UnitedHealth Annual Report 2010

Plain-text annual report

New Opportunities to Serve 2010 Summary Annual Report UnitedHealth Group Overview UnitedHealth Group is a diversiﬁ ed health and well- UnitedHealthcare, our Health Beneﬁ ts platform, being company offering an array of integrated products includes three distinct businesses that share systems, and services. Our 87,000 employees serve more than networks and one uniﬁ ed brand name to offer 75 million individuals, 6,200 hospital facilities, 246,000 customers broad access to high-quality, cost-effective health care professionals or groups, all 50 states and health care at the local level. UnitedHealthcare federal and international governments. Employer & Individual serves the health beneﬁ t At our core are three competencies: needs of employers of all sizes, public sector clients, students and individuals. UnitedHealthcare Medicare Technology. Applying advanced technology to enable & Retirement delivers health and well-being beneﬁ ts interactions on enormous scale and manage data in partnership with AARP to individuals age 50 and across the complex health system. older. And UnitedHealthcare Community & State Information. Unmatched health data, the capacity to translate data into information and then into manages health care beneﬁ t programs on behalf of state Medicaid and community programs. intelligent action. Optum, our Health Services platform, includes Clinical expertise. Deep, practical know-how in care management and coordination, in clinical resource use, access and cost, combined with skills in both consumer and care provider engagement. three diversiﬁ ed information and technology-enabled services businesses, serving the broad health care marketplace. OptumHealth is focused on health management and wellness, clinical services and ﬁ nancial services. OptumInsight, formerly Ingenix, We apply these competencies in two broad specializes in technology, intelligence, consulting and and growing domains —Health Beneﬁ ts and business outsourcing solutions. OptumRx, formerly Health Services. Prescription Solutions, is among the largest pharmacy beneﬁ t management organizations. Table of Contents Letter to Shareholders . . . . . . . . . . . . . . . . . . . . . . . . . 1 2010 Financial Results . . . . . . . . . . . . . . . . . . . . . . . . 22 New Markets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Non-GAAP Reconciliation and Disclaimer . . . . . . . . . 26 New Opportunities to Serve . . . . . . . . . . . . . . . . . . . . 8 Ofﬁ cers and Directors . . . . . . . . . . . . . . . . . . . . . . . . 27 New Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Investor Information . . . . . . . . . . . . . . . . . . . . . . . . . 28 Business Summary . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Mission and Culture . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Foundations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 The names and health information for individuals included in this report have been used with their express permission. 10% This annual report is printed on recycled papers certiﬁ ed by Bureau Veritas per FSC (Forest Stewardship Council) standards for Chain of Custody ensuring environmentally responsible, socially beneﬁ cial and economically viable forest management, and also uses reduced VOC (Volatile Organic Compounds) vegetable-based inks. letter to shareholders Dear shareholder: In 2010, the elevated focus on the U.S. health care system—both its greatness and its shortcomings—was striking. There is a growing national will to consistency and connectivity among all the participants address core issues in the health care system to make it work better for everyone. Recognition of the need for fundamental change makes this a time of signifi cant challenge and in health care and ﬁ nding new ways to improve quality while controlling the rising costs of health care. In 2010, this approach to serving people in health care enabled us to exceed our growth goals. Our revenue grew by 8 percent, or $7 billion, reaching $94 billion in 2010. We met our ﬁ nancial commitments for 2010 and opportunity for the modernization introduced a meaningful dividend to our shareholders. of health care. We see new markets Our Health Beneﬁ ts businesses are growing. opening, new opportunities to serve In 2010, our beneﬁ ts businesses were privileged and new growth for our enterprise. to serve a million more people than in 2009. They also transitioned smoothly and successfully to a For three decades, we have worked to develop single, unifying brand name, UnitedHealthcare. innovative, practical and ﬁ nancially responsible ways to make higher quality health care more Our beneﬁ ts platform has strong growth capacity, across geographies, products and beneﬁ t sponsors. accessible and affordable for more people. We focus Millions more people will be entering the market for on making it easier for people to get the care they health beneﬁ ts over the next several years and the need, personalizing and simplifying their health care UnitedHealthcare brand and its capabilities will make experience, strengthening the bonds between patients it simple and easy for all our customers to understand and physicians, modernizing technology to improve the value we offer through every stage in life. 2010 Summary Annual Report 1 letter to shareholders 2009 Revenue 2010 Revenue In 2010, we continued to focus, as we have over $87B $94B Our Health Services businesses, under the new Optum brand name, are growing. OptumInsight, OptumHealth and OptumRx delivered combined revenue growth of 15 percent year-over-year. Expanding beneﬁ t coverage, increasing government oversight and new legislation are creating needs we the last several years, on consistent fundamental execution. As a result, UnitedHealth Group’s measures of service and responsiveness were high and continued to trend upward. Our care provider relationships and clinical programs have never been more consistent, more integrated or offered greater economic value. Our cost and capital management disciplines, strong integration and modernization efforts, and our growth, distribution and market engagement programs have never been more mature. The time is right to begin to tell our story. We launched Health in Numbers, an image and reputation campaign for UnitedHealth Group, and the initial response has been strongly positive. can meet for connectivity, expanded care capacity, Our growing role in making the health care system clinical accountability and transparency, and more work aligns with our growing and deeper involvement consumer affordability. Greater cost pressures are in people’s health and health care. That relationship, impacting the entire health care system. In 2010, in such a socially and personally sensitive part of their we aligned our Health Services businesses more lives, must be built on trust. We are committed to closely to better serve this huge emerging market putting ourselves in the shoes of the people we serve, among governments, care providers, payers and other delivering not only high performance, but compassion participants in the care system. and dependability properly matched to the enabling role Health Services will not focus on the domestic we will play in the future of this nation’s health care. market alone. Our broad services capabilities are Within each of our businesses, we are redoubling our also the leading edge of our company’s continuing efforts to develop and promote innovative thinking, international expansion. along with the processes to efﬁ ciently translate new @ME9FALQ7REHWUHDWHGIDLUO\7RNQRZWKDWZKHQLWFRPHVWR\RXUKHDOWKFDUHLWLVRND\WR V KDYHTXHVWLRQV7RNQRZWKDWWKH\ZLOOEHDQVZHUHGWKRXJKWIXOO\7RKDYHKHDOWKFDUHWKDWLVVLPSOHU PRUHUHVSRQVLYHPRUHFDULQJ$W8QLWHG+HDOWKFDUHZHXVHLQIRUPDWLRQIURPDFURVVWKHKHDOWKFDUH V\VWHPWRLQQRYDWH7RFUHDWHSURJUDPVWKDWKHOSFRQQHFW\RXWRWKHULJKWGRFWRUV7RVXSSRUW\RX WKURXJK\RXUWRXJKHVWPHGLFDOGHFLVLRQV:HDUHSHRSOHORRNLQJRXWIRUPLOOLRQ$PHULFDQV $QGZHDUHXVLQJLQIRUPDWLRQGDWDDQGQXPEHUVWRDFKLHYHRQHLPSRUWDQWJRDOWUHDWLQJ\RXOLNH DKXPDQEHLQJ7KDW·V@=9DL@AFFME:=JKKE& CFGOD=GJLAFFME:=JKHGO=JAFFME:=JK@=9DL@AFFME:=JKKE V >af\gmlegj]Yl@]Ydl`afFmeZ]jk&[ge 2 UnitedHealth Group Initial response to UnitedHealth Group’s image and reputation CFGOD=GJLAFFME:=JKHGO=JAFFME:=JK@=9DL@AFFME:=JKKE V >af\gmlegj]Yl@]Ydl`afFmeZ]jk&[ge campaign, Health in Numbers, V KMHHGJL,WFRPHVZKHQ\RXQHHGDFRDFKIRU\RXUKHDOWKFDUHPRPHQWV,WFRPHVLQWKHIRUP RIDVSHFLDOO\WUDLQHG51ZKRVWDQGVE\\RXJXLGHV\RXWKURXJK\RXURSWLRQV:HDUH SHRSOHORRNLQJRXWIRUPLOOLRQ$PHULFDQV$QGZHDUHXVLQJLQIRUPDWLRQDQGQXPEHUVWR DFKLHYHRQHLPSRUWDQWJRDOWUHDWLQJ\RXOLNHDKXPDQEHLQJ7KDW·V@=9DL@AFFME:=JKKE& has been very positive. UnitedHealth Group is building new relationships to help reach and serve people from different perspectives, like our collaboration with Sesame Street. ideas into scalable reality. The results are new product We serve people —we support the health care needs designs and network and payment approaches, new of more than 75 million people in the United States ways to engage people in their health and health care and around the