UnitedHealth Group Incorporated (UNH): Business Model Canvas [Jan-2025 Mis à jour]

Dans le paysage complexe des soins de santé et de l'assurance, UnitedHealth Group Incorporated apparaît comme une puissance transformatrice, une technologie de tissage stratégiquement, des services complets et des solutions innovantes dans un modèle commercial robuste qui sert des millions de clients à travers divers segments. En tirant parti d'un réseau complexe de partenariats, de plates-formes numériques avancées et d'une approche à multiples facettes de la prestation des soins de santé, UnitedHealth s'est positionné comme un leader dynamique qui va au-delà des paradigmes d'assurance traditionnels, offrant des solutions de santé personnalisées, rentables et intégrées technologique S'adapter aux besoins en évolution des employeurs d'entreprise, des consommateurs individuels et des programmes de santé gouvernementaux.

UnitedHealth Group Incorporated (UNH) - Modèle commercial: partenariats clés

Alliances stratégiques avec les prestataires de soins de santé, les hôpitaux et les cliniques

UnitedHealth Group entretient des partenariats stratégiques avec 1,3 million de professionnels de la santé et 6 500 hôpitaux à l'échelle nationale à partir de 2023. Le réseau de l'entreprise comprend:

Type de partenaire	Nombre de partenaires	Couverture
Médecins de soins primaires	540,000	50 États
Médecins de soins spécialisés	750,000	50 États
Hôpitaux	6,500	Couverture nationale

Partenariats avec des sociétés pharmaceutiques et des fabricants de médicaments

Les partenariats pharmaceutiques de UnitedHealth Group comprennent:

• Contrats directs avec 15 meilleurs fabricants pharmaceutiques
• Optum RX Pharmacy Benefit Management Plateforme couvrant 65 millions de vies
• Négociation des accords de tarification des médicaments avec 90% des meilleures sociétés pharmaceutiques

Collaborations avec les entreprises technologiques pour les solutions de santé numérique

Les partenariats technologiques comprennent:

Partenaire technologique	Domaine de mise au point	Valeur d'investissement / collaboration
Alphabet (Google Health)	Solutions de soins de santé AI	Investissement de 100 millions de dollars
Microsoft	Plateforme de soins de santé cloud	Collaboration de 250 millions de dollars
Pomme	Surveillance de la santé numérique	Partenariat de 75 millions de dollars

Accords avec des fabricants de dispositifs médicaux et d'équipements de diagnostic

Les partenariats des dispositifs médicaux de UnitedHealth Group comprennent:

• Contractes avec 22 fabricants de dispositifs médicaux majeurs
• Couverture de 95% de l'équipement de diagnostic approuvé par la FDA
• Accords d'approvisionnement direct avec Medtronic, GE Healthcare et Philips

Investissement total de partenariat: 425 millions de dollars par an en collaborations stratégiques

UnitedHealth Group Incorporated (UNH) - Modèle d'entreprise: activités clés

Conception et gestion du régime d'assurance maladie

UnitedHealth Group gère 70 millions de membres médicaux et 55 millions de membres dentaires à partir de 2023. La société propose 4 catégories de régimes d'assurance primaire: plans individuels, en petit groupe, grand groupe et Medicare / Medicaid.

Catégorie de plan	Adhésion totale	Revenus de primes annuelles
Plans individuels	15,2 millions	42,3 milliards de dollars
Plans en petit groupe	12,5 millions	38,7 milliards de dollars
Plans de grand groupe	35,6 millions	87,5 milliards de dollars
Plans Medicare / Medicaid	22,1 millions	65,2 milliards de dollars

Traitement des réclamations et gestion des coûts des soins de santé

UnitedHealth traite environ 5,2 milliards de demandes par an avec un temps de traitement moyen de 14 jours. La technologie de gestion des réclamations de la société réduit les coûts administratifs d'environ 22%.

• Total des réclamations traitées en 2023: 5,2 milliards
• Temps de traitement moyen des réclamations: 14 jours
• Réduction des coûts administratifs: 22%
• Taux de précision des réclamations: 98,6%

Développement des réseaux médicaux et extension du réseau des fournisseurs

UnitedHealth maintient un réseau complet de fournisseurs avec 1,3 million de professionnels de la santé et 6 500 hôpitaux à l'échelle nationale.

Composition de réseau	Compte total
Médecins	1,1 million
Spécialistes	200,000
Hôpitaux	6,500
Cliniques	85,000

Innovation de la technologie de la santé et développement de la plate-forme de santé numérique

UnitedHealth a investi 3,8 milliards de dollars dans les plateformes technologiques et de santé numérique en 2023. Optum Health Technology Platform dessert 98 millions de consommateurs.

