “I’ve had a great insurance company that took care of When a new pancreas became available, me. It might sound silly for a guy to say, David traveled to a hospital with a ‘Oh, my health care company is a huge average time to answer calls remaining below 30 seconds. Employees at call centers can immediately transfer complex benefit questions to experts who have the information and authority to resolve them on the phone. program specializing in the procedure part of my life,’ and it might sound UnitedHealthcare also offers its health and underwent surgery. It was a “life- like some advertisement that nobody advisor service. Health advisors serve as changing experience,” according to believes when you see it on TV, but a person’s advocate and single point of David. “Every moment is different it’s categorically true.” contact in helping them understand their now because with a new, functioning pancreas I’m not planning my life around diabetes.” UnitedHealth Group works hard to earn this kind of trust in the dependability of our service with everyone we touch and who touches us. In 2009, the company continued to enhance service by making it even easier, simpler and more personal. “ Every moment is different now because with a new, functioning pancreas I’m not planning my life around diabetes.” — David Reoch health care options and resolve issues across medical, pharmacy and financial products. Each health advisor is respon- sible for full resolution of a patient’s issue and will follow up with that person once resolution is complete. When appropriate, advisors help educate consumers about relevant programs to help them use their benefits most effectively and will even help them in setting up appointments with care providers or with a billing dispute. Health advisors have the highest customer satisfaction rating within UnitedHealthcare at 94.8 percent. 8 www.uhc.com Consumer call centers continued to deliver excellent results. Call center accuracy remains strong. Call center supervisor Shirlee Brown, UnitedHealthcare Claims processing accuracy climbed to 99.6 percent in 2009 with the great majority of claims processed automatically and 96.6 percent of all claims processed within 10 days. UnitedHealthcare also supplies physicians with real-time processing of claims in their offices, delivering accurate results in seconds that provide patients with details of claim benefits and their financial responsibility. A 2009 survey of health benefit plan consultants who work with large U.S. employers found that their satisfaction with UnitedHealthcare’s sales force and client management staff continued to increase. Health and wellness and consumer engagement products directly impacting customers, and the breadth and quality of UnitedHealthcare’s network, claims processing and customer service were positively noted by those consultants. UnitedHealthcare is also making service to brokers, consultants and employer 2009 call center scores groups easier to access, simpler and more personal with its Service Hotline, United eServices® and Employer eServices® Web sites, and dedicated client service managers who track 94% first call resolution 92.7% satisfaction scores issues end-to-end, providing updates on progress and ensuring client agreement 99.6% claims dollar accuracy with resolutions. 82.2% claims automatically processed 97.9% CALL ACCURACY 96.6% claims processed within 10 days Under 30 seconds average time to answer consumer calls remains below 30 seconds UnitedHealth Group 2009 Summary Annual Report 9 10 Increasing Access “21st century house call” delivers care to communities in need One of the most fundamental telecommunications and medical ways to increase access to the technology to deliver a virtual doctor’s health care system is making visit to patients wherever they are — sure people simply have the through mobile units that travel to opportunity to see a doctor patients, on-site units in the workplace when they need to. and in retail locations, and eventually Today, millions of people in rural and through home-based devices. underserved urban communities do Linked via high-definition video confer- not have adequate access to primary encing, the doctor “sees” patients in a physicians, much less to medical soundproof office with assistance from specialists. The nearest doctor may be an on-site nurse. Physicians can then many hours away and a trip to consult perform examination procedures a medical specialist could require a remotely, such as taking blood pressure plane flight. The Association of American and checking a patient’s ears, nose and Medical Colleges estimates that the throat, and treat a wide variety of acute United States is facing a shortage of 159,000 primary care physicians by 2025, which will compound the problem. UnitedHealth Group has partnered with Cisco to build the first national telehealth network, which will give patients access to physicians when in-person visits are 159,000 pOtentiAL sHORtAge OF pRiMARY CARe pHYsiCiAns not possible. This program uses modern BY 2025 Today, millions of people in rural and underserved urban communities do not have adequate access to physicians … UnitedHealth Group 2009 Summary Annual Report 11 Increasing Access UnitedHealth Group’s collaboration with Project HOPE will provide underserved communities in rural New Mexico access to much needed health services. and chronic conditions. This advanced Forty-five percent of New Mexico’s telehealth program can provide specialist population is of Hispanic origin — a consultations and checkups for more group that is highly predisposed toward complicated condi tions like diabetes, type 2 diabetes, according to the Centers hypertension and heart disease. Through for Disease Control and Prevention. telehealth technology, doctors are The mobile clinic will provide health able to consult with their colleagues screenings and treatment for diabetes, about specific cases and share critical pre-diabetes and other chronic information and expertise. conditions, such as high blood pressure UnitedHealth Group launched its first mobile telehealth clinic in 2009 in an 18-wheel tractor trailer, showcasing the technology and connectivity available through the network. Collaboration with project HOpe in new Mexico One of the first telehealth initiatives is an ongoing collaboration with Project HOPE — the world-renowned health education and assistance organization — using UnitedHealth Group’s mobile clinic to provide underserved communities in rural New Mexico access to much needed health services and to educate residents about the risks of chronic diseases. and heart disease. Collaboration with Meharry Medical College in tennessee AmeriChoice, UnitedHealth Group’s business dedicated to state Medicaid and other programs for the underserved, is collaborating with Meharry Medical College in Nashville to provide people in rural and underserved areas of Tennessee access to Meharry Medical Group physicians by using telehealth technology. Individuals seeking adult specialty medical services will be able to consult specialists located in Meharry’s Nashville offices, such as a dermatologist or neurologist, through UnitedHealth Group’s mobile telehealth clinic uses modern technology to deliver a virtual doctor’s visit to patients wherever they are located. 12 www.connectedcareamerica.com Dr. Wayne J. Riley, president and CEO, Meharry Medical College, Nashville, Tenn. telehealth technology by visiting one of the approximately 80 community health centers across the state. Meharry Medical Group is composed of physicians who serve on the faculty of Meharry Medical College, the nation’s largest private, independent, historically black academic health education and research center. Dr. Wayne J. Riley, president and CEO of the college, said, “Meharry Medical College has a rich tradition — stretching back over a hundred years — of delivering quality health care to people in poor, minority communities and underserved communities. UnitedHealth Group’s telehealth technology will help Meharry physicians provide care to even more who are in need. We take great pride in being on the cutting edge, providing opportunities to people of color and individuals from disadvantaged back- grounds, regardless of race or ethnicity; delivering high quality health services; and conducting research that fosters the elimination of health disparities. Through this innovative telehealth program, we can extend the benefits of our research and medical expertise to more people, more effectively.” “ Through this innovative telehealth program, we can extend the benefits of our research and medical expertise to more people, more effectively.” — Dr. Wayne J. Riley UnitedHealth Group 2009 Summary Annual Report 13 Containing Costs Changing lives and saving money in the fight against diabetes in 2009, the United states spent UnitedHealth Group is focused on $2.5 trillion on health care, which finding new and innovative ways to is approximately 17 percent of our promote better health while controlling nation’s gross domestic product. costs — saving lives and saving money. By 2019, that number may surpass Modernizing health care by embedding $4.5 trillion and is expected to preventive medicine in the system is continue to rise. these costs an important key to this effort. According to Dr. Deneen Vojta, senior vice president, UnitedHealth Group and a leader in the development of the Diabetes Health Plan, “The design of UnitedHealthcare’s Diabetes Health Plan meaningfully engages people based on their individual health needs. We’re finding that once people have the tools, support and incentives to make simple changes, the response is phenomenal. There