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. 

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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.

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

legacy

UnitedHealth Group

unitedhealth group

Good morning and welcome to UnitedHealth Group 4th Quarter and Full Year 2024 Earnings Conference Call. A question and answer session will follow UnitedHealth Group's prepared remarks. As a reminder, this call is being recorded. Here is 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 8 ks dated January 16, 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.

Jennifer, thank you very much and good morning everyone. I'd like to start by expressing a sincere thank you from my colleagues and from me for the overwhelming expressions of condolence and support following the murder of our friend, Brian Thompson. Many of you knew Brian personally. You knew how much he meant to all of us and how he devoted his time to help him make the health system work better for all of the people we're privileged to serve. He would dive in with passion and caring to find solutions to improve experiences, whether for an individual consumer, an employer or a public health agency.

Right now, there 400,000 nurses, doctors, caseworkers, customer service specialists, pharmacists, technologists and so many others in this organization who share that commitment and are determined to advance that work. The task in front of us, all of us, healthcare providers, payers, employers, drug companies and policymakers is to continue improving quality and health outcomes for individuals and their families, while lowering costs for everyone. We need to build on the unique foundational strengths of healthcare in America and address the areas we can make work better. Among those strengths, world leading innovation, the U. S.

Has developed the most advanced clinical approaches and patient centric care at a pace not seen anywhere else. It's why, if provided with the option, people from all over the world come here to seek care for the most complex conditions. Yet the health system needs to function better. Through decades of federal and state policy making and private sector innovation, we have a variety of program structures and processes. There are strong merits to that variety as they can be more tailored to meet the specific needs of individuals at various stages of life and health status and provide extra help for those who need it.

It avoids a one size fits all approach, but it needs to be less confusing, less complex and less costly. America faces the same fundamental health care dynamic as the rest of the world. The resources available to pay for health care are limited, while demand for health care is unlimited. Every society wrestles with that issue and approaches it in various ways. We have incredible opportunities here to improve system performance both from a care and a cost perspective, while building upon the foundational strengths I just mentioned.

The mission of this company, why we exist, is to improve this system for everybody and help people live healthier lives. That means getting more people into high quality value based care and keeping them healthy in the first place. So fewer Americans find themselves with a chronic and in many cases preventable disease. It means continuing to invest in programs like Medicare Advantage, which by providing coordinated care to seniors is proven to deliver better health outcomes at lower cost to consumers and taxpayers compared to fee for service Medicare. Seniors recognize that value, which is why the majority of them choose Medicare Advantage.

It means making healthcare easier to navigate. We're enhancing digital tools for consumers, harnessing data and using AI so they can find the best value care option and decide what is best for themselves and their families. People's health interaction should be as intuitive and seamless as every other aspect of their lives banking, shopping, streaming. This past year, we saw an extraordinary increase in the use of these modern channels. We know there is still a large gap there and we intend to keep at it until it is closed.

It means making coverage and cost easier to understand. Just one example where we already have advanced plans, we're eager to work with policy leaders to use standardization and technology to speed up turnaround times for approval of procedures and services for Medicare Advantage patients and to materially reduce the overall number of prior authorizations used for certain MA services. Some of this work we can do on our own and we're doing it. But we're encouraged also by industry and policymaker interest in solving for this particular friction across the whole system. Ultimately, improving health care means addressing the root cause of health care costs.

Fundamentally, health care costs more in the U. S. Because the price of a single procedure, visit or prescription is higher here than it is in other countries. The core fact is that price more than utilization drives system costs higher. Tackling that problem will require all parts of the system and policymakers to come together.

Yet there are participants in the system who benefit from these high prices. Lower cost equivalent quality sites of service, for example, can be good for consumers and patients, but threaten revenue streams for organizations that depend on charging more for care. Another example is the persistently high cost of drugs in the U. S, leaving American consumers, employers and public agencies to pay disproportionately more than people in other countries. Just look at GLP-one prices.

One drug, which costs $900 in the U. S. Costs about a tenth of that in Europe. Pharmacy benefit managers play a vital role in holding those prices down, which is why drug companies and their allies have spent the past several years attacking them. OptumRx alone delivers many tens of 1,000,000,000 of dollars in savings annually versus the pricing set by the manufacturers, including on the GLP-1s.