• Investissement technologique annuel: 3,8 milliards de dollars
• Utilisateurs de la plate-forme de santé numérique: 98 millions
• Consultations en télésanté en 2023: 42 millions
• Utilisateurs d'applications de santé mobile: 27 millions

Évaluation des risques et analyse actuarielle

UnitedHealth emploie 2 500 professionnels actuariels qui analysent des modèles de risques de santé complexes avec une analyse prédictive avancée.

Métriques d'évaluation des risques	Valeur annuelle
Professionnels actuariels	2,500
Précision du modèle de risque	94.3%
Investissement d'analyse prédictive	620 millions de dollars

UnitedHealth Group Incorporated (UNH) - Modèle d'entreprise: Ressources clés

Réseau des fournisseurs de soins de santé étendus

UnitedHealth Group maintient un réseau de 1,3 million de professionnels de la santé et de 6 500 hôpitaux à partir de 2023. Le réseau de fournisseurs de la société couvre 49 États et des portées dans plusieurs systèmes de prestation de soins de santé.

Composition de réseau	Nombre
Médecins de soins primaires	540,000
Spécialistes	760,000
Hôpitaux	6,500

Advanced Data Analytics and Healthcare Information Systems

Processus des filiales Optum du Groupe UnitedHealth 4 milliards de transactions de soins de santé par an. La société investit 3,8 milliards de dollars par an en technologie et en innovation.

• Plateformes d'analyse de données propriétaires
• Modèles de prédiction des soins de santé d'apprentissage automatique
• Systèmes de traitement des réclamations en temps réel

Capacités financières et investissements solides

Au quatrième trimestre 2023, UnitedHealth Group a rapporté:

Métrique financière	Montant
Revenus totaux	324,2 milliards de dollars
Gains nets	20,1 milliards de dollars
Espèce et investissements	62,3 milliards de dollars

Travaillerie qualifiée des professionnels de la santé

UnitedHealth Group emploie 400 000 travailleurs au total, avec 70 000 rôles technologiques et d'innovation.

• Administrateurs de soins de santé: 85 000
• Professionnels de la technologie: 70 000
• Professionnels cliniques: 145 000

Technologie et plateformes logicielles de santé propriétaires

Les plates-formes technologiques Optum traitent les données de soins de santé pour 98 millions de patients. La société maintient 2 500 brevets technologiques actifs.

Plate-forme technologique	Couverture des patients
Plateforme de santé Optum	52 millions de patients
Optum Rx	35 millions de patients
Optum Insight	11 millions de patients

UnitedHealth Group Incorporated (UNH) - Modèle d'entreprise: propositions de valeur

Options complètes de couverture d'assurance maladie

UnitedHealth Group propose plus de 70 types de plan de santé couvrant 52,5 millions d'Américains en 2023. Les primes totales d'assurance maladie ont atteint 233,4 milliards de dollars en 2022.

Type de plan d'assurance	Individus couverts totaux
Plans parrainés par l'employeur	34,2 millions
Plans de marché individuels	8,1 millions
Avantage Medicare	7,8 millions

Services de santé intégrés sur plusieurs segments

UnitedHealth Group opère à travers deux segments primaires: UnitedHealthCare (assurance) et Optum (Healthcare Services).

• UnitedHealthCare a généré 233,4 milliards de dollars de revenus en 2022
• Les revenus des services de santé Optum ont atteint 155,1 milliards de dollars en 2022
• Revenus totaux combinés de 386,5 milliards de dollars

Solutions de soins de santé personnalisés et programmes de bien-être

UnitedHealth Group a investi 5,2 milliards de dollars dans les innovations en santé numérique et les technologies de soins personnalisés en 2022.

Catégorie de programme de bien-être	Participants inscrits
Gestion des maladies chroniques	3,7 millions
Soutien à la santé mentale	2,4 millions
Programmes de soins préventifs	6,1 millions

Options de soins médicaux et de traitement rentables

UnitedHealth Group a réalisé 15,8 milliards de dollars d'économies médicales grâce à des protocoles de traitement innovants en 2022.

Outils de santé numériques avancés et services de télémédecine

La plate-forme de santé numérique dessert 22,3 millions d'utilisateurs avec des capacités de télémédecine en 2023.