is a massive, untapped opportunity have real world effects: forcing businesses to reduce coverage and placing unneeded hardship on families that lose access to care, while diminishing our nation’s global competitiveness in challenging economic times. UnitedHealthcare studies show the average annual cost for treating individuals with diabetes and pre-diabetes as: pre-diabetes Undiagnosed diabetes Diabetes without complications $ 5,000 $12,000 $10,000 The company is currently using this for millions of Americans to slow the approach to combat diabetes, a progression of diabetes and avoid life- devastating chronic disease that afflicts threatening complications. The added an estimated 24 million adults in the bonus is that progress in combating United States alone. Another 57 million diabetes could save U.S. employers people are considered pre-diabetic. billions of dollars in health care costs.” Though diabetes can often be controlled with effective care, research from the Centers for Disease Control and Prevention shows that 60 percent of people with diabetes do not follow their physicians’ advice on how to manage the disease. The plan was piloted with General Electric, Hewlett-Packard and Affinia in 2009. All three companies have renewed or expanded their participation in the program and a number of other groups, including the city of New Orleans and the American Postal Workers Union In UnitedHealthcare’s Diabetes Health Health Plan, will offer the plan in 2010. Plan, those suffering from diabetes or pre-diabetes, along with their family members, are guided toward physicians Diabetes with complications $30,000 who have documented success in treating $174B 2007 COst OF DiABetes the disease. Participants are educated about chronic disease, how to manage it and the importance of routine care. Out-of-pocket expenses for individuals are reduced and enhanced benefits tO tHe U.s. eCOnOMY are offered in exchange for compliance with preventive care guidelines. 14 Dr. Robert S. Galvin’s work as General Electric’s executive director of Health Services and chief medical officer, is focused on keeping 300,000 employees healthy. He is one of the nation’s leading proponents of innovation in health care management. Dr. Galvin says that General Electric was interested in participating in the Diabetes Health Plan pilot because it is one of the few new Dr. Deneen Vojta, senior vice president, UnitedHealth Group and a leader in the development of the Diabetes Health Plan programs that combines innovation, company’s investment in the program. treatment. And health care providers incentives and accountability. As he To get enhanced benefits, employees must agree to follow evidence-based puts it, the Diabetes Health Plan “really have to go see their doctors regularly, medicine to receive a performance connects the dots. make sure they get their lab tests and bonus and an increased volume of “Everybody participating in this program has to do something differently. Everybody has to take their share of the responsibility for making it work successfully,” says Dr. Galvin. “The employer has to be willing to waive or lower the copay as incentive for their employees and take the risk on the follow their physicians’ plans for their patients directed to their practices.” “ We’re finding that once people have the tools, support and incentives to make simple changes, the response is phenomenal.” — Dr. Deneen Vojta www.uhc.com UnitedHealth Group 2009 Summary Annual Report 15 Personalizing the Experience One-on-one: guiding a cancer patient to better care and a brighter future Cancer is the second most com- OptumHealth works with cancer centers mon cause of death in the United clinically proven to provide exceptional states, exceeded only by heart care for patients with complex cancers. disease. A cancer diagnosis is Treatment at these Centers of Excellence frightening and the decisions that can result in a more consistently “Patty spent a lot of time with me, explaining all the different kinds of breast cancers and what each kind of diagnosis meant,” said Nancy. “When I received my pathology reports, Patty reviewed them with me, line by line, to make sure that I understood exactly what I was dealing with.” must be made can seem over- accurate diagnosis; care that is planned, After undergoing her first round of tests, whelming. UnitedHealth group coordinated and provided by a multi- Nancy was told the cancer had spread — offers a program that provides disciplinary team of experts who specialize and she was facing a terminal diagnosis. a unique service to customers in the patient’s specific kind of cancer; Despite the grim news, Patty encouraged and their families who are facing appropriate therapy; fewer complications her to stay positive and get a second cancer: the OptumHealth Cancer and higher survival rates; and shorter opinion. She arranged for Nancy to see a support program, a highly per- hospitalizations and lower costs. cancer specialist at one of the program’s sonalized source of information and support. Patty Migler, RN, BSN, OCN, case manager, Cancer Support Program, OptumHealth In addition, experienced nurse advocates Cancer Centers of Excellence. help patients make informed decisions The second opinion disputed the first about their cancer care and navigate diagnosis and Nancy began treatment, the health care system. They help pre- which included surgery, radiation and vent and manage symptoms and side chemotherapy. Patty was there to effects to reduce inpatient admissions support Nancy throughout each step, and emergency room visits. They also explaining symptoms or often just collaborate with treating physicians, help placing a friendly phone call to see manage pharmacy costs and educate how Nancy was feeling. patients regarding hospice services and palliative care. Today, Nancy is cancer-free for more than three years and she credits Patty Nancy Mack is a director of project for getting her through the experience. management in UnitedHealth Group’s Information Technology department. When she was diagnosed with breast cancer, the news made her and her family fearful and uncertain about the future. She turned to OptumHealth’s Cancer Support Program. Nancy was connected to Patty Migler, one of 59 clinicians who staff the program. “Without Patty, I don’t think I would be here today. She was the one who encouraged me to get the second opinion. She helped me take control of the situation and fight for my life, so that I’ll be around for a long time. I think that she’s a great gift to this company and this community.” 16 www.optumhealth.com Today, Nancy is cancer-free for more than three years and she credits Patty for getting her through the experience. Nancy Mack UnitedHealth Group 2009 Summary Annual Report 17 Strengthening the Physician-Patient Relationship Welcome to the Patient Centered Medical Home in a modernized health care The Patient Centered Medical Home system, everyone should have offers a holistic and well-integrated a strong relationship with his approach to providing patients with safe, or her primary care physician effective, comprehensive care — an — a “medical home” where the antidote to what is too often fragmented patient and doctor work together and episodic care from various health to coordinate comprehensive care providers and facilities. care with an emphasis on overall wellness and preventing disease, improving the care of chronic conditions, behavioral health support and patient education. “The medical home model goes beyond simply the diagnosis and treatment of injury and illness,” said Dr. Sam Ho, chief medical officer, UnitedHealthcare. “The Patient Centered Medical Home In 2009, UnitedHealthcare launched provides an overarching context for care, Patient Centered Medical Home (PCMH) strengthening the bond between doctor projects in collaboration with select and patient because the doctor has a primary care physician practices in better understanding of each patient’s Arizona, Colorado, Ohio, Rhode Island needs and preferences. We believe that and New York. moving to this model for the delivery of Dr. Jeffrey I. Selwyn, internist and president of New Pueblo Medicine in Tucson is an enthusiastic participant. “To try to be on the cutting edge of primary care will result in higher quality, more effective care, while improving medical outcomes and reducing health care costs.” patient-centered awareness and practice Dr. Selwyn explained, “It is truly a is a tough task, but it’s something that team-based model where there’s a very has been a passion of mine,” he said. significant bond between the patient and “I’m very pleased to see this passion the physician. It’s a 50-50 partnership. finally coming to fruition.” We engage our patients to really be Dr. Sam Ho, chief medical officer, UnitedHealthcare 29% FeWeR eMeRgenCY ROOM Visits Early results from the Patient Centered Medical Home project are promising 29% fewer emergency room visits, 11% fewer preventable hospitalizations and 6% fewer visits to the doctor’s office “ The Patient Centered Medical Home will result in higher quality, more effective care …” — Dr. Sam Ho involved in their own care.” UnitedHealthcare provides the technology and infrastructure support to improve information systems and adherence to 18 evidence-based medicine. Furthermore, physicians also stand to receive enhanced reimbursement in recognition of superior care coordination, improved access, better patient communications, delivery of preventive and chronic care and improvements in patient experience and satisfaction. Increased compensation can be funded by the medical cost savings from improved health outcomes resulting in fewer