That sharply reduces the gap versus other countries, but even then prices in the U. S. Are still multiples of what the rest of the world pays for the same drugs. Last year, our PBM passed through more than 98% of the rebate discounts we negotiated with drug companies to our clients. While we offer customers 100% pass through options, a small number have historically elected other models.

We're committed to fully phasing out those remaining arrangements so that 100% of rebates will go to customers by 20 28 at the latest. We will continue to encourage all of our clients to fully pass these savings directly to patients at the point of sale, as we already do for all of the people we serve in our fully insured employer offerings. This will help make more transparent who is really responsible for drug pricing in this country, the drug companies themselves. Healthcare in every country is complex and the solutions are not simple, but you should expect this company to continue to work at it, finding what is needed, developing solutions, bringing those solutions to scale, making a positive impact on the lives of millions of people. We deliver on our commitments to the people we serve, including our investors.

Even in highly challenging periods like 2024, our results bear out that we find a way even if it's not always how we may have initially envisioned the path. Among some of the formidable challenges we navigated over the course of the year were the 1st year of the 3 year CMS Medicare rate cuts, the effects of the state driven Medicaid member redeterminations and the change healthcare cyber attack. Our people found a way to deliver solidly within the range we first offered back in November of 2023, all while improving patient and consumer health outcomes and experiences, focusing on quality and expanding upon our potential to help make the health system work better for everyone. We're invigorated by the path ahead. There are so many areas that can be enhanced, reworked, reengineered or even scrapped to make the health system work better as we know it needs to.

That is both our responsibility and it's our passion. We begin 2025 with a strong outlook for the year as we continue to deliver on our commitments and excel for those we serve in all of our key growth pillars. Now John will walk you through this performance in a little more detail.

Thank you, Andrew. And I'll add my deep gratitude for the enormous outpouring of support over the past few weeks. Brian helped build this company and forged deep trusted relationships for over 20 years and the positive impact he had on people will be felt for years to come. This morning, I'll discuss both 2024 results and our performance expectations for 2025, including some of what we had planned to discuss with you in December. 2024 revenues of over $400,000,000,000 and adjusted earnings per share of $27.66 were well within the outlook ranges we set out over a year ago.

To be sure, things played out differently than initially anticipated, but it is an enduring trait of this enterprise that we deliver on our commitments to the people we serve and to you even amid unforeseen circumstances. Over the course of 2024, we undertook initiatives and made investments to strengthen us for the future, initiatives to improve consumer experience and bring new innovations to market more quickly, drive the most compelling ways to further our mission to help make the health system work better for everyone, and continue to optimize and refine our offerings and business portfolio to enhance future growth potential, whether that meant moving into new opportunities, reconfiguring or moving out of areas which contributed historically, but may no longer be core, all with an eye to unlocking value. We know you have a number of questions that we were not able to discuss last month. So today, I'll start by stepping through a couple you have indicated are top of mind. The first one is why our 24 medical care ratio was 150 basis points above our original outlook.

It's important to frame up the challenges of 24 to offer some perspectives on the commitment and response of our people. Compared to the midpoint of the care ratio range we stepped out with over a year ago, that alone created a nearly $5,000,000,000 gap we needed to overcome. And that's before we get to the nearly $1,000,000,000 in business disruption impact due to the cyber attack. So we start with about $6,000,000,000 in unanticipated impacts just from these two examples in addition to managing through the already known multi $1,000,000,000 impact of the Medicare rate cuts as we sought to preserve as much benefit stability for seniors as possible. Regarding the elements impacting our 24 Care ratio, we've spoken about the key factors on prior earnings calls, so no surprises here.

The first comprise about 70% of the total impact and are comparable in magnitude to each other. First, the mix of people served. We ended up with a different profile of consumer than expected. This is because of one factor. We didn't grow as anticipated due to the unusual Medicare Advantage benefit designs in the marketplace in 2024.

