Grupo UnitedHealth Incorporated (UNH): Modelo de negócios Canvas [Jan-2025 Atualizado]

No complexo cenário de assistência médica e seguros, o UnitedHealth Group Incorporated surge como uma potência transformadora, a tecnologia estrategicamente tecendo, serviços abrangentes e soluções inovadoras em um modelo de negócios robusto que atende a milhões de clientes em diversos segmentos. Ao alavancar uma intrincada rede de parcerias, plataformas digitais avançadas e uma abordagem multifacetada para a prestação de serviços de saúde, a UnitedHealth se posicionou como um líder dinâmico que vai além dos paradigmas de seguros tradicionais, oferecendo soluções de saúde personalizadas, de custo-benefício e tecnologicamente integrado que Adapte -se às necessidades em evolução de empregadores corporativos, consumidores individuais e programas de saúde do governo.

UnitedHealth Group Incorporated (UNH) - Modelo de Negócios: Principais Parcerias

Alianças estratégicas com profissionais de saúde, hospitais e clínicas

O UnitedHealth Group mantém parcerias estratégicas com 1,3 milhão de profissionais de saúde e 6.500 hospitais em todo o país em 2023. A rede da empresa inclui:

Tipo de parceiro	Número de parceiros	Cobertura
Médicos de cuidados primários	540,000	50 estados
Médicos de atendimento especializado	750,000	50 estados
Hospitais	6,500	Cobertura nacional

Parcerias com empresas farmacêuticas e fabricantes de medicamentos

As parcerias farmacêuticas do UnitedHealth Group incluem:

• Contratos diretos com 15 principais fabricantes farmacêuticos
• Plataforma de Gerenciamento de Benefícios de Farmácia RX Optum, cobrindo 65 milhões de vidas
• Acordos de preços de drogas negociados com 90% das principais empresas farmacêuticas

Colaborações com empresas de tecnologia para soluções de saúde digital

As parcerias de tecnologia incluem:

Parceiro de tecnologia	Área de foco	Valor de investimento/colaboração
Alphabet (Google Health)	Soluções de saúde da IA	Investimento de US $ 100 milhões
Microsoft	Plataforma de saúde em nuvem	Colaboração de US $ 250 milhões
Maçã	Monitoramento da saúde digital	Parceria de US $ 75 milhões

Acordos com dispositivos médicos e fabricantes de equipamentos de diagnóstico

As parcerias de dispositivos médicos do UnitedHealth Group incluem:

• Contratos com 22 principais fabricantes de dispositivos médicos
• Cobertura de 95% do equipamento de diagnóstico aprovado pela FDA
• Acordos de compras diretas com a Medtronic, GE Healthcare e Philips

Investimento total de parceria: US $ 425 milhões anualmente em colaborações estratégicas

UnitedHealth Group Incorporated (UNH) - Modelo de negócios: Atividades -chave

Projeto e Gerenciamento do Plano de Seguro de Saúde

O UnitedHealth Group gerencia 70 milhões de médicos e 55 milhões de membros odontológicos a partir de 2023. A empresa oferece 4 categorias de plano de seguro primário: planos individuais, pequenos grupos, grandes grupos e Medicare/Medicaid.

Categoria de plano	Associação total	Receita premium anual
Planos individuais	15,2 milhões	US $ 42,3 bilhões
Planos de pequenos grupos	12,5 milhões	US $ 38,7 bilhões
Grandes planos de grupo	35,6 milhões	US $ 87,5 bilhões
Planos do Medicare/Medicaid	22,1 milhões	US $ 65,2 bilhões

Processamento de reivindicações e gerenciamento de custos de saúde

A UnitedHealth processa aproximadamente 5,2 bilhões de reclamações anualmente com um tempo médio de processamento de 14 dias. A tecnologia de gerenciamento de reivindicações da empresa reduz os custos administrativos em cerca de 22%.

