This ranking evaluates how Fortune 500 companies are deploying AI, and how technology leaders value those investments relative to industry peers.

Fortune AIQ 75

The companies on the Global 500 employ 70.2 million people, and their revenue represents more than one-third of the world’s GDP.

Fortune Global 500

With a combined revenue of $21 trillion and $2.1 trillion in profits, the 2026 Fortune 500 is the definitive list of America's largest companies.

Fortune 500

The 300 companies on this year’s list brought in over $12.5 trillion in revenue for the latest 12 months, with the median revenue figure at $24 billion.

America's Most Innovative Companies

AI is a major force shaping this year’s list—but it’s far from the only story.

World's Most Admired Companies

Fortune AIQ 50

The corporations on our annual list of the world's 500 largest companies combined to generate $41.7 trillion in revenue over the past year.

Almost $20 trillion in revenue—and a record-breaking $1.87 trillion in profits. Introducing the 2025 Fortune 500, the definitive list of the biggest companies in America.

UnitedHealth Group is a diversified health care company. Its four main segments are UnitedHealthcare, which offers health care coverage to employers, small businesses, and individuals; Optum Health, which provides health care delivery and management; Optum Insight, which sells health care software and provides data analysis and consulting services; and Optum Rx, which offers pharmacy benefits management and other pharmacy services. Founded in 1974, UnitedHealth has grown rapidly, organically, and through acquisitions; it was the largest U.S. health care company by revenue in 2024.

The 300 companies on this year’s list brought in over $12.6 trillion in revenue for the latest 12 months, with the median revenue figure at $22 billion.

Leaders in all industries rely more than ever on Big Tech—and appreciate the giants that deliver, at scale, without drama.

The corporations on our annual list posted aggregate revenues of $41 trillion for the second year in a row.

Industries included in the sector are insurance and managed care, medical products and facilities, pharmacy services, and pharmaceutical companies.

Fortune Sector Leaders: Health Care

The Fortune 500, in its 70th year in 2024, ranks the biggest U.S. companies by revenue.

The 200 companies on this list are transforming industries from the inside out.

The 26th edition of the list shows how much esteem Big Tech giants command among other business leaders.

The 25th Fortune World’s Most Admired Companies list suggests that tech giants’ peers respect them as much as ever.

The corporations on our annual list of the world’s largest companies delivered a record $41 trillion in aggregate revenues.

G500-2023-UnitedHealth Group

<span data-sheets-value="{&quot;1&quot;:2,&quot;2&quot;:&quot;The health insurance and health care services provider brought in $324.2 billion in revenue in 2022, making it the largest company in the U.S. health care sector.\n\n–As of the end of Q1 2023, UnitedHealthcare, the company’s insurance arm, served nearly 2 million more people than a year earlier, for a total of 52.9 million.\n–Revenue per consumer served in UnitedHealth’s Optum health services division increased 34% in Q1 2023 over the same quarter a year earlier.\n–In March 2023, the U.S. Justice Department dropped an appeal that challenged UnitedHealth Group’s $8 billion acquisition of data analytics company Change Healthcare.&quot;}" data-sheets-userformat="{&quot;2&quot;:771,&quot;3&quot;:{&quot;1&quot;:0},&quot;4&quot;:{&quot;1&quot;:2,&quot;2&quot;:16770457},&quot;11&quot;:4,&quot;12&quot;:0}">The health insurance and health care services provider brought in $324.2 billion in revenue in 2022, making it the largest company in the U.S. health care sector. 
<ul> 
 	<li><span data-sheets-value="{&quot;1&quot;:2,&quot;2&quot;:&quot;The health insurance and health care services provider brought in $324.2 billion in revenue in 2022, making it the largest company in the U.S. health care sector.\n\n–As of the end of Q1 2023, UnitedHealthcare, the company’s insurance arm, served nearly 2 million more people than a year earlier, for a total of 52.9 million.\n–Revenue per consumer served in UnitedHealth’s Optum health services division increased 34% in Q1 2023 over the same quarter a year earlier.\n–In March 2023, the U.S. Justice Department dropped an appeal that challenged UnitedHealth Group’s $8 billion acquisition of data analytics company Change Healthcare.&quot;}" data-sheets-userformat="{&quot;2&quot;:771,&quot;3&quot;:{&quot;1&quot;:0},&quot;4&quot;:{&quot;1&quot;:2,&quot;2&quot;:16770457},&quot;11&quot;:4,&quot;12&quot;:0}">As of the end of Q1 2023, UnitedHealthcare, the company’s insurance arm, served nearly 2 million more people than a year earlier, for a total of 52.9 million.</li> 
 	<li><span data-sheets-value="{&quot;1&quot;:2,&quot;2&quot;:&quot;The health insurance and health care services provider brought in $324.2 billion in revenue in 2022, making it the largest company in the U.S. health care sector.\n\n–As of the end of Q1 2023, UnitedHealthcare, the company’s insurance arm, served nearly 2 million more people than a year earlier, for a total of 52.9 million.\n–Revenue per consumer served in UnitedHealth’s Optum health services division increased 34% in Q1 2023 over the same quarter a year earlier.\n–In March 2023, the U.S. Justice Department dropped an appeal that challenged UnitedHealth Group’s $8 billion acquisition of data analytics company Change Healthcare.&quot;}" data-sheets-userformat="{&quot;2&quot;:771,&quot;3&quot;:{&quot;1&quot;:0},&quot;4&quot;:{&quot;1&quot;:2,&quot;2&quot;:16770457},&quot;11&quot;:4,&quot;12&quot;:0}">Revenue per consumer served in UnitedHealth’s Optum health services division increased 34% in Q1 2023 over the same quarter a year earlier.</li> 
 	<li><span data-sheets-value="{&quot;1&quot;:2,&quot;2&quot;:&quot;The health insurance and health care services provider brought in $324.2 billion in revenue in 2022, making it the largest company in the U.S. health care sector.\n\n–As of the end of Q1 2023, UnitedHealthcare, the company’s insurance arm, served nearly 2 million more people than a year earlier, for a total of 52.9 million.\n–Revenue per consumer served in UnitedHealth’s Optum health services division increased 34% in Q1 2023 over the same quarter a year earlier.\n–In March 2023, the U.S. Justice Department dropped an appeal that challenged UnitedHealth Group’s $8 billion acquisition of data analytics company Change Healthcare.&quot;}" data-sheets-userformat="{&quot;2&quot;:771,&quot;3&quot;:{&quot;1&quot;:0},&quot;4&quot;:{&quot;1&quot;:2,&quot;2&quot;:16770457},&quot;11&quot;:4,&quot;12&quot;:0}">In March 2023, the U.S. Justice Department dropped an appeal that challenged UnitedHealth Group’s $8 billion acquisition of data analytics company Change Healthcare.</li> 
</ul>