Next, the timing mismatch between the health status of the remaining people being served by Medicaid and lagging state rate updates. Then there were the costs related to the cyber attack and our South America business impacts. The remaining two elements comprise about 30% of the impact and are evenly split. These include a more rapid than expected acceleration in the prescribing of certain high cost medications as drug companies took early advantage of the Inflation Reduction Act and an aggressive upshift in hospital coding intensity. This is incorporated into our outlook even as we work to get it back in line.

Those are the 24 CARE ratio elements. Next question. Given all that, are we confident in the adequacy of our pricing for 2025? The answer is yes and here's why. To start for 2025, the outlook we shared in December incorporates a view of care activity commensurate with what we saw in 2024, even the care activity we experienced as we exited the year.

I'll break that down with some business line perspectives. In Medicaid, we see the gap between people's health status and state rates narrowing over the course of the year. Our outlook assumes a measured pacing of that process. Actions to date, including the important January 1 renewal cycle support this view. In commercial, pricing for 2025 is appropriately capturing the care activity we are seeing.

This is evidenced by growth heavily weighted towards self funded offerings. We will continue our disciplined approach. In Medicare, we had strong AEP results, which included winning back people we had served previously and near record retention. These are a direct result of our long history of offering sustainable benefits for seniors. With strong retention in the many returning consumers, we start the year with highly informed insights into the care needs of the people we will be serving.

In addition, this year we have seen a notable uptake of our more managed offerings. Think HMO style, which provides strong value for consumers, effective care tools for doctors and more predictable performance. We expect a 25 full year medical care ratio of 86.5 percent, plus or minus 50 basis points, 100 basis points above the 2024 result. In addition to factors discussed earlier, the increase is driven by IRA impacts, the 2nd year of the Medicare funding cuts, a continued mix shift toward public sector offerings and a respectful view of care activity. Our 2024 operating cost ratio improved about 150 basis points over the prior year.

Roughly half of the change was driven by contributions from the business portfolio initiatives mentioned earlier. The other half was due to accelerating our efforts to realize operating efficiencies, even as we improve consumer experiences. Some of these advances are a result of the very early stage impacts we are beginning to realize from AI driven initiatives to help our customer service representatives respond to consumers' needs more effectively and quickly. And we see continuing opportunities both in the near term with operating costs for 2025 improving still further and well beyond given the rapidly expanding scope and impact of these initiatives. These actions and the resourcefulness of our people helped deliver upon the objectives set out over 1 year ago and helped to partially balance the multiple billions of unanticipated impacts.

With that, I'll run through our businesses, offering some key points for each, starting with OptumHealth, where revenues grew to about $105,000,000,000 in 2024 and are expected to approach $117,000,000,000 in 2025. Our Care Delivery business continues to deepen its presence in existing areas, while expanding into new geographies and services. In 2025, we expect OptumHealth will serve about 5,400,000 value based care patients, growth of 650,000 over 24. While our current position provides a solid footing, it's a small fraction of the 100 of millions of patients who can ultimately benefit from value based care. We see value based care as foundational.

It is perhaps the fullest expression of our mission. As Andrew noted, the outdated activities based fee for service system won't help the health system work better for people. Value based care is outcomes based, aligning processes, actions and incentives, helping keep people healthy in the 1st place rather than just seeing them when they are sick. OptumHealth is an integrated multi payer care delivery company, helping to lead the transition to a truly sustainable value based care system. As we move into 2025, we will continue to enhance access and care integration through the home, a much needed area to help people with their health.

More than 3 quarters of our in home patient visits result in a primary care visit within 90 days. Medicare Advantage patients with chronic conditions who receive a home care visit have a lower rate of ER visits, fewer inpatient stays, stronger health outcomes and a better experience, all while saving the health system 1,000,000,000. Turning to OptumRx. Revenues in 2024 grew to over $130,000,000,000 and will be about $146,000,000,000 in 2025. Our pharmacy benefits management team again had customer retention exceeding 98%, while welcoming a record 750 new clients.

