Good morning. My name is Gerli Amazon Rodney. I am a nurse practitioner with Optum Complex Care Management. I love my job. And what amazes me is that so many people, people I've never even met, empower me to not just do my job, but to do it better every single day.
I'm talking about my colleagues at UnitedHealth Group who built the programs and services, the technology and analytics that allows me to do my best work. I work in Connecticut in the skilled nursing facilities, serving patients who reside long term in the nursing home setting. These elderly patients have a number of chronic medical conditions, including diabetes, heart failure, lung diseases and dementia. I manage these health issues as well as treat acute illnesses like pneumonia and provide preventative care. But my job is more than managing complex conditions.
It's about building relationships with the patients and their families as well as the physicians and the nursing home staff. I have the unique opportunity to be their voice and support their wishes. This can be both challenging and rewarding, but I rely on my clinical experience as well as collaborate with the interdisciplinary care teams, which allow me to deliver optimal care. My company provides me tools and technology with near real time pre populated data. I use the electronic medical record to document my patients' health information, including current medications, lab values and vaccinations.
I am notified through an alert in this system when preventative care is due or if there are care opportunities. This allows me to care to provide pre active care, such as testing kidney disease, colon cancer screening or diabetic screening. All of this means that I can holistically manage care and make sure the patient's entire care team has consistent and up to date information at all times. Because of the technology, I can spend more time caring for my patients and less time filling out paperwork. Within my clinical team, we provide great support to one another.
We utilize each other's clinical support for medically complex cases and support one another like when it's time for that difficult conversation with patients and families about palliative care or hospice. In my role as a clinical advisor, I mentor and manage the new clinicians and the team. I was inspired by my clinical advisor who played a pivotal role in guiding me through the transition into Actum. So I wanted the opportunity to provide a similar experience to our new clinicians and be an inspiration to our next generation of providers. And the best part is that, because of all the things that UnitedHealth Group does, I can truly say that I love my job because they allow me to be a clinician.
And that means a great deal to me because my patients are the reason I get up and go to work every day. 325,000 other people come to work every day so that I can focus on what truly matters, which is providing quality care one person at a time. Thank you. Now I present to you the CEO of UnitedHealth Group, Dave Wickman.
Thank you, Gerli. I think you can see that Gerli's role is critical to our performance today and in the next generation health system. She and many of her colleagues like her are compelling examples of what happens when human compassion and judgment intersect data, technology and clinical insights to improve patient outcomes and experiences at lower costs, one patient at a time. It's one of the strategic differentiators of our diverse business, and I'll refer back to our example here in just a moment. Good morning.
Welcome. Thank you for joining us today. We know your time is very valuable and we intend to make the most of it. We're joined by many leaders from our company today, including several emerging leaders who hold potential to be part of the future senior leadership of the UnitedHealth Group. They will be seated with you when we gather for lunch today.
Leadership and culture are essential elements of a viable and sustainable enterprise and they're important to your investment thesis as well. So we encourage you to get to know them and get to know us. Most of our Board of Directors is also here today as are every Investor Day. We have an outstanding Board with diverse skills and experiences actively engaged in governing the business. They have set the high standards that you have come to understand and appreciate at UnitedHealth Group.
1 of those standards is performance and last night we released upward revised guidance for 2019 and a more formal modestly improved first look at 2020 as well. We are performing well, containing costs, offering a wider range of consumer and customer responsive products and services, improving fundamental operating performance and advancing NPS and now growing more strongly as a result. You'll see these themes throughout the course of the day today recognizing we are far from achieving our full performance potential. As you look at our numbers and review our business today, I believe you'll see UnitedHealth Group is a fundamentally different company than the commercial insurance company I joined 22 years ago. With more than 50% of our earnings coming from Optum in 2020, it's a good time to reflect on the accelerating impact diversification has had on the capacities of UnitedHealth Group, now a broad based healthcare company, still in its formative stages of development.
It's also a good time to reflect on the opportunity this diversification has to allow us to play a valuable role in evolving the U. S. Health system at this very important time. We hope you understand the fundamental responsibility and urgency we feel to work with others to improve this system, to help it evolve to the point where it works better for everyone, those who experience care, those who provide care and those who pay for care. This is an important time in healthcare and we want you to know this capable company and its leadership team have never been more prepared and determined to contribute to leading the development and deployment of the next generation health system and to advance the pace of our growth as we pursue that goal.
Through the work of the women and men of UnitedHealth Group every day on the front lines of healthcare and through the learnings from working with other healthcare stakeholders both large and small, we can help create a more modern progressive and effective healthcare system. A system built around the people we serve where they live and seamlessly woven into their lives. Simple, convenient and compassionate, powered by 2 of the driving factors that make UnitedHealth Group's offerings distinctive data, technology and clinical insights that drive better care and the compassionate human interactions that unfold between trusted caring providers and the people we all serve together. Julie's story at the opening embodies each of these factors. Her patients see her as a highly qualified and trusted caregiver, but supporting her is the power of all the capabilities represented in the video that preceded her.
Her work is of an enterprise mission to help people and a servant leader culture focused on delivering better healthcare to her patients, informed by well cultivated and distinguished data and enabled by technology and clinical insights. She is powered by Optum's AI enabled data and technology that augments her deep clinical skills and judgment driving distinctive experiences and outcomes. In our future view, healthcare serves everyone. Everyone is covered with access to high quality care at the right location with a plan that meets their needs and at a price they can afford. It's a simpler, even more transparent and engaging system designed for those who need care as well as those who seek to maintain their healthy lifestyle.
