Shining a light on a giant.
The UnitedHealth Group Sunshine Report is a first-of-its-kind look at the nearly 2,700 acquisitions and internally created subsidiaries that make up UnitedHealth Group, the largest health care conglomerate in the world.
Named for its mission to bring light to UnitedHealth’s vast and often opaque business structure, this project compiles and analyses publicly available data in an accessible way, allowing the public to more clearly grasp the scope of the company’s reach.
UnitedHealth Group has evolved from a small U.S. health insurer into a massive health care conglomerate through decades of strategic acquisitions and vertical integration. It provides health insurance and related services globally and is broadly divided into its insurance arm (UnitedHealthcare) and another major division (Optum), which provides other health care-related services. As of the fourth quarter of 2024, UnitedHealth operated in almost every country in the world, had more than 400,000 employees, and reported 2024 revenue of $400 billion. Through its vertical integration and acquisitions, it now employs or has close contractual ties with more than 90,000 doctors (10% of the entire U.S. physician workforce) and commands 15% of the U.S. health insurance market. As a result of this vertical integration strategy, 40% of total company revenue is now generated by internal business entities, enabling profit shifting between those entities and its insurance arm, which is regulated by state and federal agencies, and its less regulated health care delivery arm.
The sheer size and complexity of the organization, coupled with its rapid pace of acquisitions, makes it extremely difficult for consumers, regulators, policymakers, employers and other group purchasers of health insurance to understand the inner workings of the organization. This is compounded by UnitedHealth’s lack of granularity in financial and regulatory reporting. For example, current financial reporting aggregates data from multiple entities and regions, often without clear delineation of contributions by subsidiary or geography, and makes it impossible to analyze the performance (and significance) of its many individual components. Similarly, corporate filings and disclosures often omit important information about entity-specific operations and people.
We believe this level of complexity and opacity can have an adverse effect on health care quality and affordability for consumers and employers by reducing choices, obscuring costs and generally leaving the public without critical information needed to make decisions about health care.Many of the acquisitions and business practices of UnitedHealth are shrouded in secrecy which, coupled with its byzantine structure, deters most people from learning more or understanding what is at stake.
That is why we undertook the massive project of helping the public understand this corporation, which has grown to become the fourth largest on the Fortune 500 list of American companies. The goal of our work was to:
1. Characterize the structure and function of the various entities that comprise UnitedHealth;
2. Detail its rapid growth through acquisitions and how it has evolved along with its vertical integration strategy.
We believe this information will help consumers, policymakers, health care providers, regulators and anyone else who has an interest in ensuring the quality, access, and affordability of our health care system.
The sunlight
report
What our work
reveals
As of the third quarter of 2024, UnitedHealth was composed of 2,694 distinct legal entities (i.e., subsidiaries). These entities largely fall into one of five functional areas:
-
Clinical entities that provide direct clinical care or services to patients. In this category we also included entities that provide administrative support to clinical subsidiaries, in service of their operations (e.g., Independent Practice Associations (IPAs), Management Service Organizations (MSOs), etc.);
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Insurance entities, including health, dental, vision, and non-health related insurers such as life and disability;
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International entities, which usually are large conglomerates that provide both insurance and health care-related services;
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Pharmacy, including specialty pharmacy, infusion, pharmacy benefits management, etc.; and
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Other entity types including areas such as consulting, technology, real estate/property management, etc.
Prior to 2010, UnitedHealth's strategic acquisitions were largely focused on expanding and diversifying its health insurance operations. Notable acquisitions and mergers during this period included:
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AmeriChoice (2002)
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Mid Atlantic Medical Services (2003)
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PacificCare Health Systems (2005)
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Sierra Health Services (2008)
Over the past decade, the number of UnitedHealth entities has increased more than 10-fold, from 219 in 2013 to 2,694 in 2023.
UnitedHealth
subsidiaries by business type
Clinical
Insurance
Other
Pharmacy
International
100+ entities
100+ entities
150+ entities
200+ entities
2050+ entities
Growing and
growing
During this period, UnitedHealth shifted its strategy aggressively toward acquiring clinical and health care service-related clinical entities (including provider groups, ambulatory surgery centers (ASCs), home care organizations and technology assets (e.g., claims processing, payment integrity, revenue cycle management, etc.) to support both its insurance and clinical operations.
Notable acquisitions during this period include:
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$2.3B acquisition of SCA Health, the second-largest ambulatory surgery center (ASC) operator with 320 facilities.
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$3.4 billion acquisition of DaVita Medical Group (2019), a large multi-specialty medical group.
NOTE: DaVita Medical Group is now called Optum Care, following the company's acquisition by Optum. Optum integrated DaVita Medical Group’s clinics and health care services into its broader broader Optum Care network, which provides what the company calls “value-based care” through physician groups and clinics across the U.S.
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$3.2 billion acquisition of Equian (2019) for payment processing services.
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$3.5 billion acquisition of Landmark Health (2021), which specializes in providing in-home medical care for patients with complex, chronic conditions.
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$8 billion acquisition of Change Healthcare, which provides data, analytic and technology capabilities for claims and payment management.
-
$5.4 billion acquisition of LHC Group (2023), which has an extensive network of home health and hospice services (700 locations across 37 states).