globe and help enable the 14 million and drive better consumer choices, and the application people who work in the U.S. health system to do of new technology to simplify the health care their jobs more effectively, every day. As we address experience end-to-end for both consumers and care the needs of the people we serve—better and more providers. We are building new relationships to help consistently than other market alternatives—we us reach and serve people from different perspectives, diversify and grow. like our collaborations with Sesame Street, the YMCA, LPL Financial, the National Restaurant Association, National Football League’s New England Patriots franchise, Walgreens and Cisco. This report highlights a number of the innovations we introduced in 2010. Our forward momentum is strong and we are optimistic as we enter 2011 and begin to prepare for continued growth in 2012 and beyond. The next wave of growth opportunities will come to those who fundamentally UnitedHealth Group has never been better prepared, more engaged or more committed to help people live healthier lives and to advance a positive health care agenda in the United States and worldwide. I would like to thank the people of UnitedHealth Group for their outstanding performance this year in serving our customers. We offer our thanks to you, our shareholders, for your continuing support. help make the health care system work better, in a Sincerely, more sustainable way. We believe UnitedHealth Group is well positioned to meet that challenge. Stephen J. Hemsley President and Chief Executive Ofﬁ cer 2010 Summary Annual Report 3 “ It was an eye-opening experience. It felt like the doctor was right there in the room with me. This is something Lamar has needed for a long time.” Gale Garrison Garrison’s pulmonologist is 200 miles away from Lamar in suburban Denver, while the nearest cardiologist is based 100 miles away in Pueblo. 4 UnitedHealth Group o d a r o l o c Denver 200m 100m Pueblo Lamar new markets The health care system is under increasing pressure to provide affordable care for more people. To make the best use of health resources and get people the care they need when they need it, no matter where they are, we are entering new markets with innovative products and services. There are not enough primary care For example, together with the state of Colorado doctors in America, especially in rural areas. Our advances in telemedicine make access to health care easier. and Centura Health, a large hospital system, we are expanding physicians’ reach into underserved communities across the state. “I just said it can’t be possible,” recalls Gale Garrison, Within 10 years, the U.S. health system is expected 59-year-old resident of rural Lamar, Colorado, who has to need an additional 45,000 primary care physicians. worked all his life on livestock feed lots in Colorado Many areas of the nation and a number of medical and Nebraska. “It just really doesn’t make sense, specialties are already reporting a scarcity of does it? How could someone hundreds of miles away physicians, according to the American Association tell you what’s going on with you?” of Medical Colleges. The effects of this shortage are perhaps most acute in rural areas. While approximately 20 percent of the U.S. population lives in rural areas, only 9 percent of U.S. physicians practice in these communities. After his ﬁ rst visit with a pulmonologist who was sitting 200 miles away in suburban Denver, Garrison became a believer. “It was an eye-opening experience,” says Garrison. “It felt like the doctor was right there in the room with me. This is something In collaboration with Cisco, UnitedHealth Group Lamar has needed for a long time.” has introduced high-resolution teleconferencing technology and digitalized diagnostic equipment to establish the ﬁ rst national telehealth network to enable physicians to see and diagnose patients face-to-face when in-person visits are not feasible. Like most of Lamar’s 9,000 residents, Garrison faced challenges accessing specialty care. In the early 1990s, he was diagnosed with chronic obstructive pulmonary disease. To see a lung specialist, Garrison had to make 2010 Summary Annual Report 5 new markets a three-hour drive to Colorado Springs. The distance, Connected Care is also proving to be a popular hassle and expense of the trip kept Garrison from professional tool for physicians. For the past year, seeing a pulmonologist for three years—until his Dr. Randy Taylor and other physicians in his Denver- Connected Care visit in fall 2010. area practice have used Connected Care to see Using Connected Care, Garrison was treated by Dr. Thomas Bost of Critical Care, Pulmonary & Sleep Associates in suburban Denver. Dr. Bost says his ﬁ rst visit with Garrison resembled many such visits via Connected Care. “The ﬁ rst visit is almost always emotional, witnessing faces of patients who walk in skeptics and walk away believers in the ability of this technology to open access to care in a way they never would have imagined,” said Dr. Bost. “Gale was no exception.” Garrison also suffers from heart problems. Today, the nearest cardiologist is based 100 miles away from Lamar in Pueblo, and Garrison makes monthly trips to see him. Encouraged by his experience with Connected Care to treat his lung condition, Garrison is planning to patients in Lamar and another rural town, Del Norte. The majority of their patients are Mexican-Americans, many struggling with poverty and the language barrier in accessing health care, in addition to the challenge of their remote locations. “It’s an empowering experience for the patient who has never had such convenient access to quality specialty care before,” said Dr. Taylor, an ear, nose and throat specialist. “But it’s just as empowering for us to be able to help patients we could not reach before.” In Lamar, Garrison now spends his days looking after his eight grandchildren, who he says will have better access to care than he did growing up—in large part because of Connected Care. start using the technology to manage his heart disease. “It gives me hope knowing I can see a doctor when I need to,” Garrison says. “And that these children will, too.” “The fi rst visit is almost always emotional, witnessing faces of patients who walk in skeptics and walk away believers…” — Dr. Bost 6 UnitedHealth Group Health Care Goes Mobile NowClinic With NowClinicSM online care, a computer with Internet access turns any location into a doctor’s ofﬁ ce. Our NowClinic online care service uses digital technology and the Internet to bring health care directly to consumers on their desktop or laptop computers. This online health care model from OptumHealth provides patients with immediate, real-time remote access to licensed physicians and other health care providers in their state, regardless of insurance coverage. It facilitates secure, live chats over the Internet that can, in many cases, also allow patients and doctors to see each other via webcams. You can talk to a doctor, clinician or specialist like you would in an exam room, and share your symptoms, receive a diagnosis, and even get a prescription, if clinically appropriate. In the workplace, whether it’s an ofﬁ ce or a construction site, NowClinic online care can help balance personal and business needs, reducing the costs and the time lost to travel and waiting room delays. In the near future, NowClinic will connect patients and physicians via computer access in retail settings like shopping malls, national chain stores and from the comfort of the patient’s home. DocGPS UnitedHealthcare was ﬁ rst to develop a Medication Reminders Many patients, particularly older people smart-phone application that makes ﬁ nding with multiple health issues, have trouble doctors and hospitals as simple as a series remembering when to take their medications. of taps. The app locates nearby United- Careful adherence to patients’ treatments Healthcare physicians and care providers, and medications plays an important role in along with simple touch-screen access to supporting better health. 23 kinds of health and urgent care facilities and 58 types of medical specialties, putting quality care right at people’s ﬁ ngertips. OptumRx, our pharmacy beneﬁ ts management organization, introduced a new mobile device application for people who use our prescrip- Search results indicate UnitedHealth tion services that makes it easier for people to Premium®-designated doctors and health remember to take their medications, as well care facilities, helping plan participants ﬁ nd as to reﬁ ll or transfer a prescription to mail physicians and health care facilities that service. It’s called “My Medication Reminder.” provide higher-quality, cost-effective care. Users can speciﬁ cally search for urgent care centers, making it easier to locate an alternative to the local emergency room for routine illnesses or injuries. And users can limit their searches to a speciﬁ c mile radius from their current location based on the GPS signal, or by ZIP code. The text message program offers two dosage reminder options: a daily reminder that can be set for any hour of the day to remind a patient to “Take your medications today;” and prescription-speciﬁ c reminders. Patients who select this option receive a list of all the active drugs (including over-the-counter medications) in their personalized OptumRx account proﬁ les. DocGPS maps the chosen doctor’s location They can then designate the drugs for which with detailed directions, and allows users they would like to receive reminders. to call the doctor’s ofﬁ ce they’ve chosen with a single tap. The app makes it easy to ﬁ nd care right where and when it’s needed, whether for families on vacation or regular business travelers on the road. DocGPS has had approximately 20,000 downloads. OptumRx also offers reminder services via e-mail or telephone. In addition, customers can access their personal prescription proﬁ le, reﬁ ll their mail service medications and check the status of their mail order prescriptions, directly from their mobile phones. 