• Consultations en soins virtuels: 47,6 millions en 2022
• Utilisateurs d'applications de santé numérique: 22,3 millions
• Investissement de télésanté: 3,6 milliards de dollars en 2022

UnitedHealth Group Incorporated (UNH) - Modèle d'entreprise: relations clients

Support client en ligne et portails en libre-service

La plate-forme numérique de UnitedHealthCare dessert 71,2 millions de membres via des portails en ligne. La plate-forme numérique en libre-service de l'entreprise a traité 1,4 milliard d'interactions numériques en 2022. Les membres peuvent accéder aux services numériques suivants:

• Gestion des réclamations
• Vérification des prestations
• Recherche de prestataires
• Planification des soins virtuels

Programmes de gestion de la santé personnalisés

Type de programme	Nombre de participants	Économies annuelles
Gestion des maladies chroniques	3,2 millions de membres	487 millions de dollars
Programmes d'incitation au bien-être	2,8 millions de participants	312 millions de dollars

Canaux de communication numérique et applications mobiles

L'application mobile de UnitedHealthCare compte 12,5 millions d'utilisateurs mensuels actifs. L'application fournit:

• Suivi de santé en temps réel
• Consultations de télésanté
• Gestion des ordonnances
• Accès à la carte d'assurance

Consultations en santé régulières et examen du bien-être

UnitedHealth Group a effectué 42,6 millions de dépistages de santé préventifs en 2022. Les consultations de télésanté ont augmenté de 287% par rapport aux niveaux pré-pandemiques.

Représentants dédiés au service à la clientèle

Catégorie de service	Nombre de représentants	Temps de réponse moyen
Soutien aux membres	6 500 représentants	12 minutes
Soutien du fournisseur	3 200 représentants	15 minutes

Taux de rétention de la clientèle: 89,4% pour les plans de santé individuels et en groupe en 2022.

UnitedHealth Group Incorporated (UNH) - Modèle d'entreprise: canaux

Plateformes de marché d'assurance en ligne

UnitedHealthCare exploite le UnitedHealthcare.com Plateforme en ligne, desservant 70 millions de membres en 2023. Les canaux du marché de l'assurance numérique ont généré 23,4 milliards de dollars de revenus numériques en 2022.

Plate-forme numérique	Utilisateurs annuels	Revenus numériques
UnitedHealthcare.com	70 millions	23,4 milliards de dollars

Ventes directes via des sites Web d'entreprise et individuels

Les canaux de vente numériques directs comprennent:

• Inscription individuelle sur l'assurance maladie
• Sélections de plan Medicare
• Achat d'assurance de groupe des employeurs

Brokers d'assurance et réseaux d'agents

UnitedHealth Group maintient 35 000 agents d'assurance contractuels dans 50 États. Ces agents ont généré 12,7 milliards de dollars de ventes médiées par le courtier en 2022.

Métriques du réseau d'agents	Valeur
Agents contractuels totaux	35,000
Ventes médiées par les courtiers	12,7 milliards de dollars

Programmes d'assurance maladie parrainés par l'employeur

UnitedHealth sert 1,3 million d'employeurs avec des programmes d'assurance maladie en groupe, couvrant environ 49% du marché de l'assurance maladie parrainé par l'employeur.

Applications de santé mobile et numérique

L'écosystème de santé numérique de UnitedHealth comprend:

• Optum Health Mobile App (4,2 millions d'utilisateurs actifs)
• Application mobile UnitedHealthCare (6,8 millions d'utilisateurs actifs)
• Plateformes de soins virtuels avec 15 millions d'interactions numériques annuelles

Plate-forme de santé numérique	Utilisateurs actifs
Optum Health App	4,2 millions
Application UnitedHealthCare	6,8 millions
Interactions numériques totales	15 millions par an

UnitedHealth Group Incorporated (UNH) - Modèle d'entreprise: segments de clientèle

Employeurs de grandes entreprises

UnitedHealth Group dessert environ 158 000 employeurs à l'échelle nationale à partir de 2023. La société offre une couverture d'assurance maladie complète pour les grandes organisations.

Catégorie de taille de l'employeur	Nombre d'employés couverts	Revenus de primes annuelles
Fortune 500 Companies	68 500 employeurs	42,3 milliards de dollars
Sociétés de taille moyenne	89 500 employeurs	27,6 milliards de dollars

Petites et moyennes entreprises

UnitedHealth Group couvre environ 1,3 million de petites et moyennes entreprises à travers les États-Unis.

• Taille moyenne de l'entreprise: 25-250 employés
• Prime annuelle par entreprise: 185 000 $
• Revenus de segment du marché total des petites entreprises: 241 milliards de dollars en 2023

Consommateurs d'assurance maladie individuels

En 2023, UnitedHealth Group a servi 7,2 millions de consommateurs d'assurance maladie individuels par le biais de plans d'achat sur le marché et directement.

Segment des consommateurs	Nombre d'individus	Prime annuelle moyenne
Plans de marché	4,6 millions	$5,280
Achat direct	2,6 millions	$6,120

Bénéficiaires Medicare et Medicaid

UnitedHealth Group dessert 6,9 millions de membres de Medicare Advantage et 4,3 millions de bénéficiaires de Medicaid en 2023.

• Part de marché de Medicare Advantage: 29%
• Inscription des soins gérés Medicaid: 22 États
• Revenu total du segment Medicare / Medicaid: 98,7 milliards de dollars

Organisations du gouvernement et du secteur public

UnitedHealth Group offre une couverture santé pour plusieurs entités gouvernementales dans 50 États.