The 300 companies on this list are transforming industries from the inside out.

F500-2020-008-United-Health-Car

UnitedHealthcare and Optum are the main subsidiaries of UnitedHealth Group.

The Fortune 500, in its 69th year in 2023, ranks the biggest U.S. companies by revenue.

F500 2023-United Health

The health insurance and health care services provider sits at No. 5 for a third consecutive year. The company’s $324.2 billion in revenue in 2022 made it the largest Fortune 500 company in the health care sector. 
<ul> 
 	<li>As of the end of Q1 2023, UnitedHealthcare, the company’s insurance arm, served nearly 2 million more people than a year earlier, for a total of 52.9 million.</li> 
 	<li>Revenue per consumer served in UnitedHealth’s Optum health services division increased 34% in Q1 2023 over the same quarter a year earlier.</li> 
 	<li>In March 2023, the U.S. Justice Department dropped an appeal that challenged UnitedHealth Group’s $8 billion acquisition of data analytics company Change Healthcare.</li> 
</ul>

Just as it dominates our economy, Big Tech now dominates Fortune’s annual ranking of corporate reputation.

Aggregate sales hit $37.8 trillion last year—an increase of 19%, the highest annual growth rate in the list’s history.

G500-2022-11-UnitedHealth Group

UnitedHealth Group maintains its status as the largest health insurance provider in the U.S., and 2021 was a year of significant growth. The company served 2.2 million more people than in the previous year and saw a 12% rise in revenue year over year, to $287 billion. Pharmacy benefits management company Optum, one of UnitedHealth’s subsidiaries, delivered a 33% increase in revenue per consumer. Adding a 16th company to its vast portfolio of acquisitions, UnitedHealth bought Golden Valley–based health insurer PreferredOne to compete for business in its home state of Minnesota.

This year’s Fortune 500 marks the 68th running of the list.

F500 2022 UnitedHealth Group

UnitedHealth Group maintains its status as the nation’s largest health insurance provider, and 2021 was a year of significant growth. The company served 2.2 million more people than in the previous year and saw a 12% rise in revenue year over year, to $287 billion. Pharmacy benefits management company Optum, one of UnitedHealth’s subsidiaries, delivered a 33% increase in revenue per consumer. Adding a 16th company to its vast portfolio of acquisitions, UnitedHealth bought Golden Valley–based health insurer PreferredOne to compete for business in its home state of Minnesota.

After a year in which humanity leaned more heavily than ever on tech giants, see which companies topped Fortune's ranking of corporate reputation.

WMAC 2021-50-UnitedHealth

Total revenue for the world’s biggest companies fell 4.8% to $31.7 trillion this year—the first decline in half a decade.

G500-2021-008-UnitedHealth Group

The Minnesota-based health insurer thrived during the pandemic year, climbing two spots on the list. While widespread layoffs led to a decline in the number of individuals covered by its commercial insurance, the firm’s 6.2% revenue growth was powered by greater enrollment in its Medicare Advantage and Medicaid plans, and by the strong performance of Optum, its sprawling $136 billion health services business. Despite the costs of covering COVID patients, UnitedHealth’s profits jumped 11.3%, owing to members’ decreased use of health services during the pandemic. In an abrupt leadership change, Andrew Witty, who previously ran the company’s Optum division, became CEO in February 2021.

This year’s Fortune 500 marks the 67th running of the list.

F500 2021-05-UnitedHealth

For an astounding 13th straight year, Apple claims the top spot in Fortune’s annual ranking of corporate reputation, based on a survey of almost 3,800 executives, directors, and analysts.

This year's Fortune Global 500 generated $33.3 trillion in revenues and $2.1 trillion in profits.

G500-2020-015-UnitedHealth-Group

The largest health insurer in the U.S. fired on all cylinders in 2019, with a 7% increase in annual revenues that brought the company's haul to $242 billion. Its UnitedHealthcare division grew by $10 billion last year, but the insurer's real and not-so-secret weapon continues to be its Optum unit, which provides an array of health care services including data analytics and pharmacy benefits management. Optum revenues climbed 12% year-over-year, to $113 billion. UnitedHealth Group also has considerable ambitions for its Medicare Advantage business, which had its best-ever enrollment last year, adding 325,000 elderly Americans.

This year's Fortune 500 marks the 66th running of the list.