2010 Summary Annual Report 7 “ To learn I was prediabetic was a shock. If I don’t get active and eat the right things, that’s the direction I’m going. I need to be around for my kids.” Todd Hopkins 24 million adults in the United States are affected by type 2 diabetes. Another 79 million Americans are affected by prediabetes. 24 million 79 million 52% By 2020, 52 percent of U.S. adults could have prediabetes or diabetes. 8 UnitedHealth Group new opportunities to serve Serving people’s health care needs is both our business and social mission. Our advances in health care coordination and management are opening new opportunities to engage people more actively in their own health and well-being. An epidemic of type 2 diabetes is prediabetes with the nation spending $3.4 trillion on sweeping the United States. We can help stop the progression of the disease and control its life-threatening consequences. diabetes-related care. At the core of the epidemic is the rising number of overweight and obese people. Yet, well-established clinical trials sponsored by the National Institutes of Health and the Centers for Todd Hopkins, 43, is the father of ﬁ ve children, Disease Control and Prevention (CDC) have proven ranging in age from 8 to 19 years old. Hopkins recalls, that lifestyle intervention and modest weight loss “My doctor said I was ‘morbidly obese.’ My good can prevent conversion from prediabetes to diabetes. cholesterol was low. My bad cholesterol was getting And documented community studies support the fact higher. A glucose test showed I was heading toward that education programs signiﬁ cantly reduce medical diabetes. To learn I was prediabetic was a shock. If complications for people who already have diabetes. I don’t get active and eat the right things, that’s the direction I’m going. I need to be around for my kids.” UnitedHealth Group is spearheading the Diabetes Prevention and Control Alliance to bring these Type 2 diabetes is a chronic and disabling disease scientiﬁ cally proven effective approaches to managing that affects nearly 24 million adults in the United prediabetes and diabetes to broad scale through a States. Another 79 million Americans are affected by unique collaboration with the YMCA of the USA, the prediabetes, the precursor of diabetes, and the vast CDC and Walgreens. majority of them don’t even know they are in danger. By 2020, if current trends continue, more than half of YMCA to offer a 16-session lifestyle intervention the U.S. population could be affected by diabetes or program staffed by Y lifestyle coaches rigorously To help prevent diabetes, we are working with the 2010 Summary Annual Report 9 new opportunities to serve trained by CDC-supported master trainers. The more fruits and vegetables, less of the high fat, high evidence-based course is aimed at teaching people cholesterol stuff. to prevent diabetes through healthy eating, increased physical activity and other lifestyle changes. To help control diabetes, UnitedHealth Group has introduced a program designed to encourage people with the disease to better understand their condition and the importance of their often complex medication strategies through education and support from trained community pharmacists, like those at Walgreens. UnitedHealth Group also provides advanced analytics and technology support, as well as funding outreach and consumer marketing and reimbursement for the services delivered under the program. Hopkins’ employer-sponsored health beneﬁ ts from UnitedHealthcare offered the diabetes prevention program at no cost, and he joined the Y’s classes near his home. He says, “It’s all about making better life choices. Over the last 16 sessions, I’ve changed a lot of the ways I eat, a lot of the foods I eat. I’m eating “People at work say, ‘You’re losing weight. You’re looking great. What diet are you on?’ I’m not on a diet. I just have to decide how much to eat and make the healthy choices along the way. But one of the beneﬁ ts for me was that it really has been a great weight loss program. The ﬁ rst class, I weighed 305 pounds. At last Monday’s class, I weighed in at 272. “Your health gets a whole lot better. I’m more active. I’ve got much more energy than I did just three months ago. My oldest son at home who’s a junior in high school says, ‘I’ve got to get in shape, because Dad can catch me now.’” Hopkins says he still has more personal goals to meet. “My wife and I have our 21st wedding anniversary coming up and we’re going away together for a week. My goal is to be at 265 before we leave for that trip. It’s an overall lifestyle change that I’m trying to make consistent in my life.” “If you want people to be successful in the program and sustain the changes they make throughout their lifetime, you really have to listen to what is going to work for them.” She said, “I raise issues and offer support and guidance, but then I step back and let the group work out the problems and challenges—that’s when the program is most beneﬁ cial. Maybe I’m biased, but I really enjoy my group, because they are really embracing the change and are ready to do whatever it takes. They are so willing to support one another.” Sarah Shimchick leads the Diabetes Prevention Program at Ys in the Phoenix area and also coaches groups of participants. 10 UnitedHealth Group Helping People Get Healthy and Stay Healthy Personal Rewards According to the Centers for Disease Control Health Impact Most of the $1 billion spent annually on care Healthy Habits for Life Our initiative, Food for Thought: Eating Well and Prevention (CDC), 50 percent of a person’s management programs in the United States on a Budget ™, under our Healthy Habits for health status is a result of behavior—choices supports treatment for people already Life partnership with Sesame Workshop, the made each day with respect to physical and diagnosed with difﬁ cult-to-manage chronic nonproﬁ t educational organization behind emotional well-being. CDC studies also show conditions, like diabetes, colorectal cancer Sesame Street®, is a bilingual educational that nearly half of the health care decisions and others. Often, by the time a person is outreach program that helps low-income people make are “sub-optimal,” meaning an diagnosed with a chronic illness, it is too late to families make food choices that are afford- alternative choice may have led to a better reverse the disease and it is expensive to treat. able, nutritional, and set the foundation for clinical and/or ﬁ nancial outcome. UnitedHealth Group’s OptumInsight information, lifelong healthy habits. UnitedHealth Personal Rewards is a wellness technology, services and consulting business Our partnership and the Food for Thought program that offers ﬁ nancial incentives to developed Health Impact to help predict and initiative offers support and resources for people in an employer-sponsored health prevent disease by identifying risk factors families with children between the ages plan who pursue a healthy lifestyle and who before an illness begins to develop or of 2 and 8 to cope with “food insecurity” get regular care when living with an illness. progress. By analyzing historical, de-identiﬁ ed —deﬁ ned by the U.S. Department of Each participant has a customized Personal medical data, the tool pinpoints the underlying Agriculture and U.S. Department of Health Rewards scorecard that serves as a guide to precursors to disease with high accuracy and Human Services as “households where his or her goals for better health, including among at-risk individuals. annual physical exams, regular cancer screen- ings and, as appropriate, weight manage- ment, disease management and smoking cessation programs. The more goals a person meets, the greater the rewards for the participant. The program encourages healthy choices, tallies the ﬁ nancial incentives and offers access to ongoing support. For example, Health Impact has identiﬁ ed not only the standard precursors for diabetes, such as metabolic syndrome, but as many as 93 other potential ﬂ ags for diabetes. Early warnings of emerging health issues give people time to make critical lifestyle choices and behavioral changes that can delay or even prevent illness and signiﬁ cantly By connecting speciﬁ c actions with meaning- reduce the costs of care. Health Impact was ful incentives, we are motivating healthier recognized for its breakthrough potential in behaviors. In 2010, UnitedHealth Group began The Wall Street Journal’s Annual Technology offering this program to our employees and Innovation Awards for 2010. family members. there is a lack of access to enough food to fully meet basic needs at all times due to lack of ﬁ nancial resources.” There is growing concern that food insecurity could contribute to childhood obesity. Over the past three decades, the rate of childhood obesity in America has tripled. Nearly one in three children is overweight or obese, putting them at risk for lifelong chronic illnesses including hypertension, heart disease and diabetes. 