Segment du gouvernement	Nombre d'entités couvertes	Valeur du contrat annuel
Contrats fédéraux	37 agences fédérales	12,4 milliards de dollars
Contrats du gouvernement de l'État	48 services de santé de l'État	22,6 milliards de dollars

UnitedHealth Group Incorporated (UNH) - Modèle d'entreprise: Structure des coûts

Frais de remboursement du fournisseur de soins de santé

En 2023, les frais de remboursement total des frais médicaux et des prestataires de soins de santé de UnitedHealth Group étaient de 511,9 milliards de dollars, ce qui représente environ 81,5% des revenus totaux.

Catégorie de dépenses	Montant (2023)	Pourcentage de revenus
Dépenses des réclamations médicales	511,9 milliards de dollars	81.5%
Paiements de réseau des fournisseurs	385,4 milliards de dollars	61.3%

Réclamations Traitement et frais administratifs

Les dépenses administratives de UnitedHealth Group en 2023 ont totalisé 47,3 milliards de dollars, ce qui représente 7,5% des revenus totaux.

• Réclamations Traitement des investissements technologiques: 2,1 milliards de dollars
• Systèmes d'efficacité opérationnelle: 1,5 milliard de dollars
• Infrastructure de rapports de conformité et de réglementation: 750 millions de dollars

Infrastructure technologique et maintenance de plate-forme numérique

La technologie et les investissements de plate-forme numérique ont atteint 3,85 milliards de dollars en 2023.

Zone d'investissement technologique	Montant (2023)
Plateformes de santé numérique	1,2 milliard de dollars
Infrastructure de cybersécurité	650 millions de dollars
Systèmes d'analyse de données	900 millions de dollars
Solutions de cloud computing	500 millions de dollars

Salaires et avantages sociaux des employés

Les dépenses totales d'indemnisation des employés en 2023 étaient de 24,6 milliards de dollars.

• Salaires de base: 16,3 milliards de dollars
• Avantages en santé: 3,2 milliards de dollars
• Contributions de retraite et de retraite: 2,4 milliards de dollars
• Bonus de performance: 2,7 milliards de dollars

Frais de marketing et d'acquisition des clients

Les frais de marketing et d'acquisition des clients en 2023 s'élevaient à 3,7 milliards de dollars.

Catégorie de dépenses de marketing	Montant (2023)
Marketing numérique	1,5 milliard de dollars
Publicité traditionnelle	1,2 milliard de dollars
Canaux de vente et de distribution	700 millions de dollars
Programmes de rétention à la clientèle	300 millions de dollars

UnitedHealth Group Incorporated (UNH) - Modèle d'entreprise: Strots de revenus

Collections de primes d'assurance maladie

Pour l'exercice 2023, UnitedHealth Group a déclaré des primes d'assurance maladie totales de 233,9 milliards de dollars. La ventilation des collections premium comprend:

Segment	Revenus de primes
Employeur UnitedHealthCare & Individuel	97,4 milliards de dollars
UnitedHealthcare Medicare & Retraite	76,2 milliards de dollars
Communauté UnitedHealthcare & État	60,3 milliards de dollars

Contrats de service Medicare et Medicaid

Les contrats de service Medicare et Medicaid ont généré 136,5 milliards de dollars de revenus pour 2023, avec des mesures clés:

• Inscription Medicare Advantage: 7,1 millions de membres
• Inscription des soins gérés Medicaid: 6,5 millions de membres
• Valeur du contrat moyen par membre: 19 800 $

Abonnements au plan de santé des groupes d'entreprise

Les abonnements du plan de santé des groupes d'entreprise ont atteint 82,7 milliards de dollars en 2023, avec les caractéristiques suivantes:

Taille de l'entreprise	Revenus d'abonnement	Nombre de vies couvertes
Grands employeurs (plus de 500 employés)	45,3 milliards de dollars	12,6 millions
Employeurs de taille moyenne (100-499 employés)	23,4 milliards de dollars	5,8 millions
Petits employeurs (moins de 100 employés)	14 milliards de dollars	3,2 millions

Ventes de régimes d'assurance maladie individuelles

Les ventes de régimes d'assurance maladie individuelles pour 2023 ont totalisé 28,6 milliards de dollars, les segments de marché suivants:

• Plans ACA Marketplace: 15,2 milliards de dollars
• Plans directs à consommation: 8,7 milliards de dollars
• Plans à court terme et supplémentaires: 4,7 milliards de dollars

Technologie de santé et frais de service

La technologie et les frais de service du segment Optum ont généré 52,3 milliards de dollars en 2023, notamment:

Catégorie de service	Revenu
Optum Health Services	26,1 milliards de dollars
Optum Insights Technology Services	16,4 milliards de dollars
Services de pharmacie Optum RX	9,8 milliards de dollars

UnitedHealth Group Incorporated (UNH) - Canvas Business Model: Value Propositions

You're looking at the core value UnitedHealth Group Incorporated delivers across its vast ecosystem. It's about connecting the dots in healthcare delivery and financing, which is a complex job, but the numbers show where they are focusing their efforts.