It better serves patients with complex care needs, both polychronic and aged, with physicians who are dynamically informed with deeply personalized data and technology at their fingertips to assist decision making. Data that is responsibly protected, used solely to improve patient health, to improve health system performance and to aid development of new curative and restorative healthcare innovations for everyone. A system where the right incentives are aligned and the right tools are used to support the proper evidence based decisions embodied in care pathways. We hope to play an increasingly valuable role in the development of that smart health system of the future in a broader more innovative ways with greater impact, helping people live healthier lives and helping make the health system work better for everyone. Today, we're going to show you how we're working with others, driving the necessary changes to improve the lives of the people we serve, continually returning to one theme, UnitedHealth Group is leading the development of the next generation health system in a socially conscious way, driving distinctive shareholder and societal returns.
We are partnering to achieve improved access to better outcomes and experiences with greater affordability. Some refer to this as the quadruple aim, where improved access means all people are fairly covered. Affordability means better overall healthcare value. Better experience means simpler, more transparent, understandable and engaging. And improved outcomes means improved health for all people.
So how do we think about framing our actions and measuring the realization of the same? First, we are committed to pursuing sustainable universal coverage for all Americans as we have been now for nearly 20 years. The system of coverage programs offered today has the potential to provide nearly every American with a sound and fair coverage option. And we believe coverage quality can be improved with broader access to a wider range of consumer responsive designs like those offered by UnitedHealthcare, aligned with higher performing systems of care such as those offered by OptumCare. Next, we are committed to continuing to work with others to accelerate achievement of market leading affordability.
Today, you will learn more about how we are intensely focused on driving greater healthcare value across the health system. Our goal is to reduce healthcare cost trends to nearer to general inflation, despite the worsening health status of U. S. Citizens. We are committed to achieving world class consumer and physician experiences.
Our MPS is steadily rising and we won't rest until we achieve world class levels nearer to 70 across UnitedHealth Group and higher in care settings and among our patients with greatest healthcare needs. Today in the showcase and seminars, you will get a chance to observe the impact of our information and technology enabled clinical intervention services when applied to patients with the greatest healthcare needs. These services are one of the many sources of our distinctive growth performance in the rapidly advancing Medicare Advantage, dual eligible Medicaid, local care delivery and specialty pharmacy markets. We are committed to driving improved health outcomes by empowering people and the health system broadly With fully protected personal health information, connected to an engagement capability that rewards people for improving their health and aligned incentives to reward high quality physicians for practicing high quality medicine. Informing the health system, engaging people and aligning incentives are 3 key actions we believe will make the largest and most sustained difference in the performance of the healthcare system.
Market evidence and our own studies and experiences show technology enabled information recommendations in the hands of engaged consumers and high performing physicians drive better health outcomes and experiences at significantly lower costs. We have built and have begun to provide health records with deeply personalized AI enabled next best action recommendations to the 50,000,000 people we discussed at this session 2 years ago. These information custodian services are provided at no cost in a highly protected HIPAA and HITRUST compliant way. You'll see this and our leading efforts in engagement and incentive alignment throughout the day. So what's ahead?
1st, we are driving 5 key growth platforms globally. We are reinventing healthcare delivery through OptumCare and globally now in 35 U. S. Regions and South America serving over 25,000,000 patients and growing. We are transforming pharmacy care services through OptumRx, driving a market leading nearly $2,000 per capita in annual healthcare value to people in the most transparent way.
We are accelerating a modern digital healthcare system offering Rally as an engagement engine to nearly 20% of the U. S. Population. We're applying advanced technologies such as our patented clinical ontology, discovering breakthrough AI capacities with health at scale and growing VIVIFY, our Internet of Things platform, helping patients and their caregivers monitor and manage chronic disease wherever they are. We are advancing consumer responsive benefits, offering more choice and flexibility with more modern and personal plan designs that better meet the unique coverage needs and financial means of people.
And we are building on our distinctive health fintech platform through our expansive payments network and market leading health bank focused solely on serving healthcare. 2nd, we intend to work better with physicians by helping them build the smart healthcare settings of the future, data driven, technology assisted, value based, local and hassle free. Supporting their decision making and helping them improve quality, lower the total cost of care, and expanding their practice capacity in an environment that provides a professionally fulfilling experience. 3rd, we are committed to building the most trusted names in healthcare, Optum and UnitedHealthcare. Delivering on our commitments, accelerating the pace of innovation and continually improving clinical engagement, service and satisfaction, demonstrating people who are cared for by Optum and UnitedHealthcare are healthier.
And most importantly, we continue to cultivate the best talent at all levels. Our 325,000 diverse team members are dedicated to creating a better future for people. They are leading experts in medicine, data analytics, digital and advanced supply technologies, healthcare financing, healthcare services and cutting edge innovation. They are doctors, nurses, technologists, customer care professionals and data scientists of all kinds. They enable us to be resilient, adaptable, restless and to grow.
Before I close, what can you, our investors count on from us? I'll start with gratitude. Thank you. Without your commitment of capital over the past 45 years, none of what you see today would be possible. Trust that we will responsibly build this business to serve others first, those who experience care, those who provide care, and those who pay for care with the highest level of integrity.
We fully understand the socially sensitive area of society that we serve. And performance, we will continue to grow our business at a long term EPS growth rate of 13% to 16%, always investing in the future to sustain market leading performance and shareholder returns. Following the strategic business overviews by Andrew and Dirk, John will share our outlook for 2019 adjusted earnings, now approaching 16.5% growth rate over 2018. It's a strong growth rate, but we're not satisfied. We should have performed better for you in our Medicaid business, in Brazil and in our commercial insured growth.