2010 Summary Annual Report 11 “ CareTracker gives me the time I need to provide more patient care.” Dr. Ruth Yoon U.S. patients receiving primary care in small practices Small practices using an electronic health record 12% 75% 12 UnitedHealth Group new growth Our enterprise is meeting the challenges of making health communities more connected, transparent, effi cient and accountable. We are experiencing growth by providing tools and new approaches that help deliver quality, evidence-based, patient-centered care. The majority of physicians’ practices IT in small physician practices. The AMA helped still use paper-based systems. Our Physician Model Offi ce project makes adoption of health IT easier, helping identify physicians to participate in the program and is coordinating resources and expertise for the project. Physician Model Ofﬁ ce practices receive free implementation and access to CareTracker, a doctors spend more time with patients. Web-based practice management and EHR system While 75 percent of people in the United States developed by OptumInsight. receive primary care in small physician practices, only Dr. Ruth Yoon is a family doctor with a small practice about 12 percent of these practices use an electronic in Okemos, Michigan, who sees 15 to 20 patients daily. health record (EHR). Working with the American She says, “We were using paper patient charts and we Medical Association (AMA), OptumInsight is helping realized how many charts we were pulling every day.” to make health IT implementations faster, easier and In fact, she and her staff sometimes found themselves minimally disruptive—and ultimately more successful. distracted from some aspects of patient care by this Over the next few years, hundreds of thousands of kind of administrative work. “There are only so many physicians who are currently dependent upon paper- hours in the day, so that cuts into patient care,” says based, manual systems for administration and patient Dr. Yoon. In joining the program, the doctor wanted to records, are expected to make the change to electronic put in place the necessary components to provide a systems and processes. The Physician Model Ofﬁ ce is building a blueprint for the effective, efﬁ cient deployment of health patient-centered medical home, including converting her practice’s operating systems to more comprehensively address her patients’ overall medical needs. 2010 Summary Annual Report 13 new growth Working closely with OptumInsight consultants, According to Dr. Yoon, “Since CareTracker has been in Dr. Yoon and her staff had CareTracker up and our ofﬁ ce, I can see the future coming. The American running in a matter of hours. CareTracker saves time Recovery and Reinvestment Act requires the usage of for physicians and staff by helping them access and EHR 80 percent of the time for patient care to give us use important clinical knowledge and patient medical funding for health IT. With scheduling, seeing patients, information right at the point of care. The system planning and follow-up, I do believe I am already there, links to thousands of labs, hospitals, pharmacies and because I’m using it from beginning to end.” Her staff commercial and government sponsors of beneﬁ ts. members are more available for patients’ tests and It also connects with all the operational functions other care. And Dr. Yoon says, “It gives me the time of a physician’s practice. It simpliﬁ es administrative I need to provide more patient care. That is my goal, to tasks such as billing, claims management, scheduling, provide better care for my patients—not only for their prescriptions, lab and hospital interactions and medical problems, but also their mental, emotional and other documentation. family problems. That is my passion.” The U.S. government recognizes health IT’s potential Feedback from physicians participating in the Physician to help reduce health care expense and improve Model Ofﬁ ce program is providing a constructive look medical outcomes. This is underscored by the at the transition hundreds of thousands of doctors $27 billion included in the 2009 American Recovery and other care providers will complete over the next and Reinvestment Act to provide incentives for several years. UnitedHealth Group will use this insight hospitals and physicians to promote the introduction and experience to continue to better serve the rapidly and use of interoperable electronic health records. growing market for technology that connects, informs and aligns health care more closely around patient needs and population health. CareTracker saves time for physicians and staff by helping them access and use important clinical knowledge and patient medical information right at the point of care. 14 UnitedHealth Group Helping Make Health Care Work Better New Payment Approach to Fight Cancer We are introducing new approaches to health care payment and Growing Our Health Services Offerings OptumInsight applies health intelligence, technology and connectivity provider reimbursement. This year, working with ﬁ ve medical oncology to help physicians, hospitals and clinics optimize clinical performance, groups across the nation, UnitedHealthcare is advancing a ﬁ rst-of-its- improve quality of care and reduce costs. In 2010, OptumInsight kind cancer-care payment model aimed at improving the quality of care acquired the following companies — Picis, Executive Health for patients with breast, colon and lung cancers— among the most Resources and Axolotl — that add important new capabilities to common cancers in the United States, according to the National our services offerings. Cancer Institute. Under the current system, oncologists recommend a speciﬁ c treatment emergency department, surgical suites and intensive care units. program that commonly includes chemotherapy drugs and administers Through Picis, OptumInsight offers information systems that provide them to the patient. The oncologist then bills the patient’s health second-by-second decision support, capture patient information and insurance plan or payer for the retail price of the drugs, plus a charge keep records of treatment for accurate billing and reimbursement. The most critical areas for care — and cost — in a hospital are the for administering the drugs. This new reimbursement model pays a new patient care fee for a necessity rules compliance and audit requirements demand patient’s total cycle of treatment— it represents the proﬁ t margins organizational planning, new infrastructure, processes and expertise. oncologists made from the drugs. It will remain the same no matter Through Executive Health Resources, OptumInsight offers the leading what chemotherapy drugs are given, but the drug cost is always physician guided solutions for medical necessity compliance. New medical industry standards and regulation programs, medical reimbursed. The new program, in effect, separates the oncologist’s income from drug sales while preserving his or her ability to maintain a regular visit schedule with the patient. Health information exchanges (HIE) are secure, intelligent, electronic networks that clinically connect care providers across a hospital system, within a region or across an entire state, pulling together This innovative approach reimburses the oncologist upfront for an all available patient data electronically. With a single click, this entire cancer treatment program, shifting away from the current information is displayed to authorized users when it is needed most— “fee-for-service” approach, which rewards volume regardless of health at the point of care. Axolotl offers a leading HIE solution, used by nearly outcomes. This program also promotes better, more patient-centric, 30,000 physicians, 100,000 health care professionals, more than 200 evidence-based care with no loss of revenue for the physician. hospitals, 20 regional health information organizations (RHIOs), and six statewide HIEs— touching the lives of more than 35 million patients. 