The nation’s largest health insurer fired on all cylinders in 2019, with a 7% increase in revenues that brought the company to a total of $242 billion. Its UnitedHealthcare division grew by $10 billion last year, but the insurer's real not-so-secret weapon continued to be its Optum unit, which provides an array of health care services including data analytics and pharmacy benefits management. Optum revenues climbed 12% year-over-year to $113 billion. UnitedHealth Group also has considerable ambitions for its Medicare Advantage business, which had its best-ever enrollment last year, adding 325,000 elderly Americans.

Here are the World's Most Admired Companies for 2019 as ranked in their industries. See who made the list.

This year's Fortune Global 500 generated $27.7 trillion in revenues and $1.5 trillion in profits.

This year's Fortune 500 marks the 65th running of the list.

Here are the World's Most Admired Companies for 2018 as ranked in their industries. See who made the list.

This year's Fortune 500 marks the 64th running of the list.

Here are the World's Most Admired Companies for 2017 as ranked in their industries. See who made the list.

This year's Fortune 500 marks the 63rd running of the list.

Here are the World's Most Admired Companies for 2016 as ranked in their industries. See who made the list.

This year's Fortune Global 500 generated $27.6 trillion in revenues and $1.5 trillion in profits.

This year's Fortune 500 marks the 62nd running of the list.

Business insiders have spoken: Asked which companies they most admire, more than 4,100 executives, directors, and analysts chose these top 50 All-Stars.

The world's 500 largest companies generated $31.2 trillion in revenues and $1.7 trillion in profits in 2014. Together, this year's Fortune Global 500 employ 65 million people worldwide and are represented by 36 countries.

This year's Fortune 500 marks the 61st running of the list. Wal-Mart claims the top spot again. See who made the list.

Global business is back. After limping through a worldwide financial crisis and economic slowdown, the 500 largest companies ranked by revenues shattered all sorts of performance records in 2013: They racked up combined revenues of $31.1 trillion, up 2.5% from 2012, and profits soared 27% to nearly $2 trillion. China’s 95 companies (up from 89 last year) posted $5.8 trillion in revenues. The U.S. has four fewer companies on the list than last year but remains (for now) the country leader, with 128 corporations on the list—including No. 1 Wal-Mart Stores—reporting $8.6 trillion in revenues. 

Wal-Mart stayed on top as its sales crept closer to half-a-trillion dollars. Apple moved into the top five. And UnitedHealth Group continued its steady climb. 

Sector

Industry

Current All-Star Rank

Previous All-Star Rank

Industry Rank

Previous Industry Rank

Overall Score

Innovation

People Management

Use of Corporate Assets

Social Responsibility

Quality of Management

Financial Soundness

Long-Term Investment Value

Quality of Products/Services

Global Competitiveness

Strongest Dimension

Years on list

Previous rank

State

Key Financials (last Fiscal Year)

Revenues ($M)

Profits ($M)

Assets ($M)

Total Stockholder Equity ($M)

Profit Ratios

Profit as % of Revenues

Profits as % of Assets

Profits as % of Stockholder Equity

Earnings Per Share (last Fiscal Year)

Earnings Per Share ($)

EPS % Change (from prior fiscal year)

EPS % Change (5 year annual rate)

EPS % Change (10 year annual rate)

Total Return

Total Return to Investors (last year)

Total Return to Investors (5 year, annualized)

Total Return to Investors (10 year, annualized)

UnitedHealth Group is a Minnetonka, Minnesota-based health-care and insurance company founded in 1974. It operates through two platforms: UnitedHealthcare, which provides employer-sponsored, individual, Medicare, Medicaid, and other health-benefit plans; and Optum, a health-services business comprising Optum Health, Optum Insight, and Optum Rx. Optum delivers and supports care, provides technology, data, analytics, and consulting services, and operates pharmacy-benefit management and pharmacy-care businesses. UnitedHealth Group has expanded through organic growth and acquisitions and reported $447.6 billion in revenue in 2025.

Q2 2026

Q1 2026

Q4 2025

Q3 2025

Q2 2025

Q1 2025

Q4 2024

UnitedHealth Group (UNH): Company Profile, Stock Price, News, Rankings

legacy

UnitedHealth Group

unitedhealth group

Good morning, and welcome to the UnitedHealth Group First Quarter twenty twenty five Earnings Conference Call. A question and answer session will follow UnitedHealth Group's prepared remarks. As a reminder, this call is being recorded. Here are some important introductory information. This call contains forward looking statements under U.

S. Federal securities laws. These statements are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present expectations. A description of some of the risks and uncertainties can be found in the reports that we file with the Securities and Exchange Commission, including the cautionary statements included in our current and periodic filings. This call will also reference non GAAP amounts.

A reconciliation of the non GAAP to GAAP amounts is available on the Financial and Earnings Reports section of the company's Investor Relations page at www.unitedhealthgroup.com. Information presented on this call is contained in the earnings release we issued this morning and in our Form eight ks dated 04/17/2025, which may be accessed from the Investor Relations page of the company's website. I will now turn the conference over to the Chief Executive Officer of UnitedHealth Group, Andrew Witty.

Good morning, everyone. Thank you for joining us today. UnitedHealth Group started 2025 in two seemingly disparate ways. One, continued strong growth across our businesses. Our people are providing more health benefits and services to more members and patients as the market responds to our distinct offerings.

The other way, however, was an overall performance that was frankly unusual and unacceptable. As you saw in our release, we're revising our adjusted earnings per share outlook for the year to $26 to $26.50. This morning, we'll detail for you the factors driving our revised outlook and how we plan to address them. I'll start with performance, which was impacted by two broad factors in our Medicare businesses, care activity and member profiles. It's important to recognize UnitedHealthcare and Optum are distinct businesses with different models, markets, and products.