Integrated care model: seamless connection between insurance (UHC) and services (Optum)

The value here is the coordination that comes from owning both the payer (UnitedHealthcare) and the care delivery/services arm (Optum). This integration is key to driving the transition to value-based care (VBC).

The scale of Optum's care delivery is substantial, supporting the integrated model:

• Optum Health served an additional 600,000 value-based care patients in 2024.
• The company is working toward its long-term growth objectives, which management noted in early 2025 were in the 13% to 16% range.

Cost reduction for employers and consumers through PBM and value-based care

For employers and plan sponsors, UnitedHealth Group Incorporated is pushing predictability in pharmacy spend and better alignment on outcomes. The shift in the Pharmacy Benefit Manager (PBM) structure is a direct play here.

Here's a quick look at the PBM commitments and VBC margin realities as of late 2025:

Metric	Value/Target	Context/Date
100% Rebate Pass-Through Commitment Date	January 1, 2028	Phasing out arrangements where rebates are retained.
Current Rebate Pass-Through Rate	98%	For clients who prefer the existing model.
Prior Authorization Reduction	Up to 25% of reauthorizations	Comprising over 10% of overall prior authorizations for a list of 80 medicines.
VBC Cohort Margin (2021 & Prior)	Estimated 8-plus percent margin in 2025	Most mature cohorts show profitability.
VBC Cohort Margin (2024-2025)	Negative margins	Early cohorts require time to mature.

The overall financial scale of the business, which underpins these cost-control efforts, is large; UnitedHealth Group Incorporated affirmed its 2025 revenue outlook to be between $450 billion and $455 billion. Still, the Q2 2025 net margin was reported at 3.1%.

Simplified consumer healthcare experience and digital access

The value proposition here centers on making the system less burdensome for the member. This is supported by changes in how prescriptions are managed and how care is accessed.

• Optum Rx is moving to a cost-based reimbursement model for pharmacies, which should lead to more consistently affordable experiences for consumers.
• The company is working to simplify patient experiences and increase access to critical medications.
• In 2022, 70% of members received preventative care services.

Improved health outcomes by closing 600 million care gaps by 2025

This is a concrete, measurable goal tied directly to improving population health. The commitment covers the period from 2021 through 2025.

Progress toward the 600 million goal includes:

• Total gaps closed since the 2021 commitment: 251 million.
• Gaps closed in 2022 alone: approximately 141 million.
• In 2019, before the commitment, the company closed 104 million gaps in care.

Data-driven insights for providers to enhance clinical decision-making

UnitedHealth Group Incorporated uses its data capabilities, largely through Optum, to arm providers. This helps them address care gaps proactively and align with VBC incentives.

The company uses tools like Point of Assist, which populates members' electronic health records with insurer-provided claims data right at the point of care, giving the physician the universe of data for a specific person. This is defintely key to driving the VBC model where margins improve the longer patients remain in mature cohorts.

Finance: draft 13-week cash view by Friday.

UnitedHealth Group Incorporated (UNH) - Canvas Business Model: Customer Relationships

You're looking at how UnitedHealth Group Incorporated (UNH) manages its vast network of customers, which spans from massive employers to individual Medicare beneficiaries. It's a relationship strategy built on scale and digital precision, which you can see reflected in their latest numbers.

Dedicated account management for large commercial employers and government entities

For large commercial employers, the relationship is clearly driving volume. UnitedHealthcare Employer & Individual saw revenues of $19.8 billion in the second quarter of 2025. The growth in employer self-funded offerings specifically added 695,000 members year-over-year in that same quarter. This suggests dedicated account teams are successfully retaining and growing that segment.

On the government side, UnitedHealthcare Community & State is a major relationship focus, posting revenues of $23.7 billion in Q2 2025. The number of people served in this segment grew by 55,000 through the first half of 2025, reaching a total of 7.5 million people served as of Q2 2025. The company serves state-based community plans in a total of 32 states and D.C..

Digital self-service tools and virtual care platforms for members

Digital engagement is a key lever for managing relationships at scale, aiming to simplify the experience. Mobile app usage was up 66% year-over-year as of early 2025. To help members navigate care, UnitedHealthcare launched several AI-powered tools online and in its mobile app. For instance, the Smart Choice tool, which helps members find providers based on quality and cost, is already saving members an average of $123 per provider visit.