UnitedHealth
subsidiary growth
Years
3000
2500
2000
1500
1000
500
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
20
22
20
23
0
Clinical
growth
LHC Group
2023
Unique legal entities (number)
DaVita Medical Group
2019
Optum360
2012
Catamaran
2015
HealthSmart Rx Solutions, Inc
2023
Landmark Health
2021
OMCO, INC
2015
Equian
2019
1000
300
200
600
500
400
900
800
700
100
Unique legal entities (number)
0
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
20
22
20
23
20
24
Years
20
24
Shift to
patient care
UnitedHealth’s clinical enterprise now spans clinical services delivered “cradle to grave” in various physical settings (clinics, home, ambulatory surgical centers), and across numerous clinical domains (e.g., primary care, specialty care, behavioral health, urgent care, imaging, home health, palliative care, hospice, etc.). In addition to the clinicians it employs, UnitedHealth has contractual relationships with an equal number of independent physicians through entities it owns, namely IPAs and Accountable Care Organizations.
Multi-Specialty Care
Primary Care
Homecare
Behavioral Health
ASC
Admin Support
0
100
200
300
400
500
600
700
800
900
Unique legal entities (number)
Clinical growth
by subtype
Major
themes
UnitedHealth has aggressively acquired entities that drive business to or that support the operations of one or more of its other owned entities. For example, MSOs provide management services to physician practices, including coding and documentation, revenue cycle management, and credentialing. To support its insurance operations, UnitedHealth owns an array of distribution channels, including brokerages, call centers and even travel agencies that support its extensive international travel insurance operations. Several other themes emerged from our analysis:
Theme 1
The sheer number of “companies” which do not appear to have assets, operations, or employees, but are designed for other business purposes, most commonly to serve as “holding companies”, facilitate mergers and acquisitions, or manage international business operations. Virtually no public information is available about these entities, so we could only make inferences about their business purposes, given the size and complexity of the organization.
Theme 2
UnitedHealth has expansive international operations, although as noted above detailed information about the operations and finances of these entities is extremely limited (as are the availability of foreign registrations or business descriptions, if required, since they are subject to different legal and regulatory requirements in local jurisdictions). To us, these entities seem to operate almost entirely camouflaged from the view of regulators, consumers and even shareholders.
Theme 3
Third, beyond clinical assets, UnitedHealth’s expansion into adjacent markets (or in some cases seemingly not health care related) is noteworthy; this activity has accelerated recently, with 92 related acquisitions since 2016.
Examples include:
1) Exploration for Mine Clearance, LLC, a company domiciled in Iraq;
2) Optum Ventures, a venture capital firm with >$1 billion in assets under management;
3) Optum Insight Life Sciences, which partners with nearly 200 life sciences companies and supports the design and conduct of clinical trials;
4) RVO Health, LLC, a joint venture between Optum and Red Ventures. Red Ventures is a major, global digital media company that operates more than 100 digital brands (including healthline.com and medicalnewtsoday.com and has nearly 1 billion monthly readers.
Why you should
care
UnitedHealth Group has pursued an aggressive vertical integration strategy through acquisitions, increasing 10-fold in size over the past decade and now consisting of 2,694 distinct legal entities. Clinical subsidiaries, including physician groups, ambulatory surgery centers, and home care organizations (including palliative care and hospice) now comprise the overwhelming proportion of its legal structure. We believe this trend should be of special interest to state and federal lawmakers and regulators given UnitedHealth’s ability to shift expenses (and profits) between its insurance arm and care delivery arms.
We suspect few consumers are aware that their doctors could be part of an enterprise that, as a publicly traded company, has a legal obligation, first and foremost, to maximize shareholder value. A means to that end can include delaying or denying medically necessary care (including in palliative and hospice care settings when patients are in their greatest time of need and are at their most vulnerable). The corporation's rapid expansion into adjacent services enables UnitedHealth to now influence or control the entire financial and clinical continuum of patient care for millions of Americans.
Research
methods
Company details were abstracted from Schedule Y filings with state regulators, which require disclosures on related party insurer members of a holding company and are publicly available. We downloaded separate Schedule Y’s for each year from 2010-2024 (limited information was available on Schedule Y’s prior to 2010, so we relied on other filings and published reports for acquisitions made in earlier years). Since many of the files were either scanned PDFs or did not have structured data elements, we manually abstracted the company names, identification numbers and the controlling (parent) entity for each year. For any controlling entity, if there were multiple owners, we included the one with the largest ownership percentage listed in the Schedule Y. If there were multiple owners with equal percentages, we listed all of them as the “controlling entity”.
We merged the data across years by linking identification numbers when available, or by name if they were missing. Since the details of many of the acquisitions are not publicly reported, we estimated the establishment date based on when it first appeared in a Schedule Y. For example, if a company first appeared on a Schedule Y in 2023, we listed the establishment date as occurring sometime between January 1, 2022, and December 31, 2022.
We also researched public information about each company, including its purpose and operations. We supplemented our searches using artificial intelligence (ChatGPT and Perplexity) when needed. We then categorized each company based on its operating unit within UnitedHealth Group’s formal organizational structure and its functional purpose.
Meet the
team
Wendell Potter
Project Lead
Seth Glickman
Research
Joey Rettino
Website Design
Gianna Jackson
Project Assistant
In partnership
The UnitedHealth Group Sunlight Report is a project of the Center for Health & Democracy (CHD), made possible through funding from Arnold Ventures. In early 2024, Arnold Ventures approached CHD with the idea of compiling and publishing a public record of UnitedHealth Group’s vast corporate structure. The grant funding supports CHD’s efforts to collect, analyze, and present this data, drawn from the company’s filings with regulatory agencies over several years, in a publicly accessible format. The goal is to provide greater transparency for all of the company’s stakeholders.