Further proof of the value, sophisticators, employers, health plans and labor unions see in OptumRx's ability to negotiate lower drug prices for consumers. OptumRx's pharmacy care services support the entire system in the delivery of clinically driven pharmacy care, serving the highest need and hardest to reach patients. These offerings include community pharmacies, specialty and infusion drug services, all large strongly growing areas with our current presence quite small. OptumInsight revenues were $19,000,000,000 in 2024 and in 2025 will approach $22,000,000,000 with a backlog of $35,000,000,000 as sales of new products begin to take hold and the customer clearinghouse business continues to rebuild. The solutions offered through OptumInsight and our health technology growth pillar delivered at scale will improve consumer experience and payment and claims flows, enable access to the next best action guidance in a doctor's workflow and help Life Sciences customers more rapidly bring innovations to market.

And there will be much more to follow. Shifting to UnitedHealthcare. Full year revenues in 2024 approached $300,000,000,000 and for 2025, we'll approach 340,000,000,000 dollars as we grow to serve upwards of an additional 1,900,000 people balanced across both the commercial and public sectors. Within our domestic commercial offerings, we grew to serve 2,400,000 more people in 2024 and expect to continue to grow strongly in 2025, especially in our self funded offerings, which serve some of the most sophisticated buyers of healthcare, large employers. The fact that so many more people are choosing UnitedHealthcare is a direct result of our bringing much needed innovation to these more mature markets through consumer centric offerings.

As noted earlier, UnitedHealthcare's 24 Medicare Advantage growth was impacted by the unusual benefit designs in the market. Our focus has always been on providing consumer stability and sustainable value, a factor that has built confidence and trust over the long term. As a result, in 2025, we expect growth of up to 800,000 people in individual, group and special needs offerings. And the growth outlook for the years ahead remains strong with nearly half of American seniors still in outdated Medicare fee for service offerings, which provide less value to them and cost taxpayers more. In Medicaid, we expect to serve more people in 2025 with redetermination activities now concluded.

UnitedHealthcare's value proposition is resonating with state customers, consumers and provider partners, and we are participating in a substantial number of expansion proposals. Most recently, we were honored to have been awarded a new opportunity in Georgia. Our growing businesses support and are supported by substantial financial capacities and a strong balance sheet. In 2024, we deployed nearly $17,000,000,000 in growth capital to help build for the future, further strengthening our capabilities to serve more people more comprehensively. We also returned over $16,000,000,000 to shareholders through dividends and share repurchase.

In 2025, we expect cash flow from operations will approach $33,000,000,000 or 1.2 times net income. We will continue to deploy growth capital and remain committed to returning to shareholders as outlined in December. Our growth capital deployment efforts deliver their greatest benefits over the course of 2, 4 or even 6 years and as new capabilities are scaled and deployed across the enterprise and beyond. To summarize, our strong start to the year reinforces the growth objectives we shared last month and is underpinned by the broad growth drivers, operational excellence and strategic capital deployment you have come to expect from us. Now I'll turn it back to Andrew.

John, thank you. The strength of this organization lies in the resilience of our people and the fundamental belief that there is no higher calling than helping other people and nothing more vital to the human condition than healthcare. Looking ahead to 2025 and beyond, we're confident in our ability to continue to add value to the health system through our focus on value based care and consumer orientated efforts to help build the health system America deserves. And that's also why we remain solidly committed to our long term 13% to 16% growth objective, a goal that reflects both the opportunities and the capabilities that we have. And now operator, we'll open it up for questions.

The floor is now open for questions. We'll go first to A. J. Rice with UBS.

Hello, everybody, and I appreciate the words about Brian. He's missed by all of us. Just maybe to focus in on the comments about cost trends and the MLR. Obviously, in the in the Q4, there's variance relative to consensus expectations. It was probably a little greater than what we thought.

It sounds like the cost items you're calling out are similar to the things you had seen all year long. Was there anything that changed in those the intensity of any of those trends? And anything any unusual items in there that impacted the results? And it sounds like you're still confident in your 20 25 MLR outlook. So nothing you saw in the Q4 changes your view on 20 25?

A. J, thanks so much for your question. I'm going to ask John in a sec to go obviously go much deeper in response to your question. But just to the last part of your question, yes, you're totally right. Not in response to your question.