• Total de reivindicações processadas em 2023: 5,2 bilhões
• Tempo médio de processamento de reivindicações: 14 dias
• Redução de custos administrativos: 22%
• Taxa de precisão de reivindicações: 98,6%

Desenvolvimento de redes médicas e expansão de rede de provedores

A UnitedHealth mantém uma rede abrangente de fornecedores com 1,3 milhão de profissionais de saúde e 6.500 hospitais em todo o país.

Composição de rede	Contagem total
Médicos	1,1 milhão
Especialistas	200,000
Hospitais	6,500
Clínicas	85,000

Inovação em tecnologia da saúde e desenvolvimento de plataformas de saúde digital

A UnitedHealth investiu US $ 3,8 bilhões em plataformas de tecnologia e saúde digital em 2023. A Plataforma de Tecnologia da Saúde Optum atende 98 milhões de consumidores.

• Investimento de tecnologia anual: US $ 3,8 bilhões
• Usuários da plataforma de saúde digital: 98 milhões
• Consultas de telessaúde em 2023: 42 milhões
• Usuários de aplicativos de saúde móvel: 27 milhões

Avaliação de risco e análise atuarial

A UnitedHealth emprega 2.500 profissionais atuariais que analisam modelos complexos de risco de saúde com análises preditivas avançadas.

Métricas de avaliação de risco	Valor anual
Profissionais atuariais	2,500
Precisão do modelo de risco	94.3%
Investimento de análise preditiva	US $ 620 milhões

UnitedHealth Group Incorporated (UNH) - Modelo de negócios: Recursos -chave

Extensa rede de prestadores de serviços de saúde

O UnitedHealth Group mantém uma rede de 1,3 milhão de profissionais de saúde e 6.500 hospitais a partir de 2023. A rede de provedores da empresa abrange 49 estados e abrange em vários sistemas de prestação de serviços de saúde.

Composição de rede	Número
Médicos de cuidados primários	540,000
Especialistas	760,000
Hospitais	6,500

Sistemas avançados de análise de dados e informações de saúde

Processos subsidiários Optum do UnitedHealth Group 4 bilhões de transações de saúde anualmente. A empresa investe US $ 3,8 bilhões anualmente em tecnologia e inovação.

• Plataformas proprietárias de análise de dados
• Modelos de previsão de saúde de aprendizado de máquina
• Sistemas de processamento de reivindicações em tempo real

Fortes capital financeiro e capacidades de investimento

A partir do quarto trimestre 2023, o UnitedHealth Group informou:

Métrica financeira	Quantia
Receita total	US $ 324,2 bilhões
Ganhos líquidos	US $ 20,1 bilhões
Dinheiro e investimentos	US $ 62,3 bilhões

Força de trabalho qualificada de profissionais de saúde

O UnitedHealth Group emprega 400.000 trabalhadores totais, com 70.000 dedicados a funções de tecnologia e inovação.

• Administradores de saúde: 85.000
• Profissionais de tecnologia: 70.000
• Profissionais Clínicos: 145.000

Tecnologia de saúde proprietária e plataformas de software

As plataformas de tecnologia optum processam dados de assistência médica para 98 milhões de pacientes. A empresa mantém 2.500 patentes de tecnologia ativa.

Plataforma de tecnologia	Cobertura do paciente
Plataforma de saúde Optum	52 milhões de pacientes
Optum rx	35 milhões de pacientes
Optum Insight	11 milhões de pacientes

UnitedHealth Group Incorporated (UNH) - Modelo de Negócios: Proposições de Valor

Opções abrangentes de cobertura de seguro de saúde

O UnitedHealth Group oferece mais de 70 tipos de plano de saúde, cobrindo 52,5 milhões de americanos em 2023. O total de prêmios de seguro de saúde atingiu US $ 233,4 bilhões em 2022.