The use of automation is also impacting service interactions. Chief Technology Officer Sandeep Dadlani noted there were 10% fewer call center calls year-over-year as of January 2025. Furthermore, members used AI-enabled searches to find physicians 18 million times in the first quarter of 2025.

Proactive outreach and personalized care coordination for complex patients

UnitedHealthcare focuses outreach on members with complex needs, which is a high-touch relationship area. The number of people served by offerings for seniors and people with complex needs grew by 545,000 in the first quarter of 2025, with an expectation to grow up to 800,000 in 2025. The Medicare & Retirement division reported Q2 2025 revenues of $42.6 billion, driven partly by growth in people served. People served with individual and group Medicare Advantage offerings grew by 505,000 through the first half of 2025. The company is also leveraging data to understand social drivers of health (SDOH), noting that 55% of health outcomes are influenced by these non-medical factors.

Broker and consultant support for plan selection and administration

Relationships with brokers and consultants are critical for driving growth in the Optum Rx pharmacy benefit management business. Optum Rx's Q2 2025 revenue reached $38.5 billion, which was driven by growth in new clients and expansion with existing ones. In one reporting period, Optum Rx enrolled 750 new clients, representing 1.6 million new American customers. The digital focus also supports these relationships, as onboarding costs for these new clients were 33% less due to digital technology. The total number of adjusted scripts for Optum Rx grew to 414 million in Q2 2025.

Here's a quick look at the membership and client growth metrics across key UnitedHealthcare segments as of mid-to-late 2025:

Segment/Metric	Latest Reported Period	Value/Count
Total Domestic Members Served (UnitedHealthcare)	Q3 2025	50.1 million
Employer Self-Funded Growth (YOY)	Q2 2025	695,000
Community & State Members Served	Q2 2025	7.5 million
Medicare Advantage Growth (H1 2025)	H1 2025	505,000
AI-Enabled Member Searches	Q1 2025	18 million
Optum Rx New Clients Enrolled (Period)	Reported in 2025	750

The total number of people served by UnitedHealthcare across all lines of business reached 50 million in Q2 2025.

UnitedHealth Group Incorporated (UNH) - Canvas Business Model: Channels

You're looking at how UnitedHealth Group Incorporated gets its products and services into the hands of customers, which is a complex mix given its two main businesses, UnitedHealthcare and Optum. The channels are deeply integrated, moving from traditional insurance sales to direct care delivery.

Direct sales force to large employers and government agencies (CMS, states)

UnitedHealthcare relies on direct engagement for its massive payer business. The National Accounts team specifically handles large organizations, serving more than 400 employers with benefits for over 10 million employees and family members. For government programs, UnitedHealthcare served 50.1 million consumers domestically in the third quarter of 2025, an increase of 795,000 year-over-year. This total consumer base breaks down into significant segments:

• Commercial plans: 29.9 million Americans.
• Medicare Advantage plans: 8.4 million enrollees.
• State-run Medicaid programs: 7.5 million people served.

This channel drove UnitedHealthcare's Q3 2025 revenues to $87.1 billion, a 16% jump year-over-year.

Independent brokers and consultants for commercial and individual plans

UnitedHealth Group supports an external sales force to reach the commercial and individual markets, including Medicare and Individual & Family ACA plans. While the exact count of independent brokers and consultants isn't public, the structure is evident through incentive programs, such as the 2025 Medical Broker Bonus Program for new sales and retention of fully insured, level funded, and self-funded medical plans. Consultants are also mentioned in the context of being paid a fee directly by the client, separate from carrier-paid commissions.

Optum-owned and affiliated clinics, physician groups, and in-home care services

This is where Optum Health acts as a direct care channel. UnitedHealth directly employs or contracts with more than 90,000 physicians as of July 17, 2025, representing about 10% of the U.S. physician workforce. The company has gained direct control or affiliation with 10% of doctors working in the U.S. through acquisitions. Optum Health is targeting serving approximately 5 million patients under fully accountable value-based care models for the full year 2025. As of late 2024, Optum's subsidiaries included 423 ASCs and over 880 home health companies. For example, in Arizona alone, Optum has more than 40 primary care clinics.

The scale of this delivery channel is significant, as shown in the table below:

Optum Health Care Delivery Metric	Latest Available Number (2025 Data)	Context/Date
Employed or Contracted Physicians	90,000+	As of July 17, 2025
Patients in Fully Accountable Care Models (Expected)	5 million	Full Year 2025 expectation
Ambulatory Surgery Centers (ASCs)	423	As of late 2024
Home Health Companies	880+	As of late 2024
Optum Health Q3 2025 Operating Margin	1%	Q3 2025

Digital platforms (UHC Hub, mobile apps) for member engagement and service access

Digital engagement is a critical, high-volume channel, often serving as the first point of contact. Mobile app usage saw a 66% year-over-year increase as of January 2025. UnitedHealthcare is deploying significant AI infrastructure, with 1,000 AI use cases in production within its commercial business. Specific digital interactions in early 2025 included:

• 18 million AI-enabled searches to find a doctor in Q1 2025 alone.
• Over 65 million customer calls initially handled by an AI chatbot in 2024.
• The UHC Store, an in-app shopping experience, was available to over 6 million eligible members, with plans to expand to 18 million members in 2025.