In addition, Optum's Medicare business is multi payer and not limited to just UnitedHealthcare members. Given these differences, changes in care activity and member profile do not always follow the same patterns and can result in different impacts to each business. The respective teams are urgently responding to our performance challenges. Starting with care activity. In UnitedHealthcare's Medicare Advantage business, we had planned for 2025 care activity to increase at a rate consistent with the utilization trend we saw in 2024.

Instead, though, first quarter twenty twenty five indications suggest care activity increased at twice that rate. Increases in physician and outpatient services were most notable and inpatient to a lesser extent. This increase in care activity was limited to our MA business and was not a factor in our commercial or Medicaid businesses. Care activity trends in those areas were as expected. Turning to member profile.

Unacicipated changes in our Optum Medicare membership is impacting 2025 revenue. We added more new Medicare patients to OptumHealth, a portion of whom were covered by plans that were exiting markets. They experienced a surprising lack of engagement last year, which led to twenty twenty five reimbursement levels well below what we would expect and likely not reflective of their actual health status. Additionally, many of the current and new complex patients we serve are more affected by the CMS risk model changes that we are in the process of implementing. To be sure, it is complicated, but we're not executing on the model transition as well as we should.

We must and will work to better anticipate and address these factors. Here, still early in 2025, we believe they are highly addressable as we look ahead to 2026. Let me now talk specifically about what we're doing. First, we're ensuring the complex patients most impacted by the previous administration's Medicare funding cuts engage in clinical and value based programs. Second, we're consistently engaging with members in their homes and in post discharge settings.

Engagement remains the key. Third, we are appropriately assessing and updating the health status of new patients, especially those at high risk levels. Fourth, to more effectively transition to the new CMS risk model, we're investing significantly in improving physician clinical workflow to help ensure better care and timely insights on when and where care is most efficient and effective. Finally, our Medicare Advantage plan designs and pricing for 2026 will be fully informed by these trends. While we are decidedly unsatisfied with these results, our growth and foundation for improvement remains solid.

UnitedHealthcare's Medicare Advantage business is on pace to serve an additional 800,000 people this year. OptumHealth is on track to add 650,000 net new patients to value based care arrangements. In Medicaid, we are growing and continue to see positive momentum in closing the gap between people's health status and state rates, and we are very appreciative of our state customers for the ongoing productive discussions. Within Optum, so far this year, OptumRx is off to a strong selling season characterized by new wins as well as high retention of long term customers. The growth of OptumRx underscores the vital role that PBMs play in helping to reduce the price of drugs for consumers and the value that sophisticated purchasers of health care, the employers, unions, and governments see in our efforts to counter the high prices set by drug manufacturers and to ensure that people have convenient access to high quality affordable drugs.

That's more important than ever as drug manufacturers continue to increase what they charge Americans, in some cases, 10 times what they charge people in Europe. The growth at UnitedHealthcare and Optum reflects the efforts of our 400,000 colleagues who come to work every day, thinking differently about what is possible, advancing new products and ideas while constantly refining existing programs, working to make things better for the people we are privileged to serve. Our team continues to innovate to make accessing care easier. For example, our newest tools have sparked a more than 40% increase in digital engagement among our senior members through the first quarter. We see evidence of this in sharply higher and earlier wellness visits to their primary care physicians, with total visits in the first quarter running far above the year ago period.

This will help members better manage their health and promote early detection of emerging issues. Further, Medicare Advantage also costs taxpayers less and delivers more to seniors than fee for service Medicare, especially in value based care arrangements. An essential approach in in in achieving both health outcomes and lowered costs is ensuring people get the care they need when and where they need it. And a good place to understand those needs better is in a senior's home. Our House Calls program does just that.

House Calls, which is only available in Medicare Advantage, provides a thorough in home clinical visit at no cost to seniors. Following CMS' best practices for such care, our clinicians review a patient's medical history and current medications, conduct comprehensive physical exams, provide lab tests and screenings, and coordinate necessary follow on care. Housecall's clinicians closed millions of care gaps last year, helping people stay out of the hospital and the emergency department and referring those in need to appropriate social services to help them live healthier at home. This is Medicare Advantage innovation and value in action, helping drive proactive, preventive engagement with the health system rather than more expensive reactive acute care. These benefits and innovations and their value to seniors and taxpayers were put at unnecessary risk by funding cuts in recent years to the Medicare Advantage program.

While we continue to navigate those funding cuts to seniors' benefits, it is significant that the recently released 2026 rate notice begins to reflect the accelerating care cost trends we have experienced for some time. This will provide much needed relief to seniors and reflects policymakers' understanding of the importance and the popularity of Medicare Advantage. Our work to deliver a better experience for people and lower cost spans our enterprise as it always has. Just within the last few weeks, we've introduced several initiatives that will help people in their health care journeys.

OptumRx will remove prior authorizations on 80 drugs accounting for more than 10% of our pharmaceutical prior authorizations.

And OptumRx has aligned payment models to pharmacies more closely to their cost for drugs. This helps pharmacies manage the ever increasing prices charged by drug manufacturers, enabling pharmacies to stock more medicines and ensuring more consistent pricing and access to medicine for consumers. 26,000,000 consumer calls were more accurately directed to the right advocate by an AI agent, improving the consumer experience and reducing wait times. We expect AI will direct over half of our calls to the best resource during 2025. All of these efforts are making things simpler and easier for consumers and providers, a goal we share with all health care stakeholders.