2010 Summary Annual Report 15 business summary Through its family of businesses, UnitedHealth Group provides a highly diversifi ed and comprehensive array of health and well-being products and services. The company serves more than 75 million individuals, business units focuses on the key goals in health and 6,200 hospital facilities, 246,000 health care well-being: access, affordability, quality and simplicity professionals or groups, all 50 states and the federal as they apply to their speciﬁ c market. and international governments. UnitedHealth Group has achieved marketplace The enterprise has been developed around investment leadership through a sustained focus on advancing in and application of three core competencies: clinical health and well-being; a commitment to operational care management; technology; and the use of data excellence; product and service innovation; advancement and information to improve health care performance. of practical technology applications to engage consumers These core competencies are focused in two market areas — Health Beneﬁ ts and Health Services. UnitedHealth Group has more than two dozen distinct businesses that address speciﬁ c end markets within the beneﬁ ts and services sectors. Each of these and simplify the health care experience; the analytic use of information to enhance service, quality and patient safety; support of science as the cornerstone of optimum health care delivery; diversiﬁ cation of businesses and product offerings; and, most importantly, the provision of value to its customers. Our family of businesses serves: 75 million individuals 6,200 hospital facilities 246,000 health care professionals We coordinate care through a national network of: 5,300 hospitals 730,000 physicians and other health care professionals 16 UnitedHealth Group Health Benefi ts UnitedHealthcare offers a comprehensive array of health beneﬁ ts products and services for every life stage, across the employer-sponsored, Medicare and Medicaid, and individual beneﬁ ts markets. The Health Beneﬁ ts platform includes three distinct businesses that share systems, networks and one uniﬁ ed brand name —UnitedHealthcare—to offer customers broad access to high-quality, cost-effective health care at the local level. UnitedHealthcare combines practical and measured innovation, consistently effective clinical care management, and scale—both geographic and technological—to continue to drive improved medical and operating cost positions, which are critical to the value provided to customers. The business is closely aligned with the unique needs of the local communities it serves through the largest combined network of health care providers offered within a single enterprise. UnitedHealthcare Employer & Individual UnitedHealthcare Employer & Individual serves health beneﬁ t needs of employers ranging from sole technology and robust infrastructure. The company’s innovative approach to health beneﬁ ts has been recognized with Fortune magazine’s 2010 No. 1 ranking for innovation in the health insurance and managed proprietorships and small businesses to large, multi- care category. site and national Fortune 500 employers and public sector clients, as well as students and individuals. UnitedHealthcare Employer & Individual has consistently promoted new and better ways to empower employers, clinicians and people with better information to make better health care decisions that lead to better health. When people make good health decisions, choose the right doctor or hospital, or get the right medicine, it also means reduced absenteeism, improved productivity and lower costs for our employer customers. The company offers thoughtfully designed products and market-leading expertise in consumerism; the country’s single largest care provider network, which could be conveniently accessed by 98 percent of the U.S. population; and award-winning customer and client service supported by highly sophisticated UnitedHealthcare Medicare & Retirement UnitedHealthcare Medicare & Retirement delivers health and well-being beneﬁ ts to 9 million seniors in conjunction with AARP across all major product categories in virtually every key U.S. market. Americans over the age of 50 represent the fastest growing market segment for health and well-being services. UnitedHealthcare Medicare & Retirement has a unique market position because of its multifaceted and national business scope dedicated to senior health care and Medicare, including experience with the frail elderly, the Medicare Supplement business, Medicare health plans, services for individuals with chronic conditions and prescription drug programs. The company’s proprietary clinical care 2010 Summary Annual Report 17 business summary models and software tools are designed to be effective in the community, at home, and in skilled and extended care facilities or other settings. UnitedHealthcare Community & State UnitedHealthcare Community & State serves more than 3.3 million people, including nearly 2 million children, who receive health coverage through Medicaid, Medicare and Children’s Health Insurance Health Services Programs. The company is a leader in helping low- Optum, UnitedHealth Group’s diversiﬁ ed information income adults and children and those with disabilities and technology-enabled services business platform, get access to quality, personalized health care serves the broad health care marketplace and is beneﬁ ts and services. dedicated to helping make the health care system The company has a deep understanding of the challenges faced by people who are low-income or have special needs, and particular expertise in helping them overcome these challenges to improve their health and quality of life. UnitedHealthcare work better for everyone. Optum’s products and services can enable the 14 million people who work in the U.S. health system to do their jobs more effectively, every day, and can help the nearly 310 million people in America improve their health and well-being. Community & State does this by working closely Optum’s businesses work with care providers with community-based organizations to help address (hospitals, physicians, pharmacy and other health cultural or language barriers to members getting the care professionals), plan sponsors (employers, preventive care or treatment they need. health plans, governments), life sciences companies UnitedHealthcare Community & State uses the Personal Care Model, an innovative approach that helps health plan members receive the right care, at the right time, in the right place. The Personal Care Model involves evaluating the unique health needs of members and using a collaborative support network (pharmaceuticals, biotechnology, medical devices) and consumers to achieve a common goal of optimized health outcomes, care quality and cost-effectiveness. This goal is accomplished by helping connect health system participants and providing them actionable information at the points of decision-making. of care managers, physicians and community-based Optum’s products and services are among the best in organizations to coordinate their care with a focus class and can be deployed individually or as integrated on preventive services, early intervention and health solutions, and when connected end-to-end, enable education. This approach is particularly effective the health care system to operate more efﬁ ciently and for those with serious and chronic illnesses and for effectively. The breadth of our Health Services portfolio high-risk expectant mothers—situations that require is distinctive and allows these businesses to positively high-touch care. impact key activities within the health care system. 18 UnitedHealth Group OptumHealth OptumHealth is a national leader in population health and wellness services. Employers, health insurance and beneﬁ ts payers and public sector organizations OptumInsight products and services are purchased by 6,200 hospital facilities, 246,000 health care professionals or groups, 2,000 payers and intermediaries, more than 2,200 life sciences use OptumHealth’s behavioral health solutions, clinical companies and hundreds of government entities care management and ﬁ nancial services. OptumHealth including all 50 U.S. states. educates consumers, helping them navigate the health care system, ﬁ nance their health care needs and better achieve their health and well-being goals. The company is recognized for its work in wellness, disease and care management programs, care advocacy and decision support services, complex condition management, mental health and substance abuse management, and employee assistance programs. OptumHealth is also a provider of consumer health information, private health portals and consumer engagement services and health banking services for consumers and care providers. OptumInsight OptumInsight is a leading health care information, technology, services and consulting company, providing OptumRx OptumRx is one of the largest pharmacy beneﬁ ts managers in the United States based on total claims volume, meeting the pharmacy needs of more than 12 million Americans. OptumRx provides retail pharmacy network claims processing, mail order pharmaceuticals and specialty pharmaceuticals management, processing nearly 350 million adjusted retail, mail service and specialty drug prescriptions annually. The company also provides retail network contracting, rebate contracting and management and clinical programs, such as step therapy, formulary management and disease/drug therapy management programs that assist customers in achieving a low-cost, high-quality software and services to major participants in the health pharmacy beneﬁ t. care industry. Its clients include physicians, hospitals and other care providers, governments, health insurers and beneﬁ ts payers and life sciences companies. Optum’s products and services can enable the 14 million people who work in the U.S. health system to do their jobs more effectively. 