Tuesday, June 12, 2018

Optum a step ahead in vertical integration frenzy


April 12, 2018
Vertical integration is all the rage in healthcare these days, with Aetna, Cigna and Humana making notable plays. 
If the proposed CVS-AetnaCigna-Express Scripts and Humana-Kindred deals are cleared by regulators, the tie-ups will have to immediately face UnitedHealth Group's Optum, which has been ahead of the curve for years and built out a robust pharmacy benefit manager (PBM) business already along with a care services unit, employing about 30,000 physicians and counting.
UnitedHealth formed Optum by combining existing pharmacy and care delivery services within the company in 2011. Michael Weissel, Group EVP at Optum, told Healthcare Dive the company began by focusing on three core trends in the industry: data analytics, value-based care and consumerism.
Since then, the company has been on an acquisition spree to position itself as a leader in integrated services.
"For the longest time, the market assumed that they were building the Optum business [to spin it out] and what is interesting in the evolution of the industry is that that combination has now set a trend," Dave Windley, managing director at Jefferies, told Healthcare Dive.
"United has now set the industry standard or trend ... to be more vertically integrated and it seems less likely now that United would spin this out ... because many of their competitors are now mimicking their strategy by trying to buy into some of the same capabilities," he said.
Weissel said Optum will continue to push on the three identified trends in the next three to five years, with plans to invest heavily in machine learning, AI and natural language processing.
The question will be whether and how the company can keep its edge.
What Optum is
Optum is a company within UnitedHealth Group, a parent of UnitedHealthcare. Optum's sister company UnitedHealthcare is perhaps more well known within the industry and with consumers.
However, Optum, a venture that encompasses data analytics, a PBM and doctors, has been gradually building its clout at UnitedHealth Group.
In 2017, the unit accounted for 44% of UnitedHealth Group's profits. 
In 2011, UnitedHealth Group brought together three existing service lines under one master brand. Services are delivered through three main businesses within a business within a business:
  • OptumHealth - the care delivery and ambulatory care capabilities of OptumCare, as well as the care management, behavioral health, and consumer offerings of Optum;
  • OptumInsight - the data and analytics, technology services and health care operations business; and
  • OptumRx - its pharmacy benefit service.
The company focuses on five core capabilities, including data and analytics, pharmacy care services, population health, healthcare delivery and healthcare operations. Services include but are certainly not limited to OptumLabs (research), OptumIQ (data analytics), Optum360 (revenue cycle management), OptumBank (health savings account) and OptumCare (care delivery services). 
The Eden Prairie, MN-headquartered company has recently expanded its care delivery services, with much of the growth coming from acquisitions. The past two years have seen Optum expand its footprint into surgical care (Surgical Care Affiliates), urgent care (MedExpress) and primary care (DaVita Medical Group).
Timeline of Optum Acquisitions
  • 1998
o    UnitedHealth Group forms health IT arm Ingenix (now OptumInsight) and Specialized Care Services (now OptumHealth).
  • 2002
o    UnitedHealth Group charters Exante Financial Services and Exante Bank, a health banking platform.
  • 2005
o    UnitedHealth buys PacifiCare, a health plan which had a pharmacy benefit manager. The PBM is separated within the company and named Prescription Solutions (now OptumRx).
·         Feb. 2008
o    OptumCare begins with Sierra Health Services, a multi-specialty clinic, acquisition.
·         July 2010
o    Ingenix acquires Picis, a health information company.
·         Aug. 2010
o    Ingenix acquires Axolotl, a health information exchange services company.
o    Ingenix acquires Executive Health Resources.
·         2011
o    WellMed Medical Group, a network of clinicians in Texas and Florida, joins Optum.
·         April 2011
o    UnitedHealth Group announces Optum master brand, bringing together pharmacy services, data & analytics tools, and care delivery services under one roof.
·         Jan. 2013
o    Partnering with Mayo Clinic, Optum unveils OptumLabs, a health data initiative.
·         Oct. 2013
o    Optum, partnering with Dignity Health, launches Optum360, a revenue cycle management venture.
·         Feb. 2014
o    Optum purchases a majority stake in Audax Health Solutions, a patient engagement company. Audax is later rebranded as Rally Health.
·         April 2015
o    Optum acquires MedExpress, an urgent care and preventative care services company.
·         July 2015
o    Catamaran, a pharmacy benefit manager, joins OptumRx.
·         Jan. 2017
o    Optum acquires Surgical Care Affiliates, an ambulatory surgery center and surgical hospital provider.
·         Aug. 2017
o    Optum announces it will acquire Advisory Board Company's healthcare business.
·         Dec. 2017
o    Optum announces DaVita Medical Group acquisition, expected to close in 2018.

​It's a wide pool, but the strategy affords UnitedHealth the opportunity to grab more revenue by expanding its market presence. For example, the DaVita acquisition, which is still pending, allows OptumCare to operate in 35 of 75 local care delivery markets the company has targeted for development, Andrew Hayek, OptumHealth CEO, said on an earnings call in January.

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