We will improve on all these fronts and others in 2020 while generating stronger momentum for 2021 and beyond. You'll see clear signals of accelerating growth and performance throughout the day. We start 2020 with expectations of $16.25 to $16.55 per share, an initial growth rate of 12% to 14% excluding the impact of the health insurance tax. With the accretive impact of additional strategic capital allocation not included in this initial guidance, we should end 2020 squarely within our long term growth rate target of 13% to 16%. As always, we will endeavor to achieve to our full potential.
Across UnitedHealth Group, we are taking action at this critical moment. Our opportunity is to help shape the future of healthcare in collaboration with everyone we are privileged to partner with and serve. We will continue to be responsible stewards of your capital and deliver distinctive returns on your investments in us. And you should expect us to continue to be restless, innovative and adaptable, building the next generation health system in a socially conscious way, one person at a time. Thank you.
It's now my great honor and pleasure to introduce our new President of UnitedHealth Group and CEO of Optum, Andrew Witty.
Dave, thank you very much. Good morning, everybody, and it's a real pleasure to be here this morning having the chance to talk to you. Optum's continued strong performance over the past year reflects a growing demand for the distinctive value we deliver through our data and technology driven solutions and services. We project Optum revenues for 2019 to reach $112,100,000,000 representing year over year growth of 11% and operating earnings will be up 14% to $9,350,000,000 Optum revenues have nearly quadrupled since 2011 and earnings have grown much faster than that. We now contribute almost half of UnitedHealth Group's operating earnings.
Behind this momentum are over 180 1,000 people who are determined to deliver the Optum promise for the more than 120,000,000 people we're privileged to serve and for everyone who is invested in our success. We believe better health outcomes and experiences at a lower total cost are possible at a societal scale in the years to come and we think we're uniquely positioned to help make that vision a reality. It starts with our foundation of deep data and advanced analytics, which drive a distinctive set of core capabilities modern technologies that make the system more interoperable, transparent and efficient deep clinical expertise that drives measurably better patient care and digital and operational innovations that make consumer experiences simpler, smarter and importantly compassionate. You're going to see today how we continue to develop and invest in the most advanced technologies like artificial intelligence, genomics to solve critical challenges across the healthcare spectrum. Walk into any large healthcare conference today and you'll see hundreds of companies selling point solutions designed to solve a single problem.
Many of those companies operate within a single segment of healthcare disconnected from the broader complex environment that patients, clinicians and administrators have to navigate every day. At Optum, we believe in the power of connections. We're privileged to serve all participants across the health system and we are committed to creating a more integrated and collaborative experience for everyone. So while we look forward to updating you on the performance of our 3 core businesses, this morning I'm pleased to discuss our progress in driving the strategic agenda I introduced to you all last year. We're aligning our assets across Optum to make a dramatically greater impact on quality, experiences and cost.
Over the past year, we've significantly advanced our ability to more comprehensively engage and serve people in 2 critical ways through the communities in which they live and through their specific health conditions. 1st, we continue to develop state of the art local care ecosystems in geographies across the country. We believe in connected patient centric local care that is physician led, value based and fully supported by data and technology. Primary care is the anchor point in our model because it influences everything that happens next. So we are connecting our primary care physicians with our broader ambulatory care assets, including urgent and surgical care, diverse pharmacy care services, our behavioral health network and high value specialists, all empowered by data driven insight.
These connections create a single seamless system for patients driving up standards of care, so when you meet us once, you've met us everywhere. This approach we believe will also improve physician experience and drive distinctive value for the more than 80 payers we now serve through OptumCare. It includes programs like House Calls, where with UnitedHealthcare we've helped close over 10,000,000 gaps in patient care since 2015 with an industry leading MPS score. We also use the hundreds of thousands of connections we have with consumers every single day through pharmacy to deliver more personalized cost effective care across their medical and behavioral needs. This includes making care more connected and accessible for vulnerable people like the 45,000,000 Americans struggling with mental illness.
Today, we have nearly 500 community pharmacies located inside mental health centers nationwide and we're rapidly adding more. Through these pharmacies and their connections with local health systems, we're driving more than 90% medication adherence, nearly double that achieved by most retail pharmacies. More broadly, combining our clinical programs with pharmacy care services drives materially lower ER and inpatient cost and our digital price transparency tools are guiding physicians and patients to the right medications at the right price. You can vividly see the benefits of a connected health ecosystem in Texas through the OptumCare practice you all know as WellMed. Across WellMed, we've seen total cost of care savings of 30% or more compared to fee for service.
A key component of these savings is a 9% decrease in hospital admission rates. And critically, our patients at WellMed received the highest quality care. For 2020, our primary Dallas Fort Worth Medicare Advantage Plan has a 5 star rating, one of only 18 such plans in the country to achieve that designation. In 2016, we served just 200,000 people in Texas through value based relationships. Over the past 2 years, we've more than doubled our primary care clinics to 47 and next year we will have value based relationships with more than 500,000 people.
This progress strongly positions us to expand the impact of our value based model in Texas as we start extending these capabilities to commercial payment patients and serve the growing number of duly eligible seniors. As we get better at extending and replicating the integration of our assets in our primary care markets, we're also accelerating it. Since I introduced you to our Riverside practice in New Jersey last year, we've connected the primary care team with our ambulatory surgery, urgent care and behavioral capabilities. Among Medicaid members in New Jersey, we now see 37% lower emergency department visits with significantly fewer hospital admissions and lower pharmacy cost than local market averages. We serve 70% more patients in New Jersey than we did just 3 years ago and in 2020 we'll start to take on risk with Medicaid members.