Yet, we all have to contend with the stubborn fact that health care costs more in The US than it should, even beyond the widely recognized disparities in drug prices. Common procedures such as heart bypass surgery, spinal fusions, and heart stents are four times as expensive in The US as they are in Germany, Australia, and The UK. Total Hip Replacements are twice as much. It's simply not sustainable. As we have made clear, we are as committed as ever to continuing down the path of transparency and affordability, ensuring that Americans get the health system they deserve.

With that, I'll turn it over to John who will discuss first quarter performance and full year outlook in more detail. John?

Thank you, Andrew. I'll start by walking through several updates to our '25 outlook and then elaborate on the reasons for them. As Andrew said, we now expect adjusted earnings of $26 to 26.5 per share. It's an outlook that I'm extremely disappointed to share with you. This reflects the profile of patients served at OptumHealth.

It also reflects significantly increased care activity across the UnitedHealthcare Medicare Advantage plans. Within that outlook, we expect about fifty percent to come in the first half of the year. We're affirming the consolidated revenue outlook of 450 to 455,000,000,000 we shared with you in December. Within this, we expect revenues for both UnitedHealthcare and OptumRx to be better than our initial view, offsetting a reduced outlook at OptumHealth. The full year medical care ratio is now expected to be 87.5% plus or minus 50 basis points, reflecting higher utilization across senior populations and the patient mix and revenue profile of OptumHealth.

Within this range, we expect the first half of the year to be below the midpoint and the second half to be above. At OptumHealth, our revenue outlook is 106 to 1 hundred and 7 billion, and operating earnings is 6.2 to 6 point 4 billion based on the factors discussed and which I'll get into more deeply in a moment. Over half of the $10,000,000,000 revenue change is the result of transitioning some legacy risk based arrangements to fee based and is neutral to earnings. We expect about half of OptumHealth's operating earnings to be in the first half. At UnitedHealthcare, the operating earnings outlook is updated to 16 to 16 and a half billion and reflects the higher care activity we're seeing.

Within UnitedHealthcare, pressure was largely contained within the senior business where we saw a sharp increase in care activities that became apparent as we closed out the quarter. As noted, this was most significant for both physician and outpatient care and, to a lesser extent, inpatient care. In years past, this is an insight we may not have picked up until the second quarter, so it is useful to have the information with ample time to incorporate into our '26 planning. In the quarter, we experienced percentage increases in care activity about double last year's level. Unit prices behaved as expected.

Let me start with the obvious fact that it is early in the year, and we don't know everything that might be driving our experience or how long the increase in care activity might last. But care activity was broad based across our senior individual and group populations. One example, in group MA, member retention was about ninety eight percent and as a result serves well as a same member metric. Here, we observed significant increases in elective care activity in the first quarter. Of note, in this population, we believe the behavior may have been impacted by the meaningfully higher member premiums, which were driven by the Medicare funding cuts.

Another example across senior populations was the earlier and higher wellness visit activity we saw, which, of course, drives specialty and outpatient utilization. Some of this may be a seasonal shift in consumption patterns as wellness visits happen once a year. Turning to OptumHealth. As it relates to the patient profile, we experienced a couple of key elements here. First, growth in certain markets where there were meaningful plan exits.

These new patients had not been engaged by their prior plans for most of last year, and we're seeing revenues associated with the patient profiles meaningfully below expected and normal levels. This is very addressable. Second, the ongoing execution to the new CMS risk model, while complicated given the multiyear phase in, has not been to our operational standards. Transitioning to a new model and concurrently running two distinct versions has been more operationally complex than anticipated. But no question, we need to execute better, and we will.

Across the enterprise, we continue to focus on operating costs to help mitigate external pressures while ensuring our workforce aligns to the areas of greatest opportunities and customer needs. Looking ahead, we see a long runway for further technology advances that will translate to more and sustained operating efficiency, which in turn drives opportunity for further innovation and advancements in the company and across the industry. Before we get to q and a, I want to provide a few business highlights. At UnitedHealthcare, we still expect to serve up to 800,000 more people in Medicare Advantage this year across our individual group and dual special needs offerings. This underscores our long standing commitment to stability and differentiated value.

Our growth demonstrates UHC's deep relationship with our members. People served by our community and state business increased to 7,600,000. We continue to have growth momentum with recent service expansions in Kentucky, New York, and Florida. We're also encouraged by the updated Medicaid rates so far in '25 that more closely align with underlying member acuity, but funding remains insufficient to meet the health needs of patients. Commercial self funded membership increased by approximately 700,000 in the first quarter, a result of our continued strong product innovation.

Commercial insured membership was impacted by the individual exchange products. Our disciplined pricing approach remains consistent, and as a result, we experienced some member attrition. Overall, in our commercial book, we are encouraged by the early twenty six selling season indications, which are showing strong retention rates. Turning to Optum. At OptumHealth, we continue to expect to add 650,000 new value based care patients this year.

We're working to engage with these new members ever more rapidly. By the end of twenty five, we expect to have about 5,400,000 value based care patients. At OptumInsight, we have a pipeline of new products coming to market this year with exceptional customer interest. For example, in the first quarter, we launched AI powered claims efficiency tools that increased productivity by over 20% for our revenue cycle management customers. Lastly, OptumRx revenues grew 14%, exceeding 35,000,000,000 for the quarter.

Both customer retention and new customer wins contributed to script growth of 3%. As Andrew noted, performance in the quarter was below the standards we expect. But with disciplined and urgent execution and attention to detail, we expect a return to form in the quarters ahead. With that, I'll hand it back to Andrew.