But just to the last part of your question, yes, you're totally right. Nothing we saw there that changes our view of 2025. We feel very good about how we priced into 2025. We feel really, really good about how the mix has come in, in terms of that growth. That's a huge difference to 2024.

Has come in, in terms of that growth. That's a huge difference to 2024. And we really didn't see anything in Q4 that we believe represents a challenge to that, but you go into 2025. But I'd love John to go deeper for you on the Q. Thanks.

Good morning, A. J. So a few things on this. So in terms of the items that we had called out on the 3rd quarter call, so hospital coding intensity and the specialty prescribing trends that we were seeing, very much in line with what we saw in the Q3 in terms of that run into the 4th quarter. So in line with the view on that, we weren't seeing acceleration in that.

We're seeing stabilization in those trends, I would tell you, at the levels we saw before, and we expect that to continue. That specialty prescribing, those trends were something we anticipated in our 2025 outlook. And as we had noted it back in the Q3, that was something that just moved faster in 2024 than we expected. But in terms of the levels we're seeing and how we anticipated that in our 2025, we feel very good about that. Those coating intensity levels staying at the levels that we thought that we had seen also.

And then the other elements that we talked to mix kind of important element in terms of the improvement we see as we move into 2025 and those elements. If I were to call out kind of things in the 4Q, a couple of things I'd say. So first of all, the move fast mostly driven by seasonality. Typical seasonality, we see normal deductible wear offs, those elements. A move sequentially that was similar in terms of the basis point move that we saw a year ago also 3Q to 4Q in that.

But I'd call out a couple of things, Ed, just to your point here. So in the sequential move, I'd call out probably 80 to 90 basis points I'd put into revenue effect category here. So in that, think about some elements that might have been coming in, such as group MA refunds and elements there where our performance was strong over the course of the year and those hitting in the quarter. Just some elements like that, that I'd put in the non recurring revenue non run rate revenue category in

of impacts. And that was probably about 80 to 90 basis points of the impact 3Q to 4Q. The flu RSV impact, that typical seasonal, that was kind of a, I'd say, in the quarter, 50 to 60 basis points. That's kind of a normal move. And then think of the rest of that move being in the zone of pretty much expected seasonal impact.

So the one element I'd call out there is the revenue effects that probably would be having some impact. Thank you.

Great. Thanks so much, John, and thanks again, A. J, for your question. Next question, please.

We'll go next to Josh Raskin with Nephron.

Hi, thanks. A question on the OptumHealth segment. I guess, and I apologize if I missed this, but did you comment on the change in the consumers? I know you talked about portfolio changes and things like that, but the consumer count dropped about 4,000,000 and then sort of a noticeable drop in margins. And I'm wondering if some of that is related to the MA rebates that you just mentioned in terms of the impact on the UHC side as well.

Yes. Josh, thanks so much for your question. Let me ask John to start and then ask Doctor. Desai to pick up a few details on that, please.

Good morning, Josh. So in terms of the consumer count and impacts on that, so that would go into the category of some of the strategic initiatives that have been ongoing here. So think about some elements where that we may have just been that we are maybe deemphasizing in terms of our focus on that. So an area that we deemphasize and that would go in that category is urgent care. We're approaching that a bit differently now.

There was a time when kind of standalone urgent care was an important element here. As you start developing more geographic density, however, in a marketplace, you can probably better serve those patients by just having one of your clinics have after hours presence and focus on that. So one area that we have diminished in terms of emphasis is urgent care and that's one of the areas we got out of. So really those counts are driven by, I'll call it, somewhat narrow offerings typically that we have been diminishing and that were part of kind of some of the strategic initiatives that we talked about. In terms of kind of some of the broader margin impacts you're seeing and some of the emphasis and where OptumHealth was headed in terms of in the 4Q and where their focus was.

I'll turn that to Doctor. Amar Tsai to comment on.

back, post V-twenty eight, we've been executing on our multiple year plan to reshape the business, including efforts around direct patient engagement and medical management as well as integrating our business to deliver on operating cost efficiencies. So as we look at the quarter, we took a number of planned actions, including restructuring and refining some of our legacy contracts, which had a one time impact of the year. We had some membership mix changes, which has been noted. And then we did make some investments in the quarter around clinical quality and the STARS program as well as onboarding for new membership coming on for 11. That being said, we feel very good about our position stepping into 2025.