hospitalizations, better coordination with specialists, fewer emergency room visits and more cost- effective medication use. “What UnitedHealthcare is doing allows benefits for the private physician, the patient and plan sponsors,” Dr. Selwyn said. “Better health care, better outcomes for patients and less expenditure.” The PCMH model was developed by primary care physicians in the United States, including the American Academy of Family Physicians, the American College of Physicians, the American Osteopathic Association and the American Academy of Pediatricians. UnitedHealthcare’s pilot program in Arizona is available to customers in employer-sponsored benefit plans and Medicare Advantage and Medicaid health plan customers. “ It is truly a team-based model where there’s a very significant bond between the patient and the physician.” — Dr. Jeffrey I. Selwyn Dr. Jeffrey I. Selwyn, internist and president, New Pueblo Medicine, Tucson, Ariz. www.uhc.com UnitedHealth Group 2009 Summary Annual Report 19 tracking prescriptions for dangerous interactions Many people see more than one doctor or fill prescriptions at more than one pharmacy for a broad range of medical conditions. This is true particularly for patients with multiple medical challenges and the elderly who often are facing a number of common chronic conditions. This can mean that physicians and pharmacists are unaware of all the medications a patient has been prescribed, which may lead to dangerous drug interactions that are harmful to patients, costly for the health care system and largely avoidable. Prescription Solutions, UnitedHealth Group’s pharmacy benefit management business, has developed the Drug Interaction Alert Program (DIAP), an innovative program to specifically identify potentially dangerous drug interactions. Heidi Lew, Pharm. D., Prescription Safety and support for the most vulnerable in a complex health system the U.s. health care system’s complexity and often fragmented delivery Solutions vice president, Clinical Programs, of care can negatively impact quality. UnitedHealth group uses technology explained, “First, we collaborated with to help organize care and make it safer; and the company provides expert an advisory group of physicians to guidance to help individuals navigate a confusing and sometimes identify drug interactions most likely to contradictory system. Here are two examples of how UnitedHealth group result in serious harm to patients. The is modernizing health care to improve quality. The Drug Interaction Alert Program is an innovative program that specifically identifies potentially dangerous drug interactions. drug interaction alert system monitors the millions of prescriptions filled by pharmacies for customers every month to identify instances where a person may be receiving multiple medications that could cause them harm. When possible drug interactions are identified, 20 www.prescriptionsolutions.com Improving Quality patient-specific notifications that set out the potentially clinically significant guiding a caregiver through the health care maze and challenging time. It was great to have the opportunity to help make a drug-to-drug interactions are sent to Rhonda Burcham, RN, is a care manager difference in their lives.” alert prescribing physicians promptly, in SecureHorizon’s Post Acute Transition often within 24 hours.” Physicians report that the drug interaction alert system helps them take better care of their patients. Dr. Alan Nili runs a family practice in Irvine, California. His patients range from 12 to over 90 years of age, with geriatric patients now comprising more than 50 percent of the patients he sees. Team, a clinical program offered by Ovations to Medicare recipients. She first contacted Richard Radlinger when his wife Mary Jane had just been admitted to an acute care facility after suffering a stroke. Rhonda said that Richard was full of questions and very worried: What did their insurance cover? How would he find the treatments his wife needed? How could he ever take Dr. Nili stated, “Some seniors are care of her on his own? taking 10 to 12 different medications, so it can be very difficult to keep track of the interactions. My patients could be receiving prescriptions from other specialists, such as cardiologists and orthopedists, without my knowledge. As Richard explained, “You walk into that situation and you just don’t know where to turn, and that’s where I was. I’m the only caregiver. We’ve been married 48 years and I’m 73.” Receiving a notification from Prescription Rhonda went to work immediately, Solutions alerts me to either switch helping to arrange proper speech, medications to a different group or to occupational and physical therapy in let the patient know there might be preparation for discharge from the side effects with specific combinations facility. She recommended home care of medications.” Research shows that the drug interaction alert system not only reduces the risk of adverse drug reactions and harm to patients, it provides significant savings to the health care system. Depending on the type and severity of drug interaction, the drug interaction alert system can potentially reduce medical costs up to $13,000 for treatment of a patient at risk. for a time and helped expedite out- patient speech therapy. Rhonda found answers to all their questions related to their insurance. She said, “I spent a lot of time with both of them throughout Ms. Radlinger’s stay, and at discharge he was comfortable with taking her home.” Rhonda admired their courage. “They are a really awesome couple who have been through a very difficult The admiration was mutual, as Richard stated, “I think the world of Rhonda. I’m not trying to unduly put a burden on anybody, but I can’t do all the stuff myself. The mental health of the caregiver is important, because it’s such a dramatic change in our lifestyles. Rhonda was a blessing to us. That’s all I can tell you.” Rhonda Burcham, RN, care manager, SecureHorizon’s Post Acute Transition Team, helps guide customers through a sometimes confusing health system. 315MpResCRiptiOns pROCesseD AnnUALLY BY pResCRiptiOn sOLUtiOns www.ovationshealth.com UnitedHealth Group 2009 Summary Annual Report 21 Transformative Technology Information: the lifeblood of health care information technology has Those kinds of records, combined with the power to transform health information on the activities of other care. UnitedHealth group built health consumers, allows Ingenix to a $2 billion business, ingenix, make important observations about how around that idea. ingenix is doctors practice medicine; what happens committed to using the power to the patients in their practice; why of health information and some patients get better and some don’t; analytics to help save lives, and the correlation of health outcomes improve care and modernize to how often physicians and other health the health care system. care professionals do or do not follow To begin to address the inefficiencies evidence-based guidelines for care. plaguing the health care system, Ingenix Ingenix organizes these vast data starts with large and robust resources of resources, analyzes the information and health care data, including 32 terabytes puts the results into action throughout of information covering more than the health care system — all while 90 million people, and the performance ensuring that the privacy and security of 600,000 physicians and other health of patient information is protected. care providers. Health care information is abundant. Every time a person goes to a doctor’s office or a hospital, gets a lab result, orders a prescription or interacts with the health care system in any way, a record is created. ingenix’s natural History of Disease solution Ingenix’s Natural History of Disease solution and its application to the analyses of diabetes provides one example of how this works. Ingenix looked at data — which had been Ingenix organizes these vast data resources, analyzes the information and puts the results into action throughout the health care system. 22 www.ingenix.com UnitedHealth Group 2009 Summary Annual Report 23 Transformative Technology Based on a person’s health profile, UnitedHealth Group can create a personalized blueprint for healthy living and customized outreach, including by telephone, direct mail, online and mobile device. de-identified to protect individual their diagnosis. For example, Ingenix With the insights gained from this work, privacy — related to people suffering discovered that many of these patients Ingenix moves from being able to identify from diabetes. The company studied suffered either from insomnia or sleep and suggest treatment for patients with treatments that are successful and the apnea. The company found patients with pre-diabetes to helping treat people who results of non-treatment. Ingenix also these symptoms are 30 percent more are at risk for developing pre-diabetes. closely considered the factors leading likely to become diabetic in the future, Patients can be educated about potential up to the diagnosis of diabetes: What if nothing changes. Additionally, risks to their health much earlier, and characteristics did these people share? their chances of developing diabetes helped to take measures to protect What early warning signs might there be increases in the presence of obesity themselves, potentially reducing or that would enable health interventions or certain other signals. Ingenix looked avoiding the life-changing impacts of that would help patients in the future at patients from this group who went chronic disease. to avoid diabetes altogether? on to suffer from diabetes and those Research indicated an array of symptoms diabetes patients experience long before who did not — and the difference in how these two groups were treated. Understanding these potential links and consequences is a powerful way to help improve health and dramatically reduce costs. 