Thanks, John. Even with the growth of our I'm sorry. Even with the growth our people generated this quarter, this was far from the performance we expect of ourselves. We're acutely aware it's a privilege to be a part of an organization with the capabilities to make a meaningful contribution to modernizing and simplifying the health system. And we're committed to improving our performance in the rest of 2025 and into '26, and in dough in doing so to delivering consistent positive results for you and returning to our long term earnings per share growth target of 13 to 16%.

With that, we can now turn to your questions. Operator?

Thank you. The floor is now open for questions. We We'll take our first question from Justin Lake with Wolfe Research.

question is on Medicare Advantage cost trend. You said that you came into the year assuming trend at similar levels to 2024. Can you share with us precisely what that trend estimate was? Meaning, what did you expect for this year? And what are you expecting now?

And can you tell us how much of that you actually saw in the first quarter? For instance, how much did you miss your MLR by, your own estimate of MLR? And how much you are expecting that to accelerate? Or how different the back three quarters is versus what you saw in the first quarter?

Even if this is emerging, it's the way it is. Yeah. Justin, thanks so much for the question. I'll ask Tim Knoll to respond just in a second, in detail to your question.

I mean, obviously, it's still very early in the year, but but, we have we have clearly seen, a pickup in trend in in a specific part of the UHC business, particularly in the senior business. Tim will talk a little more about to you in a second. That is still early. Still, our even our first quarter is, only partially complete, but, unusually, we've seen this pickup and, which is what's obviously, influencing our our position here. So let me get ask Tim to give you a little bit more detail on that.

Morning, Justin. Thanks for the question. Yeah. I'll I'll attempt to break it all down for you here. So, as was mentioned in the opening remarks, in 2025, we anticipated care levels consistent with what we observed in 2024, which felt appropriate as we stepped into the year.

And what we were assuming, and if you think about this as units consumed, we, we're assuming that in 2025, we'd see a similar increase by that metric that we observe in 2024. And if you break that down, in the Medicare book, you can think that, in total in terms of total trend drivers, about one third of that is related to increase in care activity, or units consumed. And what we are, seeing, and, again, that's focused on physician and outpatient, but driving an overall two times increase in that level of units consumed in q one of twenty twenty five. And, again, that metric is about one third of the total trend drivers, in the Medicare book. We are, you know, seeing that inside of, the first quarter of this year, but we are making the assumption right now that that trend will persist throughout 2025 and then also making the same assumption that it will persist into 2026, and that will shape, our overall, pricing assumptions.

Now some of the, you know, the drivers that, John mentioned, behind what we're seeing, you might, you know, presume that some of those would result in a change in our seasonal consumption patterns. But at this distance, we feel like we need to make the assumption that that activity will persist throughout the year, and into 2026.

Alright, Tim. Thanks so much. Next question, please.

And we'll take our next question from Josh Raskin with Nephron Research.

Hi. Thanks. Good morning. Can you help us connect the higher incidence of primary care visits and the OptumHealth pressure? I assume you don't have that that primary care issue in OptumHealth, which should also mitigate the downstream impact.

So why are you expecting the higher follow through if you control primary care? And then based on the fact that you're seeing worse performance in OptumHealth or value based care, could you remind us why you think you can control costs better in that environment, and it's probably a good time to get the refresher on why the strategy to allocate a lot more capital to VBC in the ecosystem totally is is best for the long term?

Yeah. Josh, thanks so much for the question. So, I'm gonna ask, Tim just to address the first part of your question, then I'd then, Arma to talk a little doctor Desai to talk a little bit around the OptumHealth experience during the quarter and the differences of what we're seeing there and and the like. And as I said in my commentary at the beginning, the businesses do operate very different kind of models, and it's not it's not completely surprising to see somewhat different experiences. And then I'm gonna ask Heather to just, do as as you as you kindly requested, a kind of refresher on the value based care position.

So, we'll do that also for you. So bear with us. This answer is probably gonna take a little a few minutes. But, Tim, if I could ask you to start, and then we'll pass over to doctor Amadasai.

Yeah. Thanks, Josh, for the question. So, yeah, let me just dive in a little bit with a little bit more detail, into some of what we're seeing that's driving the increase in care activity. Now let me start with our fee for service, so kind of our non capitated community MA members. We have seen increase in physician outpatient care activity in that population.

And one of the dynamics that we're seeing is they are generally seeking more preventative care, which is a good thing, and that also includes, more in home visits, more in home clinical assessments. And that in and of itself really not the trend driver, but it's the, follow on care, that is more than what we have anticipated and that, constitutes specialist visits, physician specialist visits, as well as some other, outpatient, services. You know, a dynamic, at play in our group Medicare Advantage business is we're seeing a significant and disproportionate increase in utilization largely within our public sector group retiree business, and this is a population that experienced the greatest year over year premium increases. And while we've seen a similar dynamic play out historically in our individual Medicare Advantage business when, premium increases, have been in play, we've really never seen this dynamic before in the group MA business. I mean, we're seeing it because of the pressures related to, the Medicare funding cuts, that are really driving up premiums in the group retiree business, like they really never have before and kinda think groups with premiums going from $50 to $200.

And we did assume that we would see some care activity level increases in this population, but we're seeing, FAR surpasses what we would have, reasonably anticipated. And in that population as well, we are seeing, you know, more preventive care, more annual wellness visits, no more in home clinical assessments. But, again, the driver there also being really the follow on care that results from that.