Our AEP growth was strong. We've also had very strong retention across our care delivery organizations, again reflecting the strength of our provider network and the differentiated care they provide. We also have a better understanding of V28 as we're in the 2nd year of it. And with this progression, our payer relationships and contracts have evolved into the year. As we step into 2025, we're in a more favorable spot.

And then the impact of our engagement efforts in 2024, 85% of our value based patients were engaged and 90% among our highest risk patients. And again, this is best ever patient engagement for us and is the foundation for the maturation of our value based cohorts over time. So overall, our operating model for OptumHealth is stronger, just underpinned by significant momentum around these engagement and affordability as well as operating efficiencies, and we're confident in delivering against our long term margin targets.

Thanks so much. And I'll maybe just finish off that response, Josh, if I might, by really reiterating something you heard me say just a month ago that even in a very challenging year of 2024 with a lot of changes coming from the outside world in terms of funding reductions and the like from the administration, alongside our commitment to perform, we also relentless around how we continue to modernize and shape the company for the longer term. And what you heard John just talk about and you just heard Amar refer to really there is within OptumHealth alongside strengthening our core business, we recognize some parts of that business aren't necessarily as important in the future as they were in the past. We're not going to shy away from making the choices to ensure that we have real clarity and focus on what we know supports our business and most importantly gives us the highest chance of giving the best possible service to patients and members who we serve. And I think during 2024, you saw the organization be very focused, not just on the year, but on the shape of how we want the company to develop over the next several years.

And that's really what you're seeing reflected in the commentary that John and Ama just touched on. Josh, thanks so much for your question. If we go to the next question.

We'll go next to Lisa Gill with JPMorgan.

Thanks very much for taking my question. Andrew, I want to talk about PBM reform. There seems to be a very large drumbeat right now that we'll see reform at some point in 2025. Really two things here. 1, what do you think that means to your business?

And then secondly, you talked about educating those in the marketplace to better understand what you actually bring to the market from a PBM place to better understand what you actually bring to the market from a PBM perspective. Are there incremental ways that you can potentially maybe educate Congress because it seems to be a very big disconnect versus how Congress is viewing this versus what PBMs actually do?

Lisa, thanks so much for your question. And this is obviously a topic of a lot of people's interest and that's not surprising because pharmaceutical prices in the U. S. Are too high. And I just made that super clear in my comments and it's not the first time you've heard any of us at United make those comments over the last several years.

As you think about that, the issue really is that you have a situation where the PBMs are really the only effective mechanism across the system, which really holds the pharmaceutical company to account once it chooses to set its price. And by the way, also has the freedom to inflate that price every single year, which is what we see happen. The PBM is there to try and hold that to account to negotiate on behalf of employers, unions, states and others to try and bring down those prices. But within that, Lisa, is the very first thing that people really need to truly understand. The PBM acts on behalf of the ultimate payer, the employer, the union, the state and such.

It acts on their behalf because they're ultimately the ones who are typically underwriting the ultimate cost of the medicine for the patients, the consumers who are beneficiaries of their plans that are supported by those organizations. That is often lost in terms of how this mechanism works. And it's critical to understand it. What's important, therefore, is that we and you heard me make a couple of references to this, and I hope alongside others across the sector really focus on the facts of the situation. Prices in America are de novo set too high relative to any other price in the world, first off.

Secondly, they're inflated every year, which is pretty unusual when you compare that to the rest of the world. Thirdly, as we negotiate to bring those prices down, the benefit of that negotiation, those rebates, which are achieved are very significant, are passed back to the employers, unions and states. They choose what to do with those rebates. Now in the case of UnitedHealthcare, where in the population of employer benefits that we manage, where we have essentially control over that decision. We pass those all the way through to the consumer and the patient who receives the drug.