24 Ingenix can also compare the difference in the cost of caring for these patients. Because untreated diabetes is linked to cardiovascular disease, the cost difference between patients who follow their treatment plan and those who do not can be staggering. Understanding these potential links and consequences is a powerful way to help improve health e-mail, personal Web portals, fax and of actionable, high-priority steps that can and dramatically reduce costs. mobile device. be taken to help a patient manage his or Based on average costs, the difference The eSync Platform constantly reviews in the cost of care for treated and data to identify opportunities to engage untreated patients for the group Ingenix with patients and care providers to help studied was more than $340 million per improve health. eSync concentrates year. Applied across the U.S. population, on four key areas: choosing the right that bill adds up to billions of dollars. provider, making decisions about the right care, taking the right medication her health. And at critical junctures in a patient’s care or in medical emergencies, eSync’s care provider and patient alerts and the integrated personal health information eSync has available online can make a crucial difference in a patient’s care. the esync platformsM To apply information and analytics capabilities and make them more relevant for individual patients and their care providers, as well as for UnitedHealth Group’s clinical engagement teams, OptumHealth worked with Ingenix to launch the eSync Platform. eSync helps create a holistic view of a patient’s medical history by organizing an individual’s appropriate health care data, such as laboratory and claims information, prescription drug use and recent medical procedures and behavioral health, plus the information each person wishes to add about himself or herself and basic demographic information. Then, using each individual’s health profile, the eSync Platform creates a practical blueprint for healthy living that allows UnitedHealth Group to offer recommendations, opportunities to improve health and tips for healthy living. Outreach methods can be customized to fit patients’ and care providers’ needs, including telephone, direct mail, secure and engaging in the right lifestyle. Today, OptumHealth is using eSync If needed, eSync also informs an OptumHealth personal care consultant to help deliver personalized health management programs to approximately 22 million consumers. Information matters 37% CHAngeD pHYsiCiAns Better Decisions: 37 percent of consumers in the treatment decision support program changed to a quality-rated physician best suited for their health needs. Better Health: Quality-designated surgeons have a 23 percent lower rate of medical complications and a nearly 20 percent lower cost. 64% ReDUCtiOn in ReADMissiOn RAtes One specific example: UnitedHealth group has seen a 64 percent reduction in readmission rates when high-risk pregnant moms deliver at a Center of excellence. Better Economics: transplant Centers of excellence produce a 57 percent lower average cost per transplant. 57% LOWeR AVeRAge COst peR tRAnspLAnt www.optumhealth.com/eSync UnitedHealth Group 2009 Summary Annual Report 25 Business Summary UnitedHealth Group focuses on improving the nation’s health UnitedHealth Group has achieved care system, helping to make quality care more accessible market leadership by providing value to our customers through: and affordable for all Americans. Our family of businesses • A sustained focus on advancing today provides more than 70 million individuals with a highly diversified and comprehensive array of health and well-being health and well-being; • A commitment to operational excellence; products and services. We are dedicated to helping people • Product and service innovation; live healthier lives. By developing innovative solutions to the care landscape and make important challenges of health care and harnessing health and lifestyle decisions. • Advancement of practical technology applications to engage consumers and simplify the health care experience; • The analytic use of information to enhance service, quality and patient the power of modern technology, we create new health care options for customers. Our products and services expand consumer choice, engage people more directly in their own health care and strengthen patient-physician relationships. Through our extensive network of health safety; care providers and facilities, we purchase more than $120 billion in health care per year for our customers from roughly 700,000 physicians and other care providers, 5,200 hospitals and all major • Support of science as the cornerstone of optimum health care delivery; and • Diversification of businesses and product offerings. We offer health benefits in the drug and device companies. We process At UnitedHealth Group, we value the commercial market for employer and more than 800 million claims, respond to personal nature of our relationship with individual customers, and hold market more than 80 million phone calls, execute our customers, understanding that leading positions in the public and senior more than three quarters of a billion individuals and families often rely on our sectors. We provide health services Internet transactions and support more services at crucial moments in their lives. to the participants in the health care than 24 million electronic personal health system itself, ranging from employers records. We maintain the only major and health plans, to physicians and life chartered health care bank, manage sciences companies. We are a valuable partner in supporting the health and financial needs of our customers, and we serve as a trusted source of information for patients as they navigate today’s complex health almost $1 billion in assets, service nearly 2 million consumer health care accounts, and process $36 billion in electronic pay- ments to providers annually. Our health care data assets are some of the most robust in the nation. Because health care is delivered and accessed locally by the people we serve, UnitedHealth Group closely aligns our businesses with local communities and markets. This focus, combined with the company’s national scale and breadth of resources, provides effective, responsive health care service, greater access and higher quality coast-to-coast. Fast facts $120B in HeALtH CARe pURCHAseD peR YeAR 26 www.unitedhealthgroup.com 700,000 pHYsiCiAns & CARe pROViDeRs in netWORk 5,200 HOspitALs in netWORk Our strong capital structure and asset base enable us to invest in research and development activities, which in turn stimulate business innovation and opportunity while providing stability and security for customers, business partners and our investors. UnitedHealth Group performed well in 2009 with just over $87 billion in revenues — 7 percent year-over-year growth — and earnings of $3.24 per share. Satisfaction levels improved for every key constituency — consumers, physicians and other care providers; employers and benefit sponsors; and brokers and consultants. We managed through many unforeseen obstacles to achieve these results, including significantly higher unemploy- ment, anemic short-term investment yields, the H1N1 outbreak, slower buying behaviors in the market for health Health Benefits in 2009, revenues in Health Benefits increased $5.5 billion, or 7 percent, to $81.3 billion, driven by the addition of nearly 1.1 million customers across the public and senior markets, as well as rate increases reflecting underlying medical cost trends. this growth was offset by a decrease of 1.7 million people served in the commercial benefits market, reflecting the significant decline in U.s. employment in 2009. Health Benefits earnings from operations for the full year were $4.8 billion. • Services that empower consumers to take active control of their health care needs and drive down costs; and • Meaningful economic discounts and innovative clinical advocacy programs that promote quality care. In 2009, UnitedHealthcare posted a gain of 115,000 people participating in consumer-driven health plans, strengthening its position as the leader in the consumer-driven health plan services, COBRA benefit extensions, More than 24 million customers market segment. unexpected state tax actions on insurance premiums and more. While cautious about the expected economic recovery and the uncertainty surrounding health reform, we are well positioned to capture the growth opportunities that are likely to accompany receive a comprehensive array of consumer-oriented health benefit plans and services from UnitedHealthcare, which serves the full spectrum of the commercial benefits market, from individual consumers to Fortune 500 companies. the continuing modernization of the U.S. UnitedHealthcare’s national scale allows Initiatives like UnitedHealthcare’s Premium® designation program drive better and more efficient health decisions by encouraging use of physicians who meet quality and efficiency standards through benefit design incentives. health care system. We also continue to expand internationally in select markets as other industrialized nations confront challenges similar to those UnitedHealth Group helps resolve for Americans. it to provide employers and consumers innovative, personalized and cost-effective solutions geared toward their changing health care needs. These include: • Consumer-driven