Tipo de plano de seguro	Total de indivíduos cobertos
Planos patrocinados pelo empregador	34,2 milhões
Planos de mercado individuais	8,1 milhões
Vantagem do Medicare	7,8 milhões

Serviços de saúde integrados em vários segmentos

O UnitedHealth Group opera através de dois segmentos primários: UnitedHealthcare (seguro) e Optum (serviços de saúde).

• A UnitedHealthcare gerou US $ 233,4 bilhões em receita em 2022
• As receitas de serviços de saúde da Optum atingiram US $ 155,1 bilhões em 2022
• Receita total combinada de US $ 386,5 bilhões

Soluções de saúde personalizadas e programas de bem -estar

O UnitedHealth Group investiu US $ 5,2 bilhões em inovações em saúde digital e tecnologias de atendimento personalizado em 2022.

Categoria do Programa de Bem -Estar	Participantes inscritos
Gerenciamento de doenças crônicas	3,7 milhões
Apoio à saúde mental	2,4 milhões
Programas de cuidados preventivos	6,1 milhões

Cuidados médicos e opções de tratamento econômicas

O UnitedHealth Group alcançou US $ 15,8 bilhões em economia de custos médicos por meio de protocolos inovadores de tratamento em 2022.

Ferramentas de saúde digital avançadas e serviços de telemedicina

A plataforma de saúde digital atende 22,3 milhões de usuários com recursos de telemedicina em 2023.

• Consultas de atendimento virtual: 47,6 milhões em 2022
• Usuários de aplicativos de saúde digital: 22,3 milhões
• Investimento de telessaúde: US $ 3,6 bilhões em 2022

UnitedHealth Group Incorporated (UNH) - Modelo de Negócios: Relacionamentos do Cliente

Suporte ao cliente on-line e portais de autoatendimento

A plataforma digital da UnitedHealthcare serve 71,2 milhões de membros por meio de portais on -line. A plataforma de autoatendimento digital da empresa processou 1,4 bilhão de interações digitais em 2022. Os membros podem acessar os seguintes serviços digitais:

• Gerenciamento de reivindicações
• Verificação de benefícios
• Pesquisa de provedores
• Programação de cuidados virtuais

Programas personalizados de gestão de saúde

Tipo de programa	Número de participantes	Economia anual de custos
Gerenciamento de doenças crônicas	3,2 milhões de membros	US $ 487 milhões
Programas de incentivo de bem -estar	2,8 milhões de participantes	US $ 312 milhões

Canais de comunicação digital e aplicativos móveis

O aplicativo móvel da UnitedHealthcare possui 12,5 milhões de usuários mensais ativos. O aplicativo fornece:

• Rastreamento de saúde em tempo real
• Consultas de telessaúde
• Gerenciamento de prescrição
• Acesso ao cartão de seguro

Consultas regulares à saúde e check-ups de bem-estar

O UnitedHealth Group conduziu 42,6 milhões de exames de saúde preventiva em 2022. As consultas de telessaúde aumentaram 287% em comparação com os níveis pré-pandêmicos.

Representantes de atendimento ao cliente dedicados

Categoria de serviço	Número de representantes	Tempo médio de resposta
Suporte ao membro	6.500 representantes	12 minutos
Suporte ao provedor	3.200 representantes	15 minutos

Taxa de retenção de clientes: 89,4% para planos de saúde individual e em grupo em 2022.

UnitedHealth Group Incorporated (UNH) - Modelo de Negócios: Canais

Plataformas de mercado de seguros online

UnitedHealthcare opera o UnitedHealthcare.com Plataforma on -line, atendendo a 70 milhões de membros a partir de 2023. Os canais de mercado de seguros digitais geraram US $ 23,4 bilhões em receita digital em 2022.

Plataforma digital	Usuários anuais	Receita digital
UnitedHealthcare.com	70 milhões	US $ 23,4 bilhões

Vendas diretas através de sites corporativos e individuais

Os canais de vendas digitais diretos incluem:

• Inscrição individual de seguro de saúde
• Seleções do plano do Medicare
• Compra de seguros do grupo de empregadores

Corretores de seguros e redes de agentes

O UnitedHealth Group mantém 35.000 agentes de seguros contratados em 50 estados. Esses agentes geraram US $ 12,7 bilhões em vendas mediadas por corretores em 2022.