In Southern California, we now serve 30 different payers and over the past 3 years have nearly tripled the number of people we serve through value based arrangements. In this region, we recently worked with UnitedHealthcare to create a distinctive product called Harmony. It unites care and coverage and is achieving 20% savings for people when compared to UnitedHealthcare's similar coverage offerings. We're working to bring Harmony now to more geographies including initially Seattle and Texas. Last year, we told you OptumCare would continue moving aggressively to help our provider practices transition to taking risk on their populations and this progress continues.
Through both organic growth and business combinations over the last year, we have increased the number of patients served through value based contracts by nearly 50% and that number will grow further as we continue to deepen our clinical expertise. Across Optum, we now have more than 46,000 physicians committed to the goal of delivering value based care. In the last year alone, we added 10,000 further physicians. Across our care practices, we're implementing a capability we introduced to you last year called optimal care that targets low value care. This directly embedded in the clinicians workflow combines evidence based medicine with point of care technologies to ensure patients get needed care more affordably.
For example, we've reduced certain knee procedures by more than 50% by simply guiding patients to alternate more effective treatment options. Now in addition to our own local care systems, we advance improved outcomes experience and affordability by supporting established health systems. As you know, earlier this year, we announced a comprehensive new partnership with John Muir Health in the Bay Area of California. We're bringing together multiple Optum solutions including revenue cycle management, information technology, managed analytics and care coordination to advance value based care in that region. When it comes to caring for people with chronic conditions, we believe in supporting the whole person throughout their care journey.
We do this through fully coordinated personalized patient care that uses data driven insights to deliver consistently high outcomes at lower cost. We've now launched our 1st condition centric model, a comprehensive approach to cancer care that uses data and evidence based protocols to ensure every step a patient takes is the right one for them. Care is fully coordinated by a dedicated team that supports the patient through diagnosis all the way through recovery. And we provide balanced compassionate guidance when discussing continued treatment options versus palliative care. Our proprietary cancer guidance program gives oncologists a real time view of treatment plans consistent with National Comprehensive Center Network guidelines developed by leading oncology centers.
When a clinician is supported by data and insight in those few vital minutes of a patient visit, it empowers a more personal relationship. It makes the art of medicine more precise and helps patients get the care they need faster. Today through this program, treatments have been automatically approved over 60% of the time and that rate is rising quickly. When treatment is not automatically approved, our oncology experts engage with physicians directly to guide them to clinically appropriate treatment, which significantly increases adoption of evidence based practices. The denial rate used in this approach is less than 1% and since launching it a year ago, we've already achieved a 6% reduction in inpatient hospital admission.
Today, this model is available to 22,000,000 UnitedHealthcare members nationwide across commercial Medicare and Medicaid and other clients will start using it from January of next year. The Optum Cancer Center in Las Vegas is another compelling example of what's possible when we take a more connected approach to treating chronic disease. Here we bring together all the key capabilities and services that cancer patients need chemotherapy, genetic counseling, tumor board, surgical oncology and more. And about 600 new patients are being referred to this facility every month already. Early results show that our approach which includes decoupling drug payments from compensation can reduce oncology drug cost for seniors by nearly 30%.
Oncology is just the first step as we connect our capabilities to better manage chronic care. Next year, you'll see us launch advanced care models in other high cost areas including cardiology. Diligently managing the cost of specialty drugs needed to treat chronic disease is increasingly critical. We continue to see unsustainable levels of inflation with specialty drug spend expected to hit nearly 50% of the total pharmaceutical market by 2022. So we're really zeroing in on both unit cost and how these medicines are used as part of an overall care plan.
Importantly, this includes change in how we negotiate with manufacturers. Advanced analytics help us understand the value a drug delivers and we will agree to pay more when it truly benefits a patient. Benefit sponsors who use our advanced specialty management strategies achieve an average of 24% lower specialty cost. Better outcomes happen 1 person at a time. For example, like the patient who suffered from a genetic disease that made it impossible for her to administer her own medicine by infusion, which inevitably meant a visit to the emergency room.
An Optum specialty pharmacist found a drug that worked just as well, but was much simpler for her to take. This switch has improved her quality of life and reduced her care cost by as much as $21,000 a month. By allowing patients to administer medicine at home, we can deliver savings of up to 50% per infusion compared to a hospital setting. The unique value we're delivering to our customers today is what's driving the distinctive growth of our specialty pharmacy business. As we continue this work, we see many more promising opportunities to align our assets and bring more transformative solutions to the market.
1 is improving the financial experience of healthcare for both consumers and care providers. And here we have 2 extraordinary assets to highlight. Optum Bank, a leading HSA provider in the U. S. And Rally, our digital platform which is now available to 55,000,000 consumers.
Geared together, they hold the potential to transform the way people experience and pay for healthcare. And we're now developing a highly personalized digital experience that connects all of the patient's interactions across providers, benefits and pharmacy with their financial transactions. Our consumers are already able to find the best prices and locate and schedule appointments with high quality providers. And as we further align Optum Bank and Rally, we see a future where services and payments will be authorized instantly within minutes. We can also see Optum Bank becoming the healthcare bank and health FinTech supplier, harnessing the power of transactions the way we harness data across the system today To give consumers more choice managing health expenses, to ease the stress on providers who are often underserved by traditional banking systems and to establish new healthcare relationships with both consumers and providers.