So they see the benefit of that rebate. We'd like to see others do the same. Within that overall system, there is also opportunity for people to lose a thread of where the money goes in the system. And that is often what you hear policymakers be concerned about. That is why this morning we are committing to a full 100% pass through of all rebates that we negotiate at the PBM back to the payer, the state or the union.

Right now, we already passed 98% of that through. But unfortunately, even that's just that small residual that we retain because those clients want to pay us that way is enough to give people the excuse to argue that the system is not working properly. We're taking that excuse off the table today. We are committed to full transparency. We are committed to full pass through to clients.

We believe that takes away the excuse of who really is setting the price and we would like to work with others across the system to relentlessly achieve the lowest net cost for everybody in the system. We'd like to see patients see the benefits of that and we'd like to work with anybody who wants to work with us to make it happen. And that's how we're going to engage this year with policymakers and others across the country. With that, Lisa, thanks so much for the question. Let me go to the next question, please.

We'll go next to Stephen Baxter with Wells Fargo.

the policy front, I was wondering if you had any early perspective to share on the Medicare Advantage advance notice for 2026. I guess anything you see as encouraging or any potential areas of concern as you progress from advance to final? And then I guess as a related point, it seems like many would think that the reimbursement that's embedded in these rates is still not reflective of the elevated cost trend that we saw in 2024. Even if taking a step in the right direction, is that a company perspective that you share? Thank you.

Hey, Stephen, thanks so much for the question. I'm going to ask Tim to Tim Noll to comment on that, please.

Yes. Thanks for the question, Stephen. As you know, these rates are preliminary at this point in time and won't be finalized until April. And so therefore, probably not super productive to start speculating on elements of that. I will say we are looking forward very much to engaging the new administration on this item and also host of other items as it relates to the Medicare Advantage program.

Great. Thanks so much, Tim. And as you suggest, Stephen, what's most important is that this is all rational, right? So it's not difficult to figure out in retrospect what trend was and we'd like to hope that over the next few cycles, we see that reflected in a way that it hasn't been over the last several years. And that for us is really the important element of what we hope will come and it's simply just rational.

And it's interesting when you look at the states in Medicaid, you see that kind of rational behavior. We've seen that improve. We've been super clear that there's been historic offset lag, if you will, to that. That's not surprising. That can create some discontinuity as we saw this year in 2024.

But underneath all of that, we see rational understanding and engagement from the states. We super appreciate that. It's important and that's what we want to hope to see a return around the MA rate setting in a way that we have not seen over the last several years. Okay. Next question, please.

We'll go next to Justin Lake with Wolfe Research.

Thanks. Good morning. Got a question here, but first I wanted to ask a quick follow-up on this Medicare Advantage, our revenue adjustment. Given the MLR for the quarter came in higher than expected, It appears this might have come as a surprise and given that the employers the size of the employer segment feels like this adjustment is pretty large like maybe 5% or more of annual revenue. So just trying to understand, can you give us more color here?

How did the mechanics work What's going on? Maybe you could tell us why this would have been a surprise? And what periods do they relate to? Is it all 2024? And then my actual question is more on MA growth.

Curious what you saw during AEP, both in terms of what proportion of your 8% growth expectation do you expect to come from AEP? And then do you still see industry growth at mid single digits? Thanks.

Hey, Justin. Thanks so much for the question. That was an impressive way of sneaking 2 instead of 1. I'll let you get away with it because of just this time. So, John, if you wouldn't mind taking the first part of Justin's good question And then I'm going to ask Bobby Hunter to take the second.

Bobby leads our business in Medicare. So please go ahead.

Justin, good morning. So yes, in terms of those elements, so MA kind of group customer refunds was one element of it. And certainly these are and there were a few other adjustments running through that we're all putting the non run rate revenue impacts here. In terms of surprise or not, so perhaps not anticipated a year ago when we set out kind of in terms of our expectation for medical care ratio and revenues and such. Not a surprise in terms of where we've been the last while though in terms of understanding these things because as they develop and you see, okay, better performance in certain group MA plans, there's going to be a refund that's given to those employers as we do, as we're performing well.

UnitedHealth Group (UNH) Q4 2024 Earnings Call Transcript

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