Métricas de rede de agentes	Valor
Agentes contratados totais	35,000
Vendas mediadas por corretores	US $ 12,7 bilhões

Programas de seguro de saúde patrocinados pelo empregador

UnitedHealth Serves 1,3 milhão de empregadores Com os programas de seguro de saúde em grupo, cobrindo aproximadamente 49% do mercado de seguros de saúde patrocinado pelo empregador.

Aplicativos móveis e de saúde digital

O ecossistema de saúde digital da UnitedHealth inclui:

• Optum Health Mobile App (4,2 milhões de usuários ativos)
• UnitedHealthcare Mobile App (6,8 milhões de usuários ativos)
• Plataformas de atendimento virtual com 15 milhões de interações digitais anuais

Plataforma de saúde digital	Usuários ativos
Optum Health App	4,2 milhões
UnitedHealthcare App	6,8 milhões
Interações digitais totais	15 milhões anualmente

UnitedHealth Group Incorporated (UNH) - Modelo de negócios: segmentos de clientes

Grandes empregadores corporativos

O UnitedHealth Group atende a aproximadamente 158.000 empregadores em todo o país a partir de 2023. A empresa oferece cobertura abrangente de seguro de saúde para grandes organizações.

Categoria de tamanho do empregador	Número de funcionários cobertos	Receita premium anual
Fortune 500 empresas	68.500 empregadores	US $ 42,3 bilhões
Corporações de tamanho médio	89.500 empregadores	US $ 27,6 bilhões

Pequenas e médias empresas

O UnitedHealth Group cobre aproximadamente 1,3 milhão de empresas pequenas e médias nos Estados Unidos.

• Tamanho médio dos negócios: 25-250 funcionários
• Premium anual por empresa: US $ 185.000
• Receita total do segmento de mercado de pequenas empresas: US $ 241 bilhões em 2023

Consumidores de seguro de saúde individuais

Em 2023, o UnitedHealth Group atendeu a 7,2 milhões de consumidores individuais de seguro de saúde através do mercado e planos de compra direta.

Segmento do consumidor	Número de indivíduos	Prêmio médio anual
Planos de mercado	4,6 milhões	$5,280
Compra direta	2,6 milhões	$6,120

Beneficiários do Medicare e Medicaid

O UnitedHealth Group atende 6,9 ​​milhões de membros do Medicare Advantage e 4,3 milhões de beneficiários do Medicaid em 2023.

• Participação de mercado do Medicare Advantage: 29%
• Medicaid Gerenciado Cuidado Inscrição: 22 estados
• Receita total do segmento Medicare/Medicaid: US $ 98,7 bilhões

Organizações do governo e do setor público

O UnitedHealth Group oferece cobertura de saúde para várias entidades governamentais em 50 estados.

Segmento do governo	Número de entidades cobertas	Valor anual do contrato
Contratos federais	37 agências federais	US $ 12,4 bilhões
Contratos do governo do estado	48 Departamentos de Saúde do Estado	US $ 22,6 bilhões

UnitedHealth Group Incorporated (UNH) - Modelo de negócios: estrutura de custos

Despesas de reembolso do provedor de serviços de saúde

Em 2023, os custos médicos totais do UnitedHealth Group e as despesas de reembolso do profissional de saúde foram de US $ 511,9 bilhões, representando aproximadamente 81,5% da receita total.

Categoria de despesa	Valor (2023)	Porcentagem de receita
Despesas de reivindicações médicas	US $ 511,9 bilhões	81.5%
Pagamentos de rede de provedores	US $ 385,4 bilhões	61.3%

Reivindicações de processamento e custos administrativos

As despesas administrativas do UnitedHealth Group em 2023 totalizaram US $ 47,3 bilhões, representando 7,5% da receita total.