2010 Summary Annual Report 19 business summary UnitedHealth Center for Health Reform & Modernization UnitedHealth Group Community Activities in 2010 Through our Center for Health Reform and United Minnesota. The company’s “United Minnesota” Modernization we are committed to helping tackle initiative is a 10-year, $100 million philanthropic the toughest health challenges facing the nation. program to create sustainable improvements in health, Supplementing the resources and experience of our education and well-being in Minnesota. Among other enterprise with leading research groups and academic activities in 2010, UnitedHealthcare contributed teams, the Center assesses and develops innovative $17.5 million to enhance trauma care for children policies and practical solutions and seeks to share across the region by supporting the creation of a information with policymakers and the public. Level I Pediatric Trauma Center at Children’s Hospitals In 2010, the Center contributed three major research and Clinics of Minnesota in Minneapolis. reports, which can be downloaded from our website Make-A-Wish Foundation®. In 2010, UnitedHealth at unitedhealthgroup.com/reform: Group renewed its commitment to help bring hope, Coverage for Consumers, Savings for States: Options for Modernizing Medicaid. The report shows how states and the federal government could save an estimated $366 billion over the next decade by modernizing Medicaid. (April 2010) U.S. Deﬁ cit Reduction: The Medicare and Medicaid Modernization Opportunity. A new study offers practical solutions to reduce the growing U.S. budget deﬁ cit through Medicare and Medicaid reform, strength and joy to children with life-threatening medical conditions by pledging $3 million to the Make-A-Wish Foundation over the next three years. UnitedHealth Group is one of the Foundation’s largest national sponsors. American Heart Association. UnitedHealthcare, in 2010, committed $1.95 million over three years to the American Heart Association to help establish walking paths throughout the country. including practical ways federal and state governments United Volunteers. UnitedHealth Group employees could save taxpayers about $3.5 trillion over the next participated in more than 11,900 volunteer community 25 years. (October 2010) projects with an estimated in-kind value of $4 million, The United States of Diabetes: Challenges and an increase of $1.5 million over 2009. Opportunities in the Decade Ahead. Research Annual Employee Giving Campaign. UnitedHealth indicates that more than 50 percent of Americans Group’s annual nationwide giving campaign solicits could have diabetes or prediabetes by 2020 at a cost employee donations to community charities of their of $3.4 trillion over the next decade. This report offers choice. Employee pledges and the company-matching practical solutions that could improve health and life pledge totaled $14 million for 2010, our highest amount expectancy, while also saving up to $250 billion over to date, up 11 percent over 2009. the next 10 years. (November 2010) Please see our 2010 Social Responsibility Report for more information: unitedhealthgroup.com/SR 20 UnitedHealth Group foundations United Health Foundation The United Health Foundation is a not-for-proﬁ t, private UnitedHealthcare Children’s Foundation foundation that provides actionable information to Children who have medical needs sometimes lack support decisions that lead to better health outcomes comprehensive insurance that covers all of their and healthier communities. Established by UnitedHealth medical treatments. There are few places their families Group in 1999, the Foundation has committed more can turn for additional funds. than $187 million to improve health and health care. Following are examples of its initiatives: As a result, far too many children risk going without necessary treatment, or they receive needed care The United Health Foundation’s America’s Health while their families are burdened with large ﬁ nancial Rankings® is an annual state-by-state assessment obligations. The UnitedHealthcare Children’s of the nation’s health. In collaboration with the Foundation provides medical grants, up to $5,000, American Public Health Association and Partnership to help meet this need. for Prevention, for more than 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. Jayden, a 3-year-old from South Carolina, was diagnosed with three types of congenital heart defects To increase access to health care for underserved at birth. He had heart communities, the Foundation’s Community Health surgery a few months ago, Centers of Excellence initiative supports community is recovering quickly and clinics that are part of our nation’s health care safety his energy level has soared. net in New Orleans, Miami, New York City and Washington, D.C. "This grant has meant so much to our family and has The Foundation’s Diverse Scholars initiative supports allowed us to focus on the Three-year-old Jayden and his family received a grant from the UnitedHealthcare hundreds of low-income minority students pursuing recovery of our son," says Children’s Foundation. degrees in the health ﬁ eld. The goal of the initiative is to Jacqueline, Jayden’s mom. increase the number of qualiﬁ ed, yet under-represented, college graduates entering the health workforce. In 2010, the UnitedHealthcare Children’s Foundation provided 787 medical grants, 75 percent more than The Foundation collaborates with health research 2009. The medical grants are made possible by our agencies, medical specialty societies and others to generous contributors, which include more than 8,000 translate science into practice and helps make reliable UnitedHealth Group employees, UnitedHealth Group medical evidence available to physicians and other care and individuals and corporations who believe in this providers. Through Advancing Clinical Excellence, the mission. www.uhccf.org United Health Foundation helps physicians and other health professionals achieve the best possible health outcomes for their patients. www.unitedhealthfoundation.org 2010 Summary Annual Report 21 2010 fi nancial results UnitedHealth Group Highlights • UnitedHealth Group revenues increased $7 billion, or • Diluted net earnings per common share were $4.10. 8 percent from 2009, to $94.2 billion in 2010, with four business units posting revenue increases of more than 10 percent year-over-year. • UnitedHealth Group achieved business growth across each of its reporting segments and generated earnings from operations of $7.9 billion. • The Board of Directors moved the company to a quarterly dividend payment cycle and raised the annual dividend rate to $0.50 per share in May 2010. The 2010 ﬁ nancial results on pages 22 through 25 should be read together with the consolidated ﬁ nancial statements and notes in the 2010 Annual Report on • Cash ﬂ ows from operations reached nearly Form 10-K. The 2010 Annual Report on Form 10-K is $6.3 billion, representing 135 percent of 2010 an integral part of this Summary Annual Report. net earnings. In millions, except percentages and per share data 2006 2007 2008 2009 2010 For the Year Ended December 31, Consolidated operating results Revenues Earnings from operations Net earnings $ 71,542 $ 75,431 $ 81,186 $ 87,138 $ 94,155 6,984 4,159 7,849 4,654 5,263 2,977 6,359 3,822 7,864 4,634 Return on shareholders’ equity 22.2% 22.4% 14.9% 17.3% 18.7% Basic net earnings per common share Diluted net earnings per common share Common stock dividends per share Consolidated cash ﬂ ows from (used for) Operating activities Investing activities Financing activities $ 3.09 2.97 0.030 $ 6,526 (2,101) 474 $ 3.55 3.42 0.030 $ 5,877 (4,147) (3,185) $ 2.45 2.40 0.030 $ 4,238 (5,072) (605) $ 3.27 3.24 0.030 $ 4.14 4.10 0.405 $ 5,625 $ 6,273 (976) (2,275) (5,339) (1,611) Consolidated ﬁ nancial condition (As of December 31) Cash and investments Total assets Total commercial paper and long-term debt Shareholders’ equity Debt-to-total-capital ratio $ 20,582 $ 22,286 $ 21,575 $ 24,350 $ 25,902 48,320 7,456 20,810 50,899 11,009 20,063 55,815 12,794 20,780 59,045 11,173 23,606 63,063 11,142 25,825 26.4% 35.4% 38.1% 32.1% 30.1% 22 UnitedHealth Group Revenues (in millions) Earnings from Operations (in millions) Operating Margin $94,155 $87,138 $81,186 $6,984 $71,542 $75,431 $7,849 $7,864 10.4% 9.8% $6,359 $5,263 8.4% 7.3% 6.5% 06 07 08 09 10 06 07 08 09 10 06 07 08 09 10 Cash Flows from Operations (in millions) Diluted Earnings per Share Cash Dividend per Share of Common Stock $6,526 $5,877 $6,273 $5,625 $4,238 $3.42 $2.97 $3.24 $2.40 $4.10 $0.405 06 07 08 09 10 06 07 08 09 10 06 07 08 09 10 $0.03 $0.03 $0.03 $0.03 2010 Summary Annual Report 23 2010 fi nancial results UnitedHealthcare Highlights (includes UnitedHealthcare Employer & Individual, Medicare & Retirement and Community & State) • For full year 2010, UnitedHealthcare revenue of $87.4 billion increased $6.1 billion, or 8 percent, year-over-year. The UnitedHealthcare businesses provided services to more than 37 million people at year-end, a net increase of 1.2 million people during the year. • UnitedHealthcare Employer & Individual revenues of $41.2 billion grew by 1 percent in 2010. This business grew to serve 24.8 million individuals in 2010, an increase of 185,000 people during the year. • UnitedHealthcare Medicare & Retirement revenues of $35.9 billion increased 12 percent compared to 2009, driven by an increase of 600,000 customers in UnitedHealthcare’s primary senior market offerings—including growth of 280,000 seniors in Medicare Advantage products, 90,000 in active Medicare Supplement offerings, and 230,000 in stand-alone Part D prescription drug plans. At year-end, the company served 9 million seniors. • UnitedHealthcare Community & State revenues of $10.4 billion in 2010 increased by $2 billion, or 24 percent, year-over-year primarily due to strong organic growth in individuals served. The business grew its risk-based Medicaid programs by 420,000 individuals and served more than 3.3 million people in 24 markets at year-end. Optum Highlights The Optum businesses—OptumHealth, OptumInsight and OptumRx—increased their combined revenues by 15 percent to $25 billion in 2010. OptumHealth • OptumHealth revenues of $5.8 billion increased $321 million, or 6 percent, over 2009 primarily due to new business development in large scale public sector care management and behavioral health programs, and increased sales of beneﬁ ts and services to external employer markets, partially offset by a decline in revenues from the sale of internal commercial products and the loss of some smaller specialty beneﬁ ts customers. • OptumHealth Financial Services grew its connectivity network to more than 540,000 physicians and care providers in 2010 and electronically transmitted more than $43 billion in medical payments to them, a year-over-year increase of 22 percent. Assets under management in health-linked savings and investment accounts reached $1.1 billion, an increase of 28 percent over 2009. OptumInsight • OptumInsight provided services in more than 70 countries and serves virtually every category of participant in the U.S. health system. • Revenues for OptumInsight increased $518 million, or 28 percent, during 2010 to $2.3 billion primarily due to acquisitions and organic growth in health information technology offerings and services focused on cost and data management and regulatory compliance. OptumInsight operating margin was 3.6 percent (12.1 percent* excluding goodwill impairment and business line disposition charges related to certain i3 branded clinical trial service businesses). • The OptumInsight contract revenue backlog grew by 57 percent during 2010 to $2.8 billion, driven by acquisition-related backlog expansion and organic growth. The backlog does not include approximately $500 million for the portion of the i3 business that is being divested. OptumRx • OptumRx 2010 revenues of $16.8 billion grew $2.3 billion, or 16 percent, year-over-year due to strong growth in consumers served through Medicare Part D prescription drug plans. • During the year, OptumRx processed nearly 350 million adjusted scripts for 12.3 million individuals. • Generic prescriptions reached 73.2 percent of all scripts ﬁ lled by OptumRx by the fourth quarter 2010, an increase of 350 basis points year-over-year. The expanded use of generics increases the affordability of health care and also increases earnings from operations at OptumRx. *See page 26 for a reconciliation of adjusted operating margin, which is a non-GAAP ﬁ nancial measure, to operating margin. 24 UnitedHealth Group Revenues (in millions) Earnings From Operating Margin Operations (in millions) UnitedHealthcare $67,817 $71,199 $75,857 $87,442 $81,341 $6,595 $5,860 $6,636 9.3% 8.6% $5,068 $4,788 7.6% 6.7% 5.9% 06 07 08 09 10 06 07 08 09 10 06 07 08 09 10 Optum (combined) $19,474 $19,350 $9,382 $24,966 $21,803 $1,571 $1,430 $1,310 $1,228 $1,124 12.0% 7.3% 6.8% 7.2% 4.9% 06 07 08 09 10 06 07 08 09 10 06 07 08 09 10 OptumHealth $4,921 $5,225 $5,528 $5,849 $895 $809 $4,342 $718 $636 $610 18.6% 18.2% 13.7% 11.5% 10.4% 06 07 08 09 10 06 07 08 09 10 06 07 08 09 10 OptumInsight $1,552 $1,304 $956 $2,341 $1,823 $176 $266 $246 $229 20.4% 18.4% 14.8% 13.5% 12.1%* $84 06 07 08 09 10 06 07 08 09 10 06 07 08 09 10 OptumRx $16,776 $13,249 $12,573 $14,452 $689 $534 $4,084 $363 $269 $139 4.8% 3.2% 3.4% 2.9% 2.0% 06 07 08 09 10 06 07 08 09 10 06 07 08 09 10 *See page 26 for a reconciliation of adjusted operating margin, which is a non-GAAP ﬁ nancial measure, to operating margin. 2010 Summary Annual Report 25 non-GAAP reconciliation and disclaimer Non-GAAP Reconciliation UNITEDHEALTH GROUP Reconciliation of Non-GAAP Financial Measures OptumInsight Results Excluding Special Items (in millions, except percentages) Year Ended December 31, 2010 Consolidated GAAP Reporting Non-GAAP Reconciling Items (a) Operating Results Excluding Non-GAAP Reconciling Items $ 84 $ 200 $ 284 3.6% 8.5% 12.1% OptumInsight Earnings from Operations OptumInsight Operating Margin (a) Includes a total of $200 million in goodwill impairment and business line disposition charges. Forward-Looking Statements This Summary Annual Report may contain statements, estimates, projections, guidance or outlook that constitute “forward-looking” statements as deﬁ ned under U.S. federal securities laws. Generally the words “believe,” “expect,” “intend,” “estimate,” “anticipate,” “plan,” “project,” “should” and similar expressions identify forward- looking statements, which generally are not historical in nature. These statements may contain information about ﬁ nancial prospects, economic conditions, trends and uncertainties and involve risks and uncertainties. We caution that actual results could differ materially from those that management expects, depending on the outcome of certain factors. Some factors that could cause results to differ materially from the forward-looking statements include: our ability to effectively estimate, price for and manage our medical costs, including the impact of any new coverage requirements; the potential impact that new laws or regulations, or changes in existing laws or regulations, or their enforcement or application could have on our results of operations, ﬁ nancial position and cash ﬂ ows, including as a result of increases in medical, administrative, technology or other costs resulting from federal and state regulations affecting the health care industry; the ultimate impact of the Patient Protection and Affordable Care Act, which could materially adversely affect our ﬁ nancial position and results of operations through reduced revenues, increased costs, new taxes and expanded liability, or require changes to the ways in which we conduct business or put us at risk for loss of business; uncertainties regarding changes in Medicare, including potential changes in risk adjustment data validation audit and payment adjustment methodology; potential reductions in revenue received from Medicare and Medicaid programs; failure to comply with restrictions on patient privacy and data security regulations; regulatory and other risks and uncertainties associated with the pharmacy beneﬁ ts management industry; competitive pressures, which could affect our ability to maintain or increase our market share; 2010 OptumInsight earnings from operations and operating margins excluding special items as used in this Summary Annual Report are not calculated in accordance with GAAP and should not be considered substitutes for or superior to ﬁ nancial measures calculated in accordance with GAAP. Management believes that the use of non-GAAP ﬁ nancial measures improves the comparability of our results between periods. These ﬁ nancial measures provide investors and our management with useful information to measure and forecast our results of operations, to compare on a consistent basis our results of operations for the current period to that of prior periods, and to compare our results of operations on a more consistent basis against that of other companies in the health care industry. These non-GAAP ﬁ nancial measures have limitations in that they do not reﬂ ect all of the special items associated with the operations of our business as determined in accordance with GAAP. As a result, one should not consider these measures in isolation. We compensate for these limitations by analyzing current and future results on a GAAP basis as well as non-GAAP basis, disclosing these GAAP ﬁ nancial measures, and providing a reconciliation from GAAP to non-GAAP ﬁ nancial measures. the potential impact of adverse economic conditions on our revenues (including decreases in enrollment resulting from increases in the unemployment rate and commercial attrition) and results of operations; our ability to execute contracts on competitive terms with physicians, hospitals and other service professionals; our ability to attract, retain and provide support to a network of independent third party brokers, consultants and agents; events that may negatively affect our contracts with AARP; increases in costs and other liabilities associated with increased litigation, government investigations, audits or reviews; the performance of our investment portfolio; possible impairment of the value of our intangible assets in connection with dispositions or if future results do not adequately support goodwill and intangible assets recorded for our existing businesses or the businesses that we acquire; increases in health care costs resulting from large-scale medical emergencies; failure to maintain effective and efﬁ cient information systems or if our technology products do not operate as intended; misappropriation of our proprietary technology; our ability to obtain sufﬁ cient funds from our regulated subsidiaries to fund our obligations; the potential impact of our future cash and capital requirements on our ability to maintain our quarterly dividend payment cycle; failure to complete or receive anticipated beneﬁ ts of acquisitions; potential downgrades in our credit ratings; and failure to achieve targeted operating cost productivity improvements, including savings resulting from technology enhancement and administrative modernization. This list of important factors is not intended to be exhaustive. A further list and description of some of these risks and uncertainties can be found in our reports ﬁ led with the Securities and Exchange Commission from time to time, including the cautionary statements in our annual reports on Form 10-K, quarterly reports on Form 10-Q and current reports on Form 8-K. Any or all forward-looking statements we make may turn out to be wrong. You should not place undue reliance on forward-looking statements, which speak only as of the date they are made. We do not undertake to update or revise any forward-looking statements. 26 UnitedHealth Group offi cers and directors Ofﬁ cers and Leaders Stephen J. Hemsley President and Chief Executive Ofﬁ cer Gail K. Boudreaux Executive Vice President, UnitedHealth Group and Chief Executive Ofﬁ cer, UnitedHealthcare G. Mike Mikan Executive Vice President, UnitedHealth Group and Chief Executive Ofﬁ cer, Optum William A. Munsell Executive Vice President Don Nathan Senior Vice President and Chief Communications Ofﬁ cer John S. Penshorn Senior Vice President, Capital Markets Communications and Strategy Eric S. Rangen Senior Vice President and Chief Accounting Ofﬁ cer Larry C. Renfro Executive Vice President Jeannine M. Rivet Executive Vice President Simon Stevens Executive Vice President and President, Global Health Lori K. Sweere Executive Vice President, Human Capital 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 David S. Wichmann Executive Vice President and Chief Financial Ofﬁ cer, UnitedHealth Group 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 Ofﬁ cer, Johnson & Johnson Stephen J. Hemsley President and Chief Executive Ofﬁ cer, UnitedHealth Group Michele J. Hooper President and Chief Executive Ofﬁ cer, The Directors’ Council Rodger A. Lawson Retired President and Chief Executive Ofﬁ cer, Fidelity Investments – Financial Services Douglas W. Leatherdale Retired Chairman and Chief Executive Ofﬁ cer, The St. Paul Companies, Inc. Glenn M. Renwick President and Chief Executive Ofﬁ cer, 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. 2010 Summary Annual Report 27 investor information Market price of common stock Investor relations The following table shows the range of high and low You can contact UnitedHealth Group Investor sales prices for the company’s common stock as Relations to order, without charge, ﬁ nancial reported by the New York Stock Exchange, where documents such as the Annual Report on it trades under the symbol UNH. These prices do Form 10-K and the Summary Annual Report. not include commissions or fees associated with purchasing or selling this security. You can write to us at: Investor Relations, MN008-T930 2011 First Quarter (through February 9, 2011) 2010 First Quarter Second Quarter Third Quarter Fourth Quarter 2009 First Quarter Second Quarter Third Quarter Fourth Quarter high low UnitedHealth Group P.O. Box 1459 Minneapolis, Minnesota 55440-1459 $44.09 $36.37 $36.07 $34.00 $35.94 $38.06 $30.25 $29.69 $30.00 $33.25 $30.97 $27.97 $27.13 $33.94 $16.18 $19.85 $23.69 $23.50 You can also obtain information about UnitedHealth Group and its businesses, including ﬁ nancial 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 23, 2011, 10:00 a.m. Paciﬁ c Time at the following location: Anthony Marlon Auditorium As of February 4, 2011, the company had 17,563 shareholders of record. UnitedHealthcare, a UnitedHealth Group company 2700 North Tenaya Way Las Vegas, Nevada You will need to bring your admission card with you to the annual meeting in order to be admitted. Common stock dividends In May 2010, our Board of Directors increased our cash dividend to shareholders and moved us to a quarterly dividend payment cycle of $0.125 per share. Declaration and payment of future quarterly dividends is at the discretion of the Board and may be adjusted as business needs or market conditions change. Prior to May 2010, our policy had been to pay an annual dividend of $0.030 per share. 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 certiﬁ cates • 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 28 UnitedHealth Group Our Mission Our Mission Our mission is to help people live healthier lives. Our role is to help make health care work for everyone. Our mission is to help people live healthier lives. Our role is to help make health care work for everyone. We seek to enhance the We seek to enhance the We work with health care We work with health care We support the physician/ We support the physician/ performance of the health performance of the health professionals and other key professionals and other key patient relationship and patient relationship and system and improve the system and improve the partners to expand access to partners to expand access to empower people with the empower people with the overall health and well-being overall health and well-being quality health care so people quality health care so people information, guidance and tools information, guidance and tools of the people we serve and of the people we serve and get the care they need at an get the care they need at an they need to make personal they need to make personal their communities. their communities. affordable price. affordable price. health choices and decisions. health choices and decisions. Our Culture The people of this company are aligned around basic other health care professionals, hospitals and the values that inspire our behavior as individuals and individual consumers of health care. Trust is earned as an institution: Integrity. We are dedicated to the highest levels of personal and institutional integrity. We make honest commitments and work to consistently honor those commitments. We do not compromise ethics. We and preserved through truthfulness, integrity, active engagement and collaboration with our colleagues and clients. We encourage the variety of thoughts and perspectives that reflect the diversity of our markets, customers and workforce. strive to deliver on our promises and we have the Innovation. We pursue a course of continuous, courage to acknowledge mistakes and do whatever positive and practical innovation, using our deep is needed to address them. experience in health care to be thoughtful advocates Compassion. We try to walk in the shoes of the people we serve and the people we work with across the health care community. Our job is to listen with empathy and then respond appropriately and quickly of change and to use the insights we gain to invent a better future that will make the health care environment work and serve everyone more fairly, productively and consistently. with service and advocacy for each individual, each Performance. We are committed to deliver and group or community and for society as a whole. We demonstrate excellence in everything we do. We celebrate our role in serving people and society in an will be accountable and responsible for consistently area so vitally human as their health. delivering high-quality and superior results that make Relationships. We build trust through cultivating relationships and working in productive collabo ration with government, employers, physicians, nurses and a difference in the lives of the people we touch. We continue to challenge ourselves to strive for even better outcomes in all key performance areas. 2010 Summary Annual Report 29 UnitedHealth Group Center 9900 Bren Road East Minnetonka, Minnesota 55343 unitedhealthgroup.com 100-10349 4/11

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