At Optum, we're incredibly energized by the opportunity and responsibility we have to make a transformative lasting impact on healthcare in the years ahead. And you can expect we will continue working tirelessly to deliver our full potential for the people and society we are privileged to serve, to deliver distinctive returns for our shareholders. We believe we have the right people, expertise and capabilities to lead in creating a connected system that delivers consistently better quality, experience and affordability for everyone and we believe in bringing it all together. Now, I'm pleased to introduce Optum President and Chief Operating Officer, Dan Schumacher.
Thank you, Andrew, and good morning. Earlier this year, we surveyed 500 leading health organizations. They told us that each of their organizations expect to invest an average of nearly $40,000,000 in AI over the next 5 years, dollars 20,000,000,000 collectively. This is just a snapshot, but it tells us that the market is ready to adopt the advanced technologies and data analytics that will play a central role in Optum's ability to help create the next generation health system and are a future growth driver for us. So before I review our financials, I'd like to share a few examples of how we are building a more connected system and giving people better experiences using advanced technologies, including AI and genomics.
We believe connecting information and people is the key to achieving true system transformation. We sit at the nexus of data flows in healthcare. To make it easier for people to share clinical data across the system, we are engineering and deploying interoperability solutions that will standardize the way health information is shared in the future. You will learn more about this in our clinical data interoperability seminar today. Standardization is the key to leveraging billions of clinical transactions to ensure the right information gets to the right person and the right system at the right time.
By enabling data to be shared securely with rigorous protocols to protect patient privacy, we can help ensure that physicians can better coordinate their patients' care even in the home. Accurate diagnoses are made the first time and patients receive the most appropriate therapies. Our solutions help inject greater intelligence into the system to support population health management, enhance the consumer, provider and payer experience and advance personalized medicine. Optum is uniquely positioned to support providers as they take on more risk and ultimately power data interoperability nationwide. Artificial intelligence will play a critical role in supporting Optum's insight driven approach to chronic care.
While most care management programs focus solely on individuals who are already diagnosed with a condition, we are using AI to create and launch hundreds of machine learning models that can help predict the onset of a disease much sooner. With our AI powered models, we see the prospect of being able to identify the onset of a condition up to a year before it would otherwise be diagnosed. This insight empowers clinicians to better understand their patient's condition, avoid more serious and costly issues down the road and may even save lives. This fall, we also continue to apply cutting edge science to real world challenges by expanding our pharmacogenomics capabilities. This includes programs designed to prevent adverse drug reactions by precisely matching consumers to medications best match to their genetic makeup.
As more genomic data becomes available, you can expect us to become increasingly sophisticated in bringing useful intelligence to providers and their patients. You will learn more about these and other advances in the next Frontier seminar today. We also continue to develop the technology driven capabilities of Optum 360. These services are used by 9 out of 10 hospitals to simplify administration and the revenue process. For customers who use the full suite of Optum 360 services, we now manage nearly $70,000,000,000 in annual billings.
This year, we expanded our payment integrity capabilities with continued investments in technology, people and services. With these growing assets, we're reducing friction between payers and providers and creating greater transparency between both parties. As we grow and refine all of our capabilities to connect and bring the system closer together, we see significant opportunities to expand our reach and impact. Today, Optum's addressable health services market stands at over $1,400,000,000,000 globally. This includes a U.
S. Market that reaches over 8 $50,000,000,000 Now, let's turn to 2019 performance and our outlook for 2020. I'll start with OptumHealth. Through OptumHealth, we engage consumers to help them achieve better health, manage complex conditions and receive high value care through OptumCare. OptumHealth has achieved continued strong growth over the past decade.
We serve 38,000,000 more consumers than we did 10 years ago and expect to end 2019 serving 96,000,000 people. Revenue per consumer continues to increase rapidly as we manage a greater portion of a person's healthcare and deliver on quality, satisfaction and cost. Over the past decade, annual revenue per consumer has quadrupled from $70 to well more than $300 And we expect this number to continue increasing steadily as we serve people's healthcare needs more comprehensively. This year, average monthly revenue per consumer will increase 20% and in 2020, it will grow faster. Over the last decade, OptumHealth's total revenue has grown at a compound annual growth rate of 22%.
In 2019, we expect OptumHealth revenue will grow 24% year over year to $30,000,000,000 For 2020, we estimate revenue to increase by as much as 30% with operating earnings increasing to around $3,800,000,000 and operating margin near 10%. Looking ahead, as I observe our growing capabilities and the expansive needs of the much broader market, I am firmly convinced that OptumHealth is just scratching the surface of the current US market opportunity. OptumInsight leverages our deep proprietary data and analytics to deliver powerful services and solutions that make the health system smarter, more efficient and more interoperable. It's an important enabler of all that we do across UnitedHealthcare and Optum. At the end of this year, we expect Optum Insights to have a revenue backlog of $19,300,000,000 a year over year increase of over 13%.
We expect to close out 2019 with revenue of $9,900,000,000 up 10% over 2018. Strong backlog and revenue growth will continue in 2020, with revenues expected to grow comfortably in the double digits and operating earnings expanding at a similar pace to around $2,800,000,000 at the midpoint and with operating margins again expected around 25%. Looking ahead, we see strong growth prospects across OptumInsight with expanding opportunities in the application of healthcare data and analytics and advanced technology in our growing portfolio of products and services. OptumRx's innovative pharmacy care services model continued to advance in 2019. As adoption of our core PBM solutions continues to grow, more customers are selecting our pharmacy care services to ensure their members receive the best care at a lower cost.