• Investimentos em tecnologia de processamento de reivindicações: US $ 2,1 bilhões
• Sistemas de eficiência operacional: US $ 1,5 bilhão
• Infraestrutura de conformidade e relatório regulatório: US $ 750 milhões

Infraestrutura de tecnologia e manutenção da plataforma digital

Os investimentos em tecnologia e plataforma digital atingiram US $ 3,85 bilhões em 2023.

Área de investimento em tecnologia	Valor (2023)
Plataformas de saúde digital	US $ 1,2 bilhão
Infraestrutura de segurança cibernética	US $ 650 milhões
Sistemas de análise de dados	US $ 900 milhões
Soluções de computação em nuvem	US $ 500 milhões

Salários e benefícios dos funcionários

As despesas totais de compensação dos funcionários em 2023 foram de US $ 24,6 bilhões.

• Salários base: US $ 16,3 bilhões
• Benefícios para a saúde: US $ 3,2 bilhões
• Contribuições de aposentadoria e pensão: US $ 2,4 bilhões
• Bônus de desempenho: US $ 2,7 bilhões

Despesas de marketing e aquisição de clientes

Os custos de marketing e aquisição de clientes em 2023 totalizaram US $ 3,7 bilhões.

Categoria de despesa de marketing	Valor (2023)
Marketing digital	US $ 1,5 bilhão
Publicidade tradicional	US $ 1,2 bilhão
Canais de vendas e distribuição	US $ 700 milhões
Programas de retenção de clientes	US $ 300 milhões

UnitedHealth Group Incorporated (UNH) - Modelo de negócios: fluxos de receita

Coleções de prêmios de seguro de saúde

Para o ano fiscal de 2023, o UnitedHealth Group registrou prêmios totais de seguro de saúde de US $ 233,9 bilhões. A quebra das coleções premium inclui:

Segmento	Receita premium
Empregador da UnitedHealthcare & Individual	US $ 97,4 bilhões
UnitedHealthcare Medicare & Aposentadoria	US $ 76,2 bilhões
Comunidade UnitedHealthcare & Estado	US $ 60,3 bilhões

Contratos de serviço do Medicare e Medicaid

Os contratos de serviço do Medicare e Medicaid geraram US $ 136,5 bilhões em receita para 2023, com as principais métricas:

• Medicare Advantage Inscrito: 7,1 milhões de membros
• Medicaid Gerenciado Cuidado Inscrição: 6,5 milhões de membros
• Valor médio do contrato por membro: US $ 19.800

Assinaturas de plano de saúde do grupo corporativo

As assinaturas do plano de saúde do grupo corporativo atingiram US $ 82,7 bilhões em 2023, com as seguintes características:

Tamanho da empresa	Receita de assinatura	Número de vidas cobertas
Grandes empregadores (mais de 500 funcionários)	US $ 45,3 bilhões	12,6 milhões
Empregadores de tamanho médio (100-499 funcionários)	US $ 23,4 bilhões	5,8 milhões
Pequenos empregadores (menos de 100 funcionários)	US $ 14 bilhões	3,2 milhões

Vendas individuais do plano de saúde

O plano de seguro de saúde individual vendas para 2023 totalizou US $ 28,6 bilhões, com os seguintes segmentos de mercado:

• ACA Marketplace Planos: US $ 15,2 bilhões
• Planos diretos ao consumidor: US $ 8,7 bilhões
• Planos de curto prazo e suplementares: US $ 4,7 bilhões

Tecnologia de saúde e taxas de serviço

Tecnologia do segmento Optum As taxas de serviço geraram US $ 52,3 bilhões em 2023, incluindo:

Categoria de serviço	Receita
Optum Health Services	US $ 26,1 bilhões
Optum Insights Technology Services	US $ 16,4 bilhões
Optum RX Farmacy Services	US $ 9,8 bilhões

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.