health plans; • Flexible benefit plans, like the Multi-Choice suite of offerings tailored to meet the needs of small businesses; Delivering a comprehensive array of consumer-oriented health benefit plans and services to more than 24 million customers. www.uhc.com UnitedHealth Group 2009 Summary Annual Report 27 Business Summary SimplyEngaged ® is a product for mid- sized employers who are seeking to engage employees in their own health care and promote personal accountability. It includes a national biometric screening network and reinforces the value of healthy actions and outcomes through financial incentives and increased consumer awareness. Ovations is the largest business in UnitedHealthcare leverages consumer- America dedicated to the health and centric innovations to integrate clinical, well-being of individuals over the age behavioral, financial, administrative and of 50 — the fastest growing segment claims data in practical ways. of the health care market. on customers and affordability. The company has a deep understanding of its customers’ needs, and offers health benefit products that ensure predictability, stability and financial protection. Ovations offers its customers access to a broad network of doctors, individualized health and wellness programs, care coordination services and products explained in “plain language” that promote informed decision-making. The business has expanded its retail presence, improved relationships with brokers and bolstered its direct-sales channels. Ovations’ In 2009, UnitedHealthcare introduced Through a diversified range of products relationship with AARP is built not only on two new programs that illustrate the and services, the company makes it providing affordable, quality products, but company’s focus on personalized and easier for more than 8 million seniors — also on driving innovation and advances cost-effective care. The Diabetes Health or one in five Medicare beneficiaries — in the delivery of senior health services. Plan is a first-of-its-kind benefit program to manage their health care needs. that gives people with diabetes and pre- diabetes tools designed to help them avoid the complications of the disease. The plan focuses on early identification of diabetes and provides incentives for patients to follow a health care plan that lessens its effects. Ovations is a market leader in delivering Medicare Advantage health benefits products, serving nearly 1.8 million people across the United States. In association with AARP, the company serves nearly 4 million people with specialized pro- ducts for the senior health care market, Making it easier for more than 8 million seniors — or one in five Medicare beneficiaries — to manage their health care needs. The second new program is Patient including operating the nation’s largest Centered Medical Home, which creates Medicare Supplement business. It also a close partnership between patients is the nation’s largest Medicare Part D and physicians to improve con sumer pre scription drug plan provider, serving access and quality at lower cost. 4.3 million individuals on a stand-alone Patient Centered Medical Homes use basis and another 1.6 million through Ovations delivers affordability through a combination of effective medical man- agement and administrative discipline. It has a 20-year track record of proficient adaptability to market and competitive the latest health-information technology Medicare Advantage Part D plans. challenges. to ensure people receive comprehensive, In addition, the business is a national coordinated and information-based leader in providing health care planning, care from their primary care physicians, coordination and benefits to individuals rather than fragmented care from a residing in skilled-nursing facilities. • Revenues grew $4.1 billion, or 15 percent, to $32.1 billion in 2009. This strong growth included revenue advances in the Medicare Advantage, range of providers. Ovations’ success in the senior market is defined by an intense focus 28 www.ovationshealth.com Medicare Supplement and Part D AmeriChoice programs are specially chronic or end-of-life diseases, including prescription drug businesses. designed to address the complex the disabled and those living in a long- Medicare Advantage enrollment set of medical and social needs that term care setting. increased 20 percent, or nearly confront this population, going beyond 300,000 seniors, while the number the immediate medical issues to focus of seniors served by Medicare on the social, behavioral and economic Supplement products grew by barriers that impede healthier living. In 2009, AmeriChoice revenues of $8.4 billion increased $2.4 billion, or 40 percent from 2008, driven by strong organic growth as well as the full 6 percent or 140,000 individuals. At December 31, 2009, approximately 4.3 million people participated in the company’s stand-alone Part D prescription drug plans, including growth of 240,000 people in 2009. Working with states, municipalities and other government agencies, AmeriChoice provides assistance to those Americans in greatest need — the economically disadvantaged, the medically underserved and those who lack access to employer-funded health care coverage. This business is focused on supporting and managing the health care needs for nearly 3 million Americans who turn to Medicaid and other public health programs for care. The cornerstone of the company’s year benefit of a mid-2008 acquisition. efforts is the AmeriChoice Personal Growth highlights in 2009 included Care Model™. This Personal Care Model expanding to Hawaii and completing program creates an ongoing relationship program implementations in Connecticut, between health care professionals and Tennessee and New Mexico. Focusing on supporting and managing the health care needs for nearly 3 million Americans who turn to Medicaid and other public health programs for care. individuals with serious and chronic illnesses, including asthma, diabetes, congestive heart failure, HIV/AIDS, hypertension and high-risk pregnancies. The Personal Care Model provides outreach and education programs to help patients and their families manage these conditions. Other long-term care programs focus on dementia, depression, coronary disease and functional deficiencies. The company also offers government agencies a broad array of management tools designed to help them effectively administer their distinctive health care delivery systems. These include clinical- care management and consulting, disease and conditions management, and administrative and technological services. AmeriChoice expanded beyond its traditional focus on mothers and children by differentiating its programs across three other primary groups: low-income families, childless adults and people with www.americhoice.com UnitedHealth Group 2009 Summary Annual Report 29 Business Summary Health Services in 2009, Health services combined revenues increased $2.5 billion, or 13 percent, to $21.8 billion. the revenue advance was driven by strong growth in consumers served, particularly through pharmaceutical benefit management programs, as well as higher revenues from public sector specialty benefit offerings and health care technology software and services. Health services earnings from operations for the full year were $1.6 billion. • Complex condition management; synchronized approach that allows OptumHealth to leverage many different types of outreach, including telephonic, fax, text messaging, mail, e-mail and personal Web portals. OptumHealth Financial Services operates the only major bank dedicated exclusively to the health care industry. OptumHealth is also a leader in the promotion of paperless payment and statement solutions. The company • Physical health networks; connects almost 500,000 health care • Mental health and substance abuse management; and • Employee assistance programs. Through myoptumhealth.com, as well as more than 1,500 private health portals (serving 36 million consumers), the company is also a leading provider of consumer health information. Every day, thousands of calls are received by OptumHealth’s NurseLineSM and employee assistance programs, which provide customers with personalized health and wellness information. OptumHealth’s innovative eSync PlatformSM is a cutting-edge clinical tech- nology capability. It provides a holistic view of a patient’s medical history by combining all pertinent data, such as providers and electronically transmits more than $3 billion of claim payments per month. Providing health information and services through four businesses — Care Solutions, Financial Services, Behavioral Solutions and Specialty Benefits. In 2009, OptumHealth continued to identify new ways to integrate its robust product offerings, while creating a more personal ized patient experience and closely partnering with care providers. The result is a meaningful and powerful lab and claims information, prescription consumer franchise that is serving health drug use, recent medical procedures, needs for one out of every five Americans. OptumHealth provides essential health information and services to nearly 58 million Americans. Through its four businesses — Care Solutions, Financial Services, Behavioral Solutions and Specialty Benefits — OptumHealth helps Americans more effectively navigate the health care system, make better informed health decisions, finance their health care needs and access the best health services. OptumHealth is a recognized leader in: • Wellness, disease and care management programs; • Care advocacy and decision support behavioral information and self-reported information. eSync’s analytic software pores through