Improving Health Care Affordability

UnitedHealth Group is committed to helping reduce health care costs both at an individual and system level. We are fulfilling that commitment by helping consumers access the right care at the right time and place, reducing prescription drug costs and expanding value-based care to pay for outcomes rather than volume of services. The cost of health care in the United States continues to increase, with overall spending reaching $3.8 trillion in 2019 or more than $11,500 per person. Costs are expected to continue to increase, exceeding $6 trillion by 2028. We are committed to helping lower the cost of care for those we serve. Working across the health system – with governments, customers, providers and consumers – our objective is to help change the trajectory of health care spending to lower the total cost of care.

Improving Cost Transparency

UnitedHealth Group has developed a broad portfolio of products and services to help people compare health care services based on quality and cost. We are providing consumers and their physicians access to more information about their health care options than ever before, whether searching for the right site of care or a preferred provider.

Empowering people with information about health care quality and cost helps them make more informed choices. Collectively, UnitedHealthcare’s transparency tools are available to over 27 million members who can search prices for more than 820 services. People who use transparency tools pay 36% less, on average, than nonusers.

PreCheck MyScript®, a digital transparency tool from OptumRx, helps patients navigate the complexities of prescription drug pricing by providing price and coverage information to physicians at the point of prescribing. It offers clinically appropriate, lower-cost options and calculates exactly how much each drug option will save the patient, while leaving ultimate decision-making to the patient and their physician.

Precheck MyScript Impact
  • 563k clinicians have access
  • 14M unique members impacted
  • $225 average savings per prescription for consumers

Advancing Value-Based Care

UnitedHealth Group is committed to advancing value-based care, with a focus on helping providers transition into arrangements where they are financially accountable for their patients’ care. UnitedHealthcare partners closely with care providers on value-based contracts that emphasize care coordination by providing actionable data and care management tools that deliver better outcomes at a lower cost to consumers, governments and the health system.

Accountable Care Organizations (ACO) – consisting of groups of health care providers that work together to coordinate patient care – provide higher-quality care at a lower cost. Providers are paid based on their ability to deliver improved patient outcomes and a better experience.

UnitedHealthcare currently operates more than 1,500 accountable care agreements in which providers take on more financial accountability for their patients’ care. Commercial ACO members are more likely to see a primary care provider, get preventive screenings and avoid a hospital admission or visit to the emergency department (ED).

ACO Outcomes
  • 14% higher likelihood members get preventive cancer screenings
  • 15% fewer hospital admissions
  • 16% fewer ED visits

Optimizing Site Of Service

UnitedHealth Group recognizes there is a meaningful opportunity to drive greater affordability for consumers and the health system by helping people access high-quality care in a low-cost setting. Treating patients in such settings can generate significant savings for the health system – including consumers, employers and government programs.

$320B

could be saved over the next decade by treating common conditions in primary care settings instead of the ED

Reducing avoidable ED visits lowers costs for the health system. Two-thirds of visits to the hospital ED by privately insured individuals are avoidable, often involving conditions like bronchitis, flu or nausea.

Optum’s Rally® platform uses digital transparency tools that allow consumers to see the cost of care before they receive it, helping people avoid the ED in favor of lower-cost settings when clinically appropriate.

Rally Outcomes
  • 9% decrease in ED utilization

Improving access to high-quality, low-cost care settings can generate significant savings for the health system. For example, conducting more joint replacement surgeries in ambulatory surgery centers instead of a hospital among commercially insured individuals could save the health system $20 billion over 10 years.

More than 53,000 employed and aligned Optum Care physicians are serving nearly 20 million U.S. patients in the most appropriate care settings, from primary and specialty care to urgent care, outpatient surgical care and in-home care. Our physician-led, technology enabled care settings are working to lower the overall cost of care for consumers and the health system broadly with a holistic, high-quality approach to patient care.

Optum Care Outcomes
  • Up to 30%

    lower cost of care compared to Medicare fee-for-service
  • 9 out of 10

    patients would send their friends to Optum Care

Our Commitment

More than 55% of outpatient surgeries and radiology services among our members will be delivered at high-quality, cost-efficient sites of care by 2030

About Our Commitment
Medical care provided at sites of care that meet quality and cost-efficiency criteria predictably leads to better health outcomes at a lower cost for the consumer. In particular, ambulatory surgery centers and stand-alone imaging centers frequently provide the same or better quality care at a lower cost compared to a hospital.

Why It’s Important
The cost of care varies considerably depending on where care is provided. For example, the average price for routine diagnostic imaging at a hospital outpatient department can be 165% more than the price of a test performed at a stand-alone imaging center or physician’s office. Consistent with the Department of Health and Human Services’ Healthy People 2030 goal of reducing preventable hospital visits, helping people access care in high-quality, lower-cost settings makes care more affordable and may lead to better health outcomes.

How We’ll Do It
In 2019, 47% of outpatient surgeries and radiology services among our members were delivered at high-quality, cost-effective sites of care. By equipping physicians with point-of-care tools that facilitate shared decision-making and help guide patients to the most appropriate, low-cost care setting, we are committed to ensuring more than 55% of outpatient surgeries and radiology services among our members are delivered at a high-quality, cost-efficient site of care by 2030. Digital tools can also help members identify the care setting that best suits their medical and financial needs and improve convenient access to quality care providers.

Potential Impact
Helping consumers access high-quality, cost-efficient sites of care can have a significant impact on the total cost of care, resulting in more affordable care and better health outcomes for the patient. For example, conducting more joint replacement surgeries in ambulatory surgery centers could save the U.S. health system $3 billion annually and lead to 500,000 fewer hospitalizations. And shifting routine diagnostic tests from an outpatient hospital department to a stand-alone imaging center or a physician’s office could reduce spending by 62% and save consumers more than $300 per test.

Lowering The Cost Of Prescription Drugs

Americans spend more than $1,200 per year, on average, on prescription drugs – among the highest in the world. UnitedHealth Group is actively working to reduce prescription drug costs for consumers, governments and employers.

Drug discounts are among the solutions we are actively advancing to help lower out-of-pocket costs for consumers while maintaining choices and stable premiums, even as drug prices continue to increase.

In 2020, OptumRx and UnitedHealthcare led the industry in expanding point-of-sale prescription drug discount programs to all new employer-sponsored plans – making medications more affordable for consumers by applying the discount at the pharmacy counter and improving health outcomes through medication adherence.

OptumRx’s commitment to prescription drug affordability also includes a drug discount card program – available to all Americans – that delivers up to 80% consumer savings on retail prices at over 64,000 pharmacies.

  • $189 annual consumer savings from point-of-sale discounts

Specialty drugs treat some of the most complex diseases, with the potential to significantly impact people’s lives. However, high-cost specialty drugs account for nearly 50% of drug spending in the U.S.

Research shows that administering specialty drugs in physicians’ offices and patients’ homes – instead of hospital outpatient settings – can save between $16,000 and $37,000 per patient per year for the five conditions that account for more than 75% of specialty drug spending. Our nurses are caring for more patients at home, making 20,000 home visits per month, on average, to administer these drugs.

OptumRx’s personalized, consumer-centric care model also helps patients manage the complexities of specialty drugs by improving medication adherence, ultimately leading to lower medical costs and better health outcomes.

OptumRx Specialty Pharmacy Services Impact on Patients
OptumRx Specialty Pharmacy Services Impact on Patients
Inflammatory Conditions
  • 20% higher medication adherence
  • 4% lower medical costs
Hepatitis C
  • 21% higher medication adherence
  • 10% lower medical costs