For the 3rd year in a row, customer attention at OptumRx stands at 98%. We've won more new business this year than any other and continue to win business across all classes of customers. Over the past 10 years, the number of total adjusted scripts has expanded by over 1,000,000,000. For 2020, we expect 1,300,000,000 total adjusted scripts. Excluding the transition of 1 large client, adjusted scripts are expected to grow 7% to 8%, well ahead of industry trends.
Revenues have grown from $14,000,000,000 in 2,009 to an expected $73,700,000,000 in 20 19, 6% growth over last year and a 10 year compounded annual growth rate of 18%. 2020 OptumRx revenues are expected to advance 7% to 9% to a range of 79 $1,000,000,000 This includes the effect from the migration of the large customer referenced earlier, which is largely offset as we align reporting of retail pharmacy co pays to broader industry convention for better comparability. We expect operating earnings in a range of around $4,100,000,000 up 5% to 8% year over year, with an expected 5.1% to 5.3% margin consistent with 2019. Looking ahead, we see significant future growth opportunities driven by our core offerings, the expanding adoption of our pharmacy care services and specialty pharmacy. I'll close with our Optum wide performance estimates for 2019 and outlook for next year.
As Andrew shared, we expect total revenues of $112,100,000,000 for 20.19, up 11% year over year, dollars 30,000,000,000 from OptumHealth, dollars 9,900,000,000 from Optum Insight and $73,700,000,000 for OptumRx. Operating earnings are expected to reach $9,350,000,000 up 14% year over year. Looking to 2020, we expect total revenue in the range of $127,000,000,000 to $128,000,000,000 an increase of 13% to 14% over 2019. And we expect our 2020 operating earnings to grow slightly faster at 13% to 16% to a range of $10,600,000,000 to $10,800,000,000 To echo Andrew's thoughts, Optum's most valuable contributions to the health system and everyone we are privileged to serve are still to come. We will continue to invest in and integrate our capabilities to lead in making a connected affordable healthcare system real and to deliver material sustainable results in the form of greater value for our customers, better care and experiences for patients and distinctive returns for our shareholders.
Thank you. And now I'd like to welcome Brett Manderfeld to the stage to lead Q and A with the Optum team.
Thank you, and good morning. It's great to see so many familiar and friendly faces. I know many of you have been coming to this event for years. Whether you're a veteran of this conference or joining us for the first time, we greatly appreciate your interest. It's been my privilege to serve on the UnitedHealth Group Investor Relations team for over a decade.
I look forward to connecting with more of you today and continuing to work with all of you in the future. In a few moments, the Optum leadership team will join the stage. First though, a quick friendly reminder, If you have a question, please raise your hand. We'll have a microphone brought to you because we want to make sure that everyone hears your question, including those joining us in the live stream. While we have limited time for on stage Q and A, we look forward to continuing the conversations during lunch and throughout the day in our showcases and our seminars.
And now, please welcome back Andrew and Dan, joined by Optum Leaders, Wyatt Decker, John Prince and Robert Musselwhite. Start with the questions. Lance?
Hi, there. Lance Wilks from Bernstein. Question on OptumCare and trying to understand the pace at which you're starting to take more risk in that business. And you have a nice statistic up there on revenue per customers. I was wondering if you could just break that out a little bit to talk about what of that is coming from inflation or volume increases as contrasted to what's coming from increased risk taking and maybe a similar way of helping us understand that is in your more advanced risk taking markets, how much more revenue per customer are you taking in those markets compared to less advanced markets like in the Northeast?
So
Lance, thanks very much for the question. Before I ask Wyatt to dive into a little bit of detail, at the highest level, you've seen very rapid expansion in the number of lives moving into risk for the company, up by about half over the last year or so. Big chunk of that obviously has been driven by DMG coming into the organization, other acquisition and then organic growth within our current geographies, so coming from all sources. In terms of that revenue per consumer or per patient, a big driver of that is the shift up the risk taking ownership of that risk. So you're really talking about multiples of potential patient within a traditional clinic patient within a traditional clinic that we might acquire as you move that clinic takes 3, 3.5 years to go through that migration path, but as those populations start to move into increasing risk, the amount of revenue potential available goes up very dramatically and is a very big driver of what you're seeing.
Wyatt, do you want to dive into the differences between the more advanced or the more progressed versus the initiating on the risk?
Absolutely. So our OptumCare model as you've heard earlier from Andrew is focused on a patient centered physician led and value based model. And when we talk about value based our preferred model is total capitation and delegation, which you see through our Medicare Advantage, but also commercial risk and other platforms. So we will continue to grow our risk based models. And as you've heard, we have some very mature markets such as Nevada and Dallas Fort Worth and Texas with WellMed and Southwest Medical Associates.
In the Northeast, as an example, we have OptumCare, where we are primarily fee for service and we are preparing the transition for risk based models. All of our practices have some risk today. So we will continue that journey and bring our deep expertise and cultural commitment of our physicians to value based care. Thank you.
Lance, I might also add to your question on inflation. I mean, at the end of the day, we have a greater proportion of risk in the Medicare space. So you think about how that's trending both on the revenue line and the cost line, low single digits. So the reality is inflation is a small proportion of that total growth as we advance it year over year. It's really the progression that Wyatt talked about.
Next, we'll go to A. J, please.
A. J. Rice from Credit Suisse. Just maybe as we start to move into 2020, any comments about the pharmacy benefit selling season? How much business you guys have up for renewal relative to last year?