this data and proactively sends out care recommendations, reminders to schedule annual exams and information about upcoming medical procedures. It’s an integrated, In 2009, OptumHealth revenues increased $303 million, or 6 percent, to $5.5 billion. The year marked OptumHealth’s best overall external growth year in its history. services; 1.9M COnsUMeR ACCOUnts seRVeD in 2009 30 www.optumhealth.com OptumHealth’s public sector business advanced analytics to strengthen clinical 350 federal and state agencies and continued to grow strongly in 2009, decision support, expand the use of health 135 United Kingdom government payers. with significant new sales for services, information technology, improve health including five state programs serving care administration — and ultimately help a total of nearly 1 million people. to improve health outcomes. Over the past decade, revenue growth for Ingenix has averaged approximately 20 percent annually. Market demand OptumHealth Financial Services ended the year serving 1.9 million consumer accounts, up 10 percent from 2008. Assets under management grew 31 percent to $860 million in 2009. In 2009, Ingenix brought its ability to for many of Ingenix services is on the innovate and its commitment to health rise with innovation driving growth. The privacy and security to an array of American Recovery and Reinvestment opportunities to address major health Act of 2009 is already accelerating care outcomes and economics issues for demand for industry-leading health care clients. With more than 10,000 knowledge technology like Ingenix CareTracker, workers in more than 50 countries, Ingenix Ingenix’s Web-based solution that made an impact in some important modernizes and integrates all the arenas, including: • Administrative simplification; functions of a physician practice, including electronic health records. • Electronic health records and health information exchanges; • Clinical decision support and analytics; • Performance management and consumer transparency; • Risk management, trend forecasting and underwriting; • Comparative effectiveness research; As one of the largest global health information technology and consulting companies in the world, Ingenix is a leading supplier of information-based solutions to the • Public health policy analysis; and • Clinical and information services for life sciences companies, improving clinical effectiveness, safety and outcomes. CareTracker modernizes and integrates all the functions of a physician practice, including electronic health records. In collaboration with Intuit, a leader in financial software, Ingenix helped develop the Quicken Health Expense TrackerSM, combining Intuit’s experience building consumer-friendly financial health care market. Included are those who diagnose and treat patients (doctors and hospitals), those who develop cures for disease (the life sciences industry) and those who pay for care (governments, com- mercial health plans and employers). Relying on vast and robust health information resources, including 32 terabytes of information covering the health experiences of more than 90 million people, Ingenix uses the power of health information and Ingenix offers clients software, services, consulting and outsourcing solutions. These solutions are provided to nearly management tools with innovative Ingenix health care technology and experience. This Web-based tool every major participant in the U.S. health guides consumers through the process care system and a growing number of international systems. Clients include of understanding and managing their health care finances. Quicken Health approximately 6,000 hospitals, 245,000 Expense Tracker will be widely available physicians, 2,000 health care payers and to UnitedHealthcare customers in 2010 other intermediaries, 200 Fortune 500 through their personalized myuhc.com companies, 655 life sciences companies, Web portals. www.ingenix.com UnitedHealth Group 2009 Summary Annual Report 31 Business Summary In 2009, The Lewin Group® launched its comparative effectiveness research, and Associates for its mail-pharmacy Center for Comparative Effectiveness international markets and electronic service, and is the only PBM to receive Research, formed to meet the growing health records. Continuing pressure to reduce health care costs and improve care quality is expected to create new demand for Ingenix’s solutions. need for fact-based, comparative effectiveness research (CER) for use by policymakers, researchers, health care providers and others to improve patient care and optimize health care resources. Ingenix’s i3 business launched i3Cube™ in March 2009, an award-winning, integrated solution for managing all drug study activities in a centralized location on a single, user-friendly Adobe® platform. i3Cube brought a unique capability to the marketplace and has attracted the attention of clients embarking on projects across all phases of the drug develop- ment research cycle. 17% 2009 ingenix ReVenUe inCReAse A new consumer Web site was launched Prescription Solutions is one of the in 2009 to offer customers enhanced largest pharmacy Benefit Managers functionality, simplified navigation and (pBMs) in the United states up-to-date information on medications, offering a comprehensive suite of as well as a real-time pricing tool for the pharmaceutical programs and growing Medicare Part D population. consumer health products including retail, mail order, specialty pharmacy and clinical services. all four accreditations from URAC (a leading health care accreditation and education organization): Pharmacy Benefit Management, Drug Therapy Management, Mail Service Pharmacy and Specialty Pharmacy. Prescription Solutions’ mail order facilities provide customers with significant discounts versus typical retail drug stores. Its purchasing scale also allows it to supply customers with cost-effective brand name and generic drugs. Prescription Solutions generic penetration rate is nearly 70 percent, the highest among major PBMs. In 2009, Prescription Solutions revenues of $14.5 billion grew $1.9 billion, or 15 percent, driven by strong growth in consumers served, script volume growth and steady gains in mail service drug fulfillment. Over the past three years, revenue has increased from $13.2 billion to $14.5 billion and the number of custom- ers served grew from 10.3 million to 11 million during the same period. 15% 2009 ReVenUe gROWtH In 2009, Ingenix also made several strategic acquisitions. In June, Ingenix acquired AIM Healthcare Services, Inc., a leading provider of health care payment solutions in all 50 states. In November, Ingenix acquired CareMedic Services, Inc., a company known for its innovation in hospital revenue cycle management. Serving 11 million people nationwide and processing approximately 315 million adjusted prescriptions annually. Ingenix increased revenues by Prescription Solutions serves 11 million $271 million, or 17 percent, to $1.8 billion people nationwide and processes in 2009. The year included significant approximately 315 million adjusted investments in new solutions related to prescriptions annually. The company has payment and revenue cycle management, twice been recognized by J. D. Power 32 www.prescriptionsolutions.com Foundations To increase access to health care for underserved communities, the Foundation’s Community Health Centers of Excellence initiative supports community clinics that are part of our nation’s health care safety net. Five health centers, in New Orleans, Miami, New York City and Washington, D.C., provide care equal to or better than care available by private-sector health care facilities, despite challenges unique to their locations. The goal of the Foundation’s Diverse Scholars Initiative is to increase the number of qualified, yet under- represented, college graduates entering the health workforce. Scholarships support hundreds of low-income minority students pursuing degrees in the health field. The development of health professionals from diverse, multicultural backgrounds will help The United Health Foundation is a not for profit, private foundation that provides actionable information to support deci- sions that lead to better health outcomes and healthier communities. Established by UnitedHealth Group in 1999, the Foundation has committed more than $170 million to improve health and health care. Following are examples of its program initiatives: The United Health Foundation’s improve the quality of culturally Children who have medical needs are sometimes not insured comprehensively for all of their medical treatments. There are few places for families who have gaps in their commercial health benefit plan coverage to turn to for funding medically necessary services for their children. As a result, children may go without necessary treatment, or they receive needed care while their families assume large financial obligations. America’s Health Rankings ® is an competent health care and help close That’s where the UnitedHealthcare annual state-by-state assessment of the health disparities gap. the nation’s health. In collaboration with the American Public Health Association and Partnership for Prevention, for nearly two decades America’s Health Rankings has provided communities and individuals with data that has spurred innovative thinking and action to strengthen our nation’s health. Pictured above: Daughters of Charity Health Center at St. Cecilia (New Orleans, La.) participates in the United Health Foundation’s Community Health Centers of Excellence initiative. (Photo taken as part of a documentary book project on community health centers sponsored by the United Health