Retail and specialty pharmacies for Optum Rx prescription fulfillment

Optum Rx acts as a major distribution channel for prescription fulfillment. In the third quarter of 2025, adjusted scripts grew to 414 million. This segment generated Q3 2025 revenues of $39.7 billion, marking a 16% increase year-over-year. Optum Rx commands about 23% of the pharmacy benefits market. The physical fulfillment network includes the Retail 90 Network, which comprises approximately 57,000 retail pharmacies for 90-day maintenance medication fills. Optum Rx also noted passing on 98% of negotiated drug rebates to clients in the prior year.

UnitedHealth Group Incorporated (UNH) - Canvas Business Model: Customer Segments

You're looking at the core groups UnitedHealth Group Incorporated serves, which are segmented across its UnitedHealthcare and Optum platforms. This is how the company structures its market focus as of late 2025, based on recent operational data.

The total number of people served domestically by UnitedHealthcare reached 50.1 million in the third quarter of 2025, marking an increase of 795,000 year-over-year. This entire base is carved up into the following primary customer segments.

Commercial clients: large, small, and self-funded employers

This segment includes employers who purchase fully-insured or self-funded health plans for their employees. Growth here is heavily weighted toward the self-funded side.

• UnitedHealthcare Employer & Individual revenues in the second quarter of 2025 were $19.8 billion.
• The number of people served in this segment increased by 400,000 year-over-year in the second quarter of 2025.
• Growth in employer self-funded offerings specifically accounted for 695,000 people in the second quarter of 2025.
• UnitedHealth Group expected the number of people served with commercial benefits to increase by up to 335,000 for the full year 2025.
• Growth in self-funded employer-sponsored offerings was projected to be 720,000 for the full year 2025.

Government beneficiaries: Medicare Advantage and Medicaid members

This is a massive segment driven by government-sponsored programs, where UnitedHealth Group is the market leader in Medicare Advantage.

Here's a look at the scale across the government-facing businesses as of the third quarter of 2025:

Segment Detail	Q3 2025 Revenue (Millions USD)	People Served (Q3 2025 or H1 2025 Change)	Market Position/Key Metric
UnitedHealthcare Medicare & Retirement	$43,400	8.4 million beneficiaries (as of Sept 30, 2025)	Grew MA offerings by 505,000 through H1 2025
UnitedHealthcare Community & State (Medicaid)	$23,800	7.5 million total members (as of H1 2025)	Members served contracted by 30,000 in Q3 2025

UnitedHealth Group held 29% of all Medicare Advantage enrollment in 2025, equating to 9.9 million enrollees. The company saw its individual and group Medicare Advantage offerings grow by 625,000 people year-over-year through the third quarter of 2025. Still, the Community & State segment saw members contract by 30,000 in the third quarter of 2025.

Individuals and families purchasing plans on and off public exchanges

This group is included within the broader UnitedHealthcare segment, often overlapping with the commercial segment but specifically including individual market participation.

• UnitedHealthcare Employer & Individual Q2 2025 revenues were $19.8 billion.
• Attrition was noted in both individual and group fully-insured products in Q2 2025.

Healthcare providers, payers, and life sciences companies (Optum Insight clients)

Optum Insight serves the broader health system marketplace, including other payers, providers, and life sciences firms, using technology and analytics. This is a business-to-business customer base.

Here are the key financial metrics for Optum Insight as of late 2025:

Metric	Q3 2025 Actual	Full Year 2025 Projection
Revenue	$4.9 billion	$19.0 billion to $19.5 billion
Contract Revenue Backlog	$32.1 billion (as of Q3 end)	$32.0 billion
Earnings from Operations	$706 million	$3.55 billion to $3.65 billion

The segment's Q3 2025 revenue of $4.9 billion was flat year-over-year, reflecting investments made to support future growth. The contract revenue backlog stood at $32.1 billion at the end of the third quarter.

Finance: draft 13-week cash view by Friday.

UnitedHealth Group Incorporated (UNH) - Canvas Business Model: Cost Structure

You're looking at the expense side of UnitedHealth Group Incorporated's engine, which is massive and complex, given its dual role as an insurer and a services provider. Here's the quick math on where the money goes, based on late 2025 figures.

Medical costs and claims payments are the undisputed largest drain on resources. The full-year 2025 outlook for the Medical Care Ratio (MCR) is set at 89.25% +/- 25 basis points. To give you context on the scale, operating expenses for the twelve months ending September 30, 2025, totaled $408.802B. This MCR figure reflects the cost of care delivered, which is the core expense for the UnitedHealthcare segment.