Do you see the overall market in terms of people putting business RFPs out? Is that going to be more or less you think than we saw last year? You obviously had a great season last year. And then as others have sort of evolved to making the same pitch in some ways about an integrated cost pitch, your synchronization of a few years ago, has that changed your approach to market and how has that evolved?
Thanks for the question. In terms of the market we've come off a great selling season. We actually had our strongest selling season in our history. I'd say when you look at the overall market, our value story is really resonating. I think what's different is we have a 5 year plus head start in terms of how we bring medical, behavioral and pharmacy together to create a unique value story.
We've also added over the last few years a portfolio of pharmacy care services which we talk about a lot and how can we bring both the benefit management as well as the services together to create a better clinical story to deliver to our clients. And so I think that the story is resonating in the market. When you look at this past year, we saw RFP volume up double digits compared to previous years. So we saw more opportunities come to the market. Our win rate only went up about 100 basis points.
So we just saw more and we actually won bigger ones this past year. As we look to next year selling season
it's just starting
as you know in the health plan market. So I'd say it's too early to decide in terms of what's going to happen. In terms of the pipeline, it's just as robust as last year in terms of same time. We do not have a lot to defend in the market. So we're feeling pretty good about our retention.
We come off 3 straight years of 98% plus retention. So I think we're delivering good value for our clients. So I think that's also a key selling point. Over the last few years, we picked up a lot of health plans. We now have 45 health plans.
We've picked up more than a dozen in the last 2 years and we've executed well for them. They're referenceable and that helps us in the market today.
I think A. J. I'd also just add to that. As you think forward over the next 3, 4, 5 years the real space where procurement of pharmaceuticals needs to be evolved very dramatically is specialty rare disease, oncology, monogenic syndrome, those sorts of areas. That's not been historically the majority of the focus requires different sort of skill set.
I think the kind of work that John has led in building the specialty pharmacy capability inside OptumRx combined with our data analytic capability being able to predict how people are going to respond to those products puts us in a really strong position to really drive innovation of the kind of advisory models that I believe clients are going to need moving forward as they deal with these super complex, very expensive technologies, which as I said earlier, going to be accounted for about half of the total marketplace. So I think you should expect to see us lean more and more into that side of the agenda as well.
Thank you. Thanks. Charles Sweet with Cowen. I just want to stay on that area on specialty pharmacy.
Maybe can you give
us a sense on the size of the specialty pharmacy within OptumRx and maybe a sense of how much of the cross sell of the specialty pharmacy capabilities into the Optum customer base and maybe some sense on growth rates there? Thanks.
So the question was on specialty pharmacy, it would be good to frame it on terms of the opportunity where we're positioned?
So the specialty pharmacy is a very sizable business within OptumRx, it's an area we've had dedicated focus on for the last few years. I'd say we've grown good double digits for the last 3 years, we expect that in the foreseeable future. We've been clearly taking market share in the market, have been for 3 years. We're expecting that in the next few years. What's differentiated about us is our clinical solution in the market we have a very different clinical offering.
We've also been bringing together the special infusion together to really differentiate that experience. Our NPS is infusion that is in the high 80s. So we've executed really well in terms of on behalf of the clients we serve. We've also been competing very well in the open market. So about a quarter of our business is we just compete for and physicians select us as their preferred specialty provider.
We've had a very dedicated effort in terms of OptumCare which is another part of your question. We've had a very dedicated effort for the last several years around how we partner closely with OptumCare in the market. We've had good traction with that, that is beyond just specialty. We've actually been bringing together our infusion, our specialty, our e pharmacy and our community pharmacies like Genoa and how they all work together in a local geography and then partner with OptumCare. So it's a partnership with OptumCare, it's a multi payer strategy as well as a standalone solution that works quite well.
And so it's been well positioned in the market and performing well.
If I could just follow on, is limited distribution networks
a key
part of the strategy for the special pharmacy within Optum? Thanks.
In terms of limited distribution drugs, we've been very effective. I don't have the exact number, but we for a given customer, we usually are 98%, 99% coverage in terms of the limited distribution drugs that they need on a formulary. So we've done very effectively in capturing new LDDs when they come to the market. We did the Evelo transaction about a year and a half ago which helped in a piece of the oncology market. So I think we're well positioned.
Pivoting forward, we look at the precision medicine market as a really high opportunity. So in that precision medicine market, we are investing in pharmacogenomics, we're looking at gene therapy, there's a whole series of categories that we see as a $100,000,000,000 market over the next 5
years. All right, Ricky?
On OptumRx, adjusted group growth of 7% to 8% is 3 times that of market, so phenomenal job there. So can you just give us some more color on what resonates in the marketplace? What specific programs are planned sponsors gravitating to that helped you gain so much share this year?
Thanks for the question. In terms of what's helped us in the market, I think is also our health plan wins. So when you are winning in the market with health plans, you take 1,500,000 lives at a time and this past year we've won over 8 health plan deals. I think we have a very unique story with health plans in the local market. We talk about how we'll win with them and we've create unique stories around a value proposition, how we'll actually sell with them, create proposals with them, help them underwrite.
It's a very unique resource that you need to have today to win in the pharmacy market and we partner closely with our health plans to be successful. This works both with our local Blues that we're working with as well as with UnitedHealthcare in terms of partnering with them and with unique value stories with a dedicated team. So a health plan will actually experience a dedicated team from the sales, pricing, underwriting proposals as well as an ops team And that is very distinctive in the market. And I think that's also why we're winning and retaining.