Foundation.) The Foundation collaborates with health research agencies, medical specialty societies and others to translate science into practice and helps make reliable Children’s Foundation (UHCCF) helps fill the gap. Established in 1999, UHCCF has provided grants to hundreds of children and their families to offset the cost of medical care. medical evidence available to physicians UHCCF is funded by contributions from and other care providers. Through Advancing Clinical Excellence, the United Health Foundation helps UnitedHealth Group and its employees, as well as the generosity of individuals and corporations. To learn more about physi cians and other health professionals the UnitedHealthcare Children’s achieve the best possible health out- Foundation, visit www.uhccf.org. comes for their patients. To learn more about the United Health Foundation, go to www.unitedhealthfoundation.org. Pictured above: UnitedHealthcare Children’s Foundation grant recipient Liam Wolf and his dad. www.unitedhealthfoundation.org www.uhccf.org UnitedHealth Group 2009 Summary Annual Report 33 2009 Financial Results UnitedHealth Group Highlights • UnitedHealth Group achieved business growth across each of its reporting segments and generated earnings from operations of $6.4 billion. • Diluted net earnings per common share were $3.24. • Revenues were $87.1 billion. • Cash flows from operations reached $5.6 billion, representing 147 percent of 2009 net earnings. • The challenging economic environment in the United States during 2009 exerted pressure on growth, product pricing and margins for UnitedHealth Group. The 2009 financial results on pages 34 through 37 should be read together with the consolidated financial statements and notes in the 2009 Annual Report on Form 10-K. The 2009 Annual Report on Form 10-K is an integral part of this summary annual report. (dollars in millions, except per share data) Year ended December 31 Consolidated Operating Results Revenues Earnings from operations Net earnings Return on shareholders’ equity Basic net earnings per common share Diluted net earnings per common share Common stock dividends per share Consolidated Cash Flows From (Used For) Operating activities Investing activities Financing activities Consolidated Financial Condition As of December 31 Cash and investments Total assets Total commercial paper and long-term debt Shareholders’ equity Debt-to-total-capital ratio 2009 2008 2007 2006 2005 $87,138 $ 6,359 $ 3,822 $81,186 $ 5,263 $ 2,977 $75,431 $ 7,849 $ 4,654 $71,542 $ 6,984 $ 4,159 $46,425 $ 5,080 $ 3,083 17.3% 14.9% 22.4% 22.2% 25.2% $ 3.27 $ 3.24 $ .030 $ 2.45 $ 2.40 $ .030 $ 3.55 $ 3.42 $ .030 $ 3.09 $ 2.97 $ .030 $ 2.44 $ 2.31 $ .015 $ 5,625 $ (976) $ (2,275) $ 4,238 $ (5,072) $ (605) $ 5,877 $ (4,147) $ (3,185) $ 6,526 $ (2,101) $ 474 $ 4,083 $ (3,489) $ 836 $24,350 $59,045 $11,173 $23,606 $21,575 $55,815 $12,794 $20,780 $22,286 $50,899 $11,009 $20,063 $20,582 $48,320 $ 7,456 $20,810 $14,982 $41,288 $ 7,095 $17,815 32.1% 38.1% 35.4% 26.4% 28.5% 34 Revenues (in millions) $87,138 $81,186 $75,431 $71,542 $46,425 05 06 07 08 09 Earnings From Operations (in millions) $7,849 $6,984 $6,359 $5,080 $5,263 Operating Margin 10.9% 10.4% 9.8% 7.3% 6.5% 05 06 07 08 09 05 06 07 08 09 Cash Flows From Operations (in millions) Diluted Earnings Per Share $6,526 $5,877 $5,625 $4,083 $4,238 $3.42 $2.97 $3.24 $2.31 $2.40 05 06 07 08 09 05 06 07 08 09 UnitedHealth Group 2009 Summary Annual Report 35 2009 Financial Results Health Benefits (includes UnitedHealthcare, Ovations and AmeriChoice) • UnitedHealthcare revenues of $40.8 billion decreased by 2 percent in 2009 primarily due to a 7 percent year-over-year decrease in total people served, partially offset by premium rate increases. Employment attrition at continuing clients contributed 55 percent of the total decrease in people served during the year. • Ovations revenues were $32.1 billion, an increase of $4.1 billion, or 15 percent, compared to 2008 driven by an increase in individuals served across each major senior health care product category including Medicare Advantage, standardized Medicare Supplement offerings and Medicare Part D, as well as premium rate increases. In total, Ovations brought services to an additional 675,000 seniors in 2009. • AmeriChoice revenues of $8.4 billion in 2009 increased by $2.4 billion, or 40 percent, year-over-year primarily due to organic growth in individuals served. Risk-based Medicaid programs organically grew by 24 percent or 565,000 individuals during the year to 2.9 million people. Health Services OptumHealth • OptumHealth revenues of $5.5 billion increased $303 million, or 6 percent, over 2008 primarily due to new business development in large-scale public sector care management and behavioral health programs for state clients, partially offset by a decline in people served in commercial products. • Growth in public sector business included new sales for services commencing in 2009 or 2010 to five state programs serving a total of nearly 1 million people. • OptumHealth Financial Services grew its connectivity network to more than 500,000 physicians and care providers in 2009 and electronically transmitted $36 billion in medical payments to them, a year-over-year increase of 36 percent. Assets under management in health-linked savings and investment accounts reached $860 million, an increase of 31 percent over 2008. Ingenix • Ingenix provides services in more than 50 countries and serves virtually every category of participant in the U.S. health system. • Revenues for Ingenix increased $271 million, or 17 percent, during 2009 to $1.8 billion primarily due to organic growth in new payer business and new internal service offerings. • The Ingenix contract revenue backlog grew $380 million, or 21 percent, during 2009 to $2.2 billion, led by growth in the government and payer sectors. Prescription Solutions • Prescription Solutions 2009 revenues of $14.5 billion grew $1.9 billion, or 15 percent, year-over-year due to strong growth in consumers served through Medicare Part D prescription drug plans. • During the year, Prescription Solutions processed approximately 315 million adjusted scripts for 11 million individuals. • Generic prescriptions reached nearly 70 percent of all scripts filled by Prescription Solutions by the fourth quarter 2009, an increase of 160 basis points year-over-year. The expanded use of generics increases the affordability of health care and also increases earnings from operations at Prescription Solutions. 36 Revenues (in millions) earnings From Operations (in millions) Operating Margin Health Benefits $81,341 $75,857 $67,817 $71,199 $44,119 $6,595 $5,860 $4,376 $5,068 $4,788 9.9% 9.3% 8.6% 6.7% 5.9% 05 06 07 08 09 05 06 07 08 09 05 06 07 08 09 OptumHealth $5,225 $4,921 $5,528 $4,342 $3,127 $895 $809 $718 $636 $574 18.4% 18.6% 18.2% 13.7% 11.5% 05 06 07 08 09 05 06 07 08 09 05 06 07 08 09 Ingenix $1,823 $1,552 $1,304 $956 $796 $266 $246 $229 $176 $130 20.4% 18.4% 16.3% 14.8% 13.5% 05 06 07 08 09 05 06 07 08 09 05 06 07 08 09 Prescription Solutions $14,452 $13,249 $12,573 $689 4.8% $4,084 $78 05 06 07 08 09 $363 $269 $139 3.4% 2.9% 2.0% $0 05 06 07 08 09 05 06 07 08 09 NM* *Not Meaningful UnitedHealth Group 2009 Summary Annual Report 37 Officers and Board Members Reed V. Tuckson, M.D. Executive Vice President and Chief of Medical Affairs Christopher J. Walsh Executive Vice President and General Counsel Anthony Welters Executive Vice President and President, Public and Senior Markets Group David S. Wichmann Executive Vice President and President, UnitedHealth Group Operations Mitchell E. Zamoff Executive Vice President and General Counsel Board of Directors William C. Ballard, Jr. Former Of Counsel, Greenebaum Doll & McDonald PLLC Richard T. Burke Non-Executive Chairman, UnitedHealth Group Robert J. Darretta Retired Vice Chairman and Chief Financial Officer, Johnson & Johnson Stephen J. Hemsley President and Chief Executive Officer, UnitedHealth Group Michele J. Hooper President and Chief Executive Officer, The Directors’ Council Douglas W. Leatherdale Retired Chairman and Chief Executive Officer, The St. Paul Companies, Inc. Glenn M. Renwick President and Chief Executive Officer, The Progressive Corporation Kenneth I. Shine, M.D. Executive Vice Chancellor for Health Affairs, The University of Texas System Gail R. Wilensky, Ph.D. Senior Fellow, Project HOPE Audit Committee William C. Ballard, Jr., Chair Robert J. Darretta Glenn M. Renwick Nominating and Corporate Governance Committee Michele J. Hooper, Chair William C. Ballard, Jr. Douglas W. Leatherdale Compensation and Human Resources Committee Douglas W. Leatherdale, Chair Robert J. Darretta Gail R. Wilensky, Ph.D. Public Policy Strategies and Responsibility Committee Gail R. Wilensky, Ph.D., Chair Michele J. Hooper Kenneth I. Shine, M.D. Officers and Leaders Stephen J. Hemsley President and Chief Executive Officer Gail K. Boudreaux Executive Vice President and President, UnitedHealthcare G. Mike Mikan Executive Vice President and Chief Financial Officer William A. Munsell Executive Vice President and President, Enterprise Services Group Don Nathan Senior Vice President and Chief Communications Officer John S. Penshorn Senior Vice President, Capital Markets Communications and Strategy Eric S. Rangen Senior Vice President and Chief Accounting Officer Larry C. Renfro Executive Vice President and Chief Executive Officer, Public and Senior Markets Group Jeannine M. Rivet Executive Vice President Simon Stevens Executive Vice President and President, Global Health Lori K. Sweere Executive Vice President, Human Capital 38 Forward-Looking Statements This Summary Annual Report may contain