Thanks for the question, Josh. So, the results for OptumHealth, to be clear, were impacted by the profile of new value based patients in OptumHealth and the second year of the v 20 eight phase in. We're taking actions to proactively address these issues. Our patient profile post AEP included many new to Medicare as well as new to Optum Health who are meaningfully less engaged by their prior health plans and providers. We believe that market specific plan exits driven by v 20 eight caused this dynamic.

Because of the strength strength and stability of our provider network, those patients chose OptumHealth. Member profile challenges were not specific to any single Medicare Advantage carrier and occurred in multi payer geographies like Texas and Washington. Additionally, we underestimated the impact of v twenty eight in particular as it relates to the higher acuity structure of our patient population, which is more impacted by the risk model change. Our planned actions around operating cost containment and medical expense management were not able to offset the cumulative impacts of v twenty eight and the new member profiles. As it relates to care patterns for OptumHealth, in general in q one, we see as a busier time for our physicians as we are engaging our patients.

We've already engaged over 50% of all members and 75% of our complex members. This year, it's particularly important given the member profile of new Medicare and new OptumHealth patients. Also,

we're seeing some elevation in outpatient behavioral utilizations. Again, we're taking incremental actions above and beyond what we've planned for in year to improve performance. First, enhancing access for employee to network PCPs to especially around new patients to diagnose, document, and treat conditions. We're expanding home based revisits and wraparound services, particularly as it relates to post discharge visits after inpatient care. And as Andrew alluded to, we've accelerated EMR unification, deploying smarter clinical workflows and point of care tools to better adapt to the v 28 related changes.

Great, Alma. Thanks so much. And let me ask Heather to maybe just take an an overview of the value based care proposition and why we continue to believe so strongly in it.

Sure. And just I think what you're seeing here is, as Andrew said, you know, you've got two different business models here, it's important to keep that in mind. Couple things I'll just point out. You know, again, in OptumHealth, capitated experience. This is specific to senior populations and our experience in a unique environment, you know, mindful of, again, what's a new risk model, a year two risk model.

And keeping in mind what, you know, doctor Desai said, we assume and anticipate certain, physician activity in the first part of the year, and that's part of our model because it drives not only that, that diagnosis, but the treatment so we can understand the gaps in care. So that's part of the plan, and I think that's why you you don't you you it it's a little different story in OptumHealth. But as doctor Desai said, we we need to be mindful of that, particularly based on two years of elevated care activity, coming into this year. Now to your point, the outcomes based model or what we call the value based care model should naturally offset some of that for a few reasons, as doctor Desai mentioned. Number one, engagement is key, and that early engagement by a network that's aligned and activated can better identify gaps in care, manage them, and support, you know, higher preventive health care and reduced emergency visits and hospital visits.

In addition to that, what's unique about OptumHealth's model is the wraparound services and the in home services, which not only help assess our members in the home, but they're able to then kick off things like post discharge visits, high the more acute acute condition management programs that are critical to those transitions of care and help reduce total cost of care and naturally offset some of trend, but in addition to that, result in a better health outcome for our patients and a better experience and help them with a healthier life. So those are kind of the basis of our model. You then wrap the integration of our behavioral health into our model, which is increasingly more an integrated part of our care delivery system. That's what I think is differentiated about the model. And even though to be incredibly direct and respectful of this year, we will see the impact of the revenue, through the year.

But the differentiated value value, based care model has meant growth for OptumHealth above industry in the in the past, and we believe you'll continue continue to see that. Why is that? Because, again, a better care delivery model, a better experience for our patients. But in addition to that, we see very high retention. So these members that need the services, that have higher acuity, that need a more intensive care model, they stay with us.

And so the work we do today will support the growth in '26, and that's why we're confident in not only the, the growth in '26 from a membership perspective, but because there's more members to serve out there. In many cases, we're serving few of the seniors in any respective geography, and we have more capacity in our, in our networks. But in addition to that, it supports our performance. Now I'll just note one last thing, and that is I think through the year, you're gonna watch us pace that. While we're still committed to our membership growth, we're gonna be looking at particular geographies, pacing through that to ensure that we're focusing on the new membership, with our PCP network and with our in home services.

Thanks, Heather. And I think, Josh, I really appreciate the question, and thanks everybody for allowing us to respond to that sort of as fully as we can. I mean, just maybe add a couple of comments to that. To that that last, you know, set of comments from Heather, when we look into, and you have often heard us talk previously about, cohorts of members who choose to join, OptumHealth value based care. What we're seeing in those earlier cohorts, going back to say 2023, for example, those folks who first came in and started to benefit from our value based care approach, we're seeing, on all basically all metrics outperformance in terms of the way in which that cohort and cohorts before them have performed.

So what we're seeing here is not really a challenge to the underlying principle of value based care. What we're seeing is how to adjust to a very dramatic price cutting regime that's been implemented over the last couple of years by, by the administration. And it's important to recognize that that was across the average of the industry, independent analysis would say that was about a 9% price cut, across the industry. Now that's a significant downdraft in terms of pressure, and, obviously, that affects participants whether you're a payer or a provider in the marketplace. And you've seen that effect over the last, first year.

We're now well into the second year of all of this. And what we're seeing during the second year is some of the let's call I would call them second order derivative effects. So, I'll give you just a couple of examples of that. You've heard one very explicitly, and we've mentioned the other already on the call. So second order effect would be, for example, as this pricing pressure has continued to press down alongside a series of underfunded rate increases.

You've seen premiums and benefits start to be affected in the marketplace. Group premiums have gone up because of these price cuts. That is now driving a different behavior from group members, and that's what we've picked up in this area. And we need to do a better job of being able to predict and anticipate these second and third order effects when they come, but they are direct consequences of this transition. A second one which we referred to and is really important within the OptumHealth story for 2025, is plan exits.

