UnitedHealth Group's Strategic Overhaul to Enhance Operational Efficiency

In December, UnitedHealth Group unveiled plans for operational enhancements after audits revealed insights into its health services and pharmacy benefit segments. The company aims to boost efficiency by integrating more automation and standardized internal procedures, addressing previous shortfalls in financial performance for the first time since 2008.

UnitedHealth faced scrutiny due to changing government reimbursement frameworks and an unexpected patient mix within Optum Health, its clinical services division. As a part of the audit review, UnitedHealth manages various segments like UnitedHealthcare, responsible for Medicare Advantage plans, and OptumRx, a pharmacy benefit manager. The company plans to execute 23 action plans by next quarter to meet regulatory compliance requirements and improve risk management.

FTI Consulting's audit highlighted the need for standardized documentation, especially in the HouseCalls program, affecting Medicare Advantage payment calculations. With ongoing investigations by the Department of Justice into Medicare Advantage billing practices, UnitedHealth continues to collaborate, maintaining that they adhere to regulatory standards in payer and provider interactions. Further process enhancements in OptumRx through automation could yield better efficiency and claims management, positioning the company for improved operational outcomes.