UnitedHealth Group Inc. wants to get a handle on the cost of your health care.
So, now more than ever, the Minnetonka-based company isn't just selling insurance — it's also involved with some of the doctoring.
In April, UnitedHealth's division for health services, Optum, announced a deal to acquire a West Virginia company with about 140 urgent care clinics across the country.
Optum already operated nine of these centers, which focus on unscheduled care for patients who need prompt attention that's short of emergency room service.
With the deal, Optum will become one of the nation's largest independent providers of urgent care, according to Merchant Medicine, a Shoreview group that tracks the industry.
Optum is a growth driver for UnitedHealth Group, the No. 1 company on the Star Tribune's annual list of largest publicly traded companies in the state, with about $130.5 billion in 2014 revenue.
UnitedHealth, the nation's largest insurer, has held the top spot on the Star Tribune 100 for nine consecutive years, thanks to dramatic growth. In 2005, the company had $45.3 billion in revenue — roughly a third of its revenue total for 2014. Employment over the period has grown from 55,000 to 170,000 people worldwide.
Most of Optum's $47.7 billion in revenue last year came from providing services to the UnitedHealthcare insurance division, analysts say. But they estimate Optum had sales to outside customers in 2014 of about $10 billion — a tally that would place the division among the 15 largest companies on the Star Tribune list, were it a stand-alone entity.
Patient care is by no means the biggest source of revenue for Optum, but it's a good fit with the division's larger goals, said Sheryl Skolnick, an analyst with Mizuho Securities USA.
"The whole point of Optum … is to transform the way we deliver and pay for care today into something that works better for all the constituents," Skolnick said. To do that, "you actually have to understand how [care] is delivered."
The budding interest in providing patient care extends to a house call program, where Optum nurses have been visiting patients in their homes for about three years. Plus, Optum does business with physician practices with 16,000 doctors, including about 1,000 physicians it directly employs.
Where will it stop?
"We say that we will never be in the hospital business — the heads in the beds," said Larry Renfro, the Optum chief executive, during an investors conference in December. "We should probably never say never, but that is not our focus," although hospitals hire Optum for certain administrative services.
UnitedHealth Group is not alone among health insurers in dabbling with patient care. For years, California-based Kaiser Permanente and Bloomington-based HealthPartners — both nonprofits — have sold health insurance while operating large systems of hospitals and clinics.
Other publicly traded insurers have made smaller moves into patient care than UnitedHealth, analysts say. Most insurers are developing new financial relationships with health care providers under the heading of "accountable care organizations," or ACOs.
Critics say that patients can suffer when doctors and health insurers share financial incentives.
"It will trim down the ability of the practitioner to make choices in the best interest of the patient," said Mike Hatch, the former Minnesota attorney general who more than 10 years ago broke up a corporate alliance between the health insurer Medica and the Allina Health System.
"Insurers are not there to spend more money — they're there to try and conserve," Hatch said.
Jack Larsen, the executive vice president for OptumCare, countered that doctors and care providers working for the company have the information technology tools to guide patients to the best care options — rather than care that could be wasteful.
The goal, Larsen said, is "the avoidance of the unnecessary, so we can fund the necessary."
Optum started its push into patient care about four years ago with deals to handle the nonclinical operations at large physician groups in California. Optum expanded the business, Larsen said, because the company decided that partnering with doctors is key to creating a better health care system.
"When you're coordinated, things work out better in terms of cost, quality and outcomes," Larsen said.
UnitedHealth Group does not release information about revenue from the OptumCare businesses, which currently don't treat patients in Minnesota. The sales roll up into a division called OptumHealth, which during the first quarter of 2015 posted revenue of $3.3 billion.
Dr. Robert McBeath, president and CEO of Southwest Medical Associates in Las Vegas, credited Optum's ownership with helping his medical group expand. Critics recall HMOs from more than 20 years ago, McBeath said, when health plan rules were viewed as threats to patient care.
"This time there's a bright spotlight on the care that the providers are providing and the quality of that care," McBeath said.
Some aren't convinced.
"The insurance company has an inherent conflict of interest with the patient. The insurance company does not want to spend money, but the patient wants to get care," said Dr. Robert Geist, a physician in North Oaks.
By owning the doctor's practice, Geist said, insurers "bring the physician into the conflict."