So we saw a very significant increase in the number of plan exits across the country last year as, as plans chose to respond to the price cutting pressure by essentially withdrawing their offer in multiple geographies across the country. And what we've seen is in in unusually complete, vacation of offers by certain plans. So to put it a different way, a % of participants in a particular payer's plan had to find a new home. They had no they had no way of staying in their old home. They had to find a new home.

And what we saw when they came to us where we were still offering, a plan option, we saw those, members had not had the level of engagement in the prior six, eight months before they vacated that plan at the level you would have expected. That has a direct consequence on how they are understood in terms of the reimbursement model of the system, and that's what's driving a lot of our issues in OptumHealth this year. But, again, that is a temporary phenomenon which gets fixed during 2025, but it is simply an example of one of the second order derivative effects of the transition of absorbing this nine or or more percent increase, decrease in pricing. None of that really speaks to the the value of value based care. Value based care delivers a completely different approach of trying to ensure people have more years of health and less years of health care acute treatment, trying to get ahead of the illness, trying to avoid the high cost consequences of late diagnosis, and tries to make sure that we are encouraging people to think about healthy lifestyle, early engagement, making sure that we're heading off problems before they arrive.

And we know that works based multiple cohorts of patients that we've been privileged to have the right to manage. What we're going through, like the rest of the industry, is a dramatic, really never seen before adjustment in pricing for this marketplace. And what we're seeing this year is two or three areas where the pressure that that has created across the market is creating new dynamics we haven't seen. That's exactly what we're responding to here, and we believe that they are largely addressable as we go through the rest of this year and and in no way undermine our confidence in the value based care strategy of the company. Josh, thanks so much for the question, and I'll move on to the next question.

Our next question comes from AJ Rice with UBS.

Thanks. Hi, everybody. Just to put a finer point on some of this discussion around, especially, what's happening at the MA side. It sounds like you're saying most of the elevated care you're seeing is on the group side,

you're putting more of that on the benefit and premium changes that have occurred rather than just an underlying uptick in utilization. I wanna make sure I understood that. Also, on the competitive exits and, and the impact of that, it doesn't sound like you're calling that out on the insurance side. You're just calling that out on the Optum side. And then finally, on part d, you had been cautious about that coming into the year, but you're not mentioning that at all.

So is that playing out about as expected?

AJ, thank excuse me. Thank you so much for the question. Let me ask Tim to respond.

Yes. Good morning, AJ. Thanks for the question. Yeah. So I'll hit those last two pieces, first.

So, yeah, you're correct. You know, we, are really seeing this focused on our community Medicare Advantage and group Medicare Advantage book. So we're not seeing it, on our chronic special needs population, or our dually eligible population. Also, not seeing, this care activity pattern in our newer members, either new to Medicare or, new to United. And the, care activity items that we talked about last year, provider up coding and some of the pressures on specialty drugs, I'm not seeing that, play into this either.

Those elements are both tracking very much in line with in line with how we've planned. When you think about the split, it is slightly more pronounced on our group business. But if you think about our overall fee for service business, it's just, I would say, just slightly more than the contribution that you'd expect on the group side. And we while we certainly do see trends that suggest that where the premiums have increased and members are paying a a high portion of that, that that is where we're seeing this pointed, pressure on care activity on the group business. However, it's very likely that, you know, some of the same underlying trends that are generating higher care activity patterns in individual community MA are also at play in the group business.

Great. Thanks so much. Next question, please.

And our next question comes from Lisa Gill with JPMorgan. Thank you very much, and

good morning. Andrew, I just want to go back to the path to the long term growth rate. You reiterated that you feel confident you can get back there. With the 2026 rates looking better, we're gonna move into the final year of v '20 '8. How do I think about what the key elements are to to get back to to that long term growth rate?

Yeah. Lisa, thanks so much for the question. So yeah. So clearly, we were we're pleased to see the beginning of recognition of, rate increases, which actually reflect reality, which we haven't seen for last couple of years. But that, you know, hopefully, that will continue to be the stance and, you know, and the and the data will drive that in the way we saw this year.

So very, very pleased to see that. Also pleased to see in the Medicaid, books of business come continue to see great, engagement with states that they also, adjust to make sure that those rates are are appropriate for what we're seeing. So those are important. Obviously, next year, there will be a further step down in terms of pricing from the v '28 model, so we we can't ignore that. That's clearly a reality.

But, you know, the way we'd look at this, Lisa, is that, you know, we are very, very much we're was we see very much the the end of this transition period in terms of having to absorb the amount of pressure. I mean, clearly, we're a leader in all of this marketplace. We're we're taking, almost certainly a a bigger fraction, if you will, of the pressure because of our market leadership position here. We feel like, we're very much getting through this. We we, obviously, this year, have picked up the two or three, second order derivative effects, which we're gonna do a much better job of anticipating and managing for as we go into 2026.

And we think that an awful lot of the issue that we're seeing early in '25, we can fix in '25 and help us deliver stronger performance for '26. And and we expect that to then be a kind of ramp into, reacquiring our target growth rate momentum that we aspire to as an organization. Thank you very much. Next question.

And we'll move to our next question from Steven Baxter with Wells Fargo.

Yes. Hi, thanks. Just a follow-up on the trend discussion. Could you talk about where MA margins are now expected to shake out inside your 2025 guidance? And what you think is a reasonable time line for recovering the target margins?

UnitedHealth Group (UNH) Q1 2025 Earnings Call Transcript

Company Participants