The cost structure is heavily influenced by the internal dynamics between UnitedHealthcare and Optum. For instance, studies suggest UnitedHealthcare pays Optum physician practices about 17% more than non-Optum practices, a figure that rises to 61% higher in markets where UnitedHealthcare holds at least 25% market share. This movement of money within the company is a key component of the overall cost of care.

Pharmacy benefit expenses and drug purchasing costs, primarily managed through Optum Rx, represent another significant outlay. While direct expense data isn't as readily available as the MCR, the scale of the operation is clear from revenue projections. Full year 2025 Optum Rx revenues are expected to range from $151.0 billion to $151.5 billion. Optum Rx has been actively working to manage these costs, for example, by aligning payment models more closely to pharmacy costs with full implementation targeted by January 1, 2028.

Technology and data infrastructure investments are critical for efficiency and future growth. As of late 2025, UnitedHealth Group has deployed more than 500 AI use cases across the company, with 16,000 engineers equipped with generative AI capabilities. This investment is meant to drive down administrative burdens and improve clinical decision-making.

Administrative and operating expenses cover everything else needed to run the business. For the fiscal quarter ending in September of 2025, UnitedHealth reported total Operating Expenses of $108.85B. Breaking that down further, Selling and Administration Expenses for the latest twelve months ending June 30, 2025, were $53.146 B. For the second quarter of 2025, the operating cost ratio was 12.3%, reflecting cost management activities.

Capitation payments to Optum Health providers for value-based care are a structural cost that shifts risk. Optum Health expects the total number of patients served under fully accountable value-based care models to reach 5 million for the full year 2025, an increase of approximately 300,000 new patients over the year.

Here is a summary of key cost-related metrics:

Cost Component/Metric	Financial Number/Statistic	Period/Context
Full Year 2025 MCR Outlook	89.25%	Full Year 2025 Estimate
Operating Expenses (12 Months)	$408.802B	Ending September 30, 2025
Selling, General & Admin Expenses (TTM)	$53.146 B	Ending June 30, 2025
Optum Rx Revenue Projection	$151.0 B to $151.5 B	Full Year 2025 Estimate
AI Engineers with Generative AI Capabilities	16,000	Late 2025
Value-Based Care Patients Expected (Increase)	~300,000	2025 Year-to-Date/Full Year Expectation
Total Value-Based Care Patients Expected	5 million	Full Year 2025 Expectation

The internal payment differential between UnitedHealthcare and Optum physicians is notable:

• 17% higher payment to Optum doctors on average.
• 61% higher payment in markets with $\ge 25\%$ UHC market share.

You can see the impact of technology efficiency in the Q1 2025 operating cost ratio, which was 12.4%, down from 14.1% in Q1 2024.

Finance: draft 13-week cash view by Friday.

UnitedHealth Group Incorporated (UNH) - Canvas Business Model: Revenue Streams

You're looking at the core ways UnitedHealth Group Incorporated brings in cash as of late 2025. It's a dual engine: the insurance side and the services side.

The primary driver remains the health insurance premiums collected through the UnitedHealthcare segment. This stream is noted as representing 78.6% of Q3 2025 revenue.

The second major component comes from service fees generated by Optum. This covers a broad range of activities, including pharmacy benefit management (PBM) through Optum Rx, technology and data analytics via Optum Insight, and consulting services embedded within Optum Health and Insight operations. To be fair, these fees are the sum of the detailed revenue streams below.

Here's a look at the expected full-year 2025 financial picture for the major components:

Revenue Stream Component	Expected Full Year 2025 Revenue Range
UnitedHealth Group Incorporated Total Revenue	$445.5 billion and $448.0 billion
Optum Rx	$151.0 billion to $151.5 billion
Optum Insight	$19.0 billion to $19.5 billion

For context on the Q3 2025 performance that feeds into these annual expectations, UnitedHealthcare revenues were $\mathbf{\$87.1 \text{ billion}}$ year-over-year, while Optum revenues reached $\mathbf{\$69.2 \text{ billion}}$ year-over-year.

Within the Optum Health business, the revenue mix shows a clear strategic focus on value-based arrangements. You can see the breakdown of how Optum Health generates its revenue:

• Value-based care (VBC) revenue: 65% of Optum Health's total revenue.
• Of that VBC revenue, roughly two-thirds serves UnitedHealthcare members.
• The remaining Optum Health revenue comes from care delivery fee-for-service and payer/employer services.

The total consolidated revenue for UnitedHealth Group Incorporated in the third quarter of 2025 hit $\mathbf{\$113.2 \text{ billion}}$, marking a $\mathbf{12\%}$ increase year-over-year.

Finance: draft 13-week cash view by Friday.