statements, estimates, changes in Medicare; potential reductions in revenue received from projections, guidance or outlook that constitute “forward-looking” Medicare and Medicaid programs, including as a result of reduced statements as defined under U.S. federal securities laws. Generally payments to private plans offering Medicare Advantage; our ability the words “believe,” “expect,” “intend,” “estimate,” “anticipate,” to execute contracts on competitive terms with physicians, hospitals “plan,” “project,” “should” and similar expressions identify forward- and other service professionals; our ability to attract, retain and provide looking statements, which generally are not historical in nature. support to a network of independent third party brokers, consultants These statements may contain information about financial prospects, and agents; failure to comply with restrictions on patient privacy and economic conditions, trends and uncertainties and involve risks and data security regulations; events that may negatively affect our contracts uncertainties. We caution that actual results could differ materially with AARP; increases in costs and other liabilities associated with from those that management expects, depending on the outcome increased litigation; possible impairment of the value of our intangible of certain factors. Some factors that could cause results to differ assets if future results do not adequately support goodwill and intangible materially from the forward-looking statements include: the outcome assets recorded for businesses that we acquire; increases in health care of proposed health care reform, which could materially adversely affect costs resulting from large-scale medical emergencies; failure to maintain our revenues, financial position and results of operations, including effective and efficient information systems; misappropriation of our increasing our costs, subjecting us to new and potentially significant proprietary technology; our ability to obtain sufficient funds from our taxes, exposing us to expanded liability, requiring us to revise the ways regulated subsidiaries to fund our obligations; failure to complete or in which we conduct business or putting us at risk for loss of business receive anticipated benefits of acquisitions; potential downgrades in (our financial outlook does not account for any potential impact of our credit ratings; and failure to achieve targeted operating cost health care reform on our businesses); our ability to effectively estimate, productivity improvements, including savings resulting from technology price for and manage our medical costs, including the impact of any enhancement and administrative modernization. new coverage requirements; the potential impact that new laws or regulations or changes in existing laws or regulations or their enforce- This list of important factors is not intended to be exhaustive. ment could have on our results of operations, financial position and A further list and description of some of these risks and uncertainties cash flows, including as a result of increases in medical, administrative, can be found in our reports filed with the Securities and Exchange technology or other costs resulting from federal and state regulations Commission from time to time, including the cautionary statements affecting the health care industry; the potential impact of adverse in our annual reports on Form 10-K, quarterly reports on Form 10-Q economic conditions on our revenues (including decreases in and current reports on Form 8-K. Any or all forward-looking statements enrollment resulting from increases in the unemployment rate and we make may turn out to be wrong. You should not place undue commercial attrition) and results of operations; regulatory and reliance on forward-looking statements, which speak only as of the other risks and uncertainties associated with the pharmacy benefits date they are made. We do not undertake to update or revise any management industry; competitive pressures, which could affect our forward-looking statements. ability to maintain or increase our market share; uncertainties regarding UnitedHealth Group 2009 Summary Annual Report 39 Investor Information Market price of common stock Investor relations The following table shows the range of high and low sales prices for the company’s common stock as reported by the New York Stock Exchange, where it trades under the symbol UNH. These prices do not include commissions or fees associated with purchasing or selling this security. high low 2010 First Quarter thru February 3, 2010 $36.07 $30.97 2009 First Quarter Second Quarter Third Quarter Fourth Quarter 2008 First Quarter Second Quarter Third Quarter Fourth Quarter $30.25 $29.69 $30.00 $33.25 $57.86 $38.33 $33.49 $27.31 $16.18 $19.85 $23.69 $23.50 $33.57 $25.50 $21.00 $14.51 You can contact UnitedHealth Group Investor Relations to order, without charge, financial documents such as the Annual Report on Form 10-K and the Summary Annual Report. You can write to us at: Investor Relations, MN008-T930 UnitedHealth Group P.O. Box 1459 Minneapolis, Minnesota 55440-1459 You can also obtain information about UnitedHealth Group and its businesses, including financial documents, online at www.unitedhealthgroup.com. Annual meeting We invite UnitedHealth Group shareholders to attend our annual meeting, which will be held on Monday, May 24, 2010, 12:00 p.m. Central Time at the Sheraton Overland Park Hotel at the Convention Center, 6100 College Boulevard, Overland Park, Kansas. You will need to bring your admission card with you to the annual meeting in order to be admitted. As of February 3, 2010, the company had 18,145 shareholders of record. Common stock dividends UnitedHealth Group’s Board of Directors regularly reviews the company’s financial statements and decides whether it is advisable to declare a dividend on the outstanding shares of common stock. The Board of Directors has declared the following dividends in 2009 and 2010: Shareholders of record on April 2, 2009, received an annual dividend for 2009 of $0.03 per share, which was paid on April 16, 2009; shareholders of record on April 6, 2010, received an annual dividend of $0.03 per share, which will be paid on April 20, 2010. Shareholder account questions Our transfer agent, Wells Fargo Shareowner Services, can help you with a variety of shareholder-related services, including: • Change of address • Lost stock certificates • Transfer of stock to another person • Additional administrative services You can write to them at: Wells Fargo Shareowner Services P.O. Box 64854 St. Paul, Minnesota 55164-0854 Or you can call our transfer agent toll free at (800) 468-9716 or locally at (651) 450-4064. You can e-mail our transfer agent at: stocktransfer@wellsfargo.com 40 www.unitedhealthgroup.com/main/Investors.aspx Table of contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Letter to Shareholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Responsive, Efficient Service . . . . . . . . . . . . . . . . . . . . . . . . 6 Increasing Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Containing Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Personalizing the Experience . . . . . . . . . . . . . . . . . . . . . . . 16 Strengthening the Physician-Patient Relationship . . . . . . . . . . . . . . . . . . . . . 18 Improving Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Transformative Technology . . . . . . . . . . . . . . . . . . . . . . . . 22 Business Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Foundations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 2009 Financial Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Officers and Board Members . . . . . . . . . . . . . . . . . . . . . . . 38 Forward-Looking Statements . . . . . . . . . . . . . . . . . . . . . . . 39 Investor Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Mission and Values . . . . . . . . . . . . . . . . inside back cover The names and health information for individuals included in this report have been used with their express permission. Our mission is to help people live healthier lives. Mission statement We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. We work with health care professionals and other key partners to expand access to quality health care so people get the care they need at an affordable price. We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions. Our values We serve people through a value and performance culture based on integrity, quality, innovation, diversity and social responsibility. The best way we can satisfy the millions of people we serve — our customers and members, employees, shareholders and partners — is to execute on the fundamentals of our business to the very best of our abilities, each and every day. That means as an organization, we are accountable for adding value to the health care system. For more information on how our 80,000 people work to fulfill our mission every day, please see our Social Responsibility Report at www.unitedhealthgroup.com/2009-social-responsibility-report 10% BV-COC-940655 BV-COC-940655 This annual report is printed on recycled papers certified by Bureau Veritas per FSC (Forest Stewardship Council) standards for Chain of Custody ensuring environmentally responsible, socially beneficial and economically viable forest management, and also uses reduced VOC (Volatile Organic Compounds) vegetable-based inks. UnitedHealth Group 2009 Summary Annual Report Modernizing Health Care UnitedHealth Group Center 9900 Bren Road East Minnetonka, Minnesota 55343 unitedhealthgroup.com 2009 Summary Annual Report 100-9409 4/10 

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