So just one follow-up there, if you think about the health plan marketplace, how do you think about a strategy of then also selling to them the OptumCare, OptumHealth, Optum Insight tools and kind of more of an integrated offering?
Yes. So we would certainly do that. That's exactly a direction of travel we go. And more than half of the Optum business in total is external to UHC. So we're very engaged very much committed to a multi payer approach.
If you look at throughout all of our businesses, whether it's OptumInsight, whether it's Care or Rx, you'll see that same pattern. And clearly, where we have opportunities to bring together strands of the different business to make those connections we were talking about earlier, that's very much the direction we want to go, whether that's a plan or an employer level or with the system, frankly. So things like the John Muir partnership in the Bay Area, very good example of almost every part of Optum is engaged in supporting that contract with John Muir, very comprehensive engagement. We think that's where the real strength of Optum gets deployed, and we can make very material impacts for our clients by doing that. Now, obviously, relationships start where they start, but as we get to know and work with and we retain relationships at the rate you heard Dan describe, it gives us a fantastic foundation to then build on that broader contribution to their success.
Pete? Pete?
Peter Costa, Wells Fargo. On the same line there, can you talk about the cadence of earnings within the PBM from spread based pricing going away versus the growth in specialty and contrast OptumRx relative to the competitors in your space?
In terms of the market, we've been migrating to a model where we are looking to get paid an administrative fee and then get paid for some type of risk share to address total cost of care. And so our strategy over time over the last several years has been transitioning our model to that framework. In terms of the Medicare market, today we are paid an administrative fee, all the rebates are passed on to our plan sponsor, there is no spread in that market. In terms of the Medicaid market, the Medicaid market, all the rebates are passed on to our plan sponsor, our client base is 75% pass through today. So the market has already been shifting from traditional to pass through over the last 2 years.
So I'd say as you look out in the next 24 months, we're expecting that market to be almost all administrative fee with no type of spread. In terms of the commercial market, when we bid a deal usually we are bidding 2 ways, one is administrative fee with some type of total cost of care guarantee or with a traditional model and it's client choice. So I'd say as you look going forward, it's going to be a question of clients choosing which model they want to have, we're indifferent, we prefer to move to the new model.
All right. We have time for one more question. Josh?
Thanks. Curious in the context of what we're seeing a lot of retail partnerships with health plans around care delivery and different types of models popping up. Sounds like United is moving sort of the opposite direction, right, physician based and away from that. So I'm curious if you believe sort of I'm curious to see why you believe that's more effective? Has MedExpress kind of no longer part of that long term growth, etcetera?
You guys sort of think more about a physician office as opposed to a different location or site of care in the community?
It's a really good question. And I think the key to our answer on that is really and. So it's not that we don't like the connectivity with retail or urgent care or anything like that, but where we see really as the core anchor point is the primary care and the ambulatory environment. That's where we really strongly believe that the decisions made there, although maybe only 5% of healthcare cost is incurred in the primary environment, a good or a bad decision determines what the next 95% looks like. So getting on top of patients quickly, understanding what's going on, being able to prevent, which is why operating within the risk cap is so important as a model.
All of that has enormous downstream consequences. Site of care strategies are initiated in that environment similarly. So we really believe that the primary care physician is really a central anchor point to all of this. The irony is that that's always been true, but unfortunately inevitably a lot of those practices have been very small, not very well powered from a capital or from an information perspective. What we're aiming to do here and what in our best practices you're seeing is great physician led decision making, fantastic focus on patient care, really then powered by industrial scale information and analytic capabilities, so that those individual physicians and clinicians really have got really phenomenal capabilities compared to where you might have seen them maybe 5, 10, 15 years ago.
Now around that and we would absolutely expect to complement that anchor point with a variety of different care models, some of which we own, MedExpress and urgent care been a fantastic example, some of which we will partner with and where we see opportunities in the marketplace on a local level where we think another organization can really add value to our patients, can make it easier for us to manage their risk, then we're obviously going to be looking at those things. But right center to all of this is the primary care role.
Andrew, also it might be worth commenting on our on demand strategy. So if you think about 1's healthcare journey, you'll intermittently need care acutely. And in that setting, we have a robust set of tools that we've deployed to allow people to interact with their OptumCare team, whether it's through a text chat system, a phone call to a nurse, a telemedicine offering, being directed to a MedExpress instead of an emergency department. So we have a robust set of on demand care tools that we wrap around our patients so that they have a unique ability and flexibility around how they get their care depending on their wishes and the severity of their concerns.
And it's a good commercial for your seminar this afternoon, Doctor. Decker. Absolutely. Please join us. All right.
Now I think we will ask the Optum team to exit and want to thank you. And I want to thank you all for your great questions. We'll now transition to UnitedHealthcare. Please welcome Chief Executive Officer, Dirk McMann.
Good morning, everyone. I'm Dirk McMann, and it's my privilege to talk with you about how UnitedHealthcare is improving access, outcomes, affordability and experience in the health benefits market for the more than 50,000,000 people we serve. UnitedHealthcare is helping transform the way health is managed in this country as we are deeply embedded in every aspect of the health system through incentives and how to finance and pay for care, through the introduction of more innovative and affordable benefit designs and through data driven clinical models to find and treat individuals facing the most complex health and social issues in our society. Our presence in the system's foundational structure means we have many ways to help people live healthier lives. We bring together different stakeholders in a way that no other company can to make the health system work better for everyone.
We're focused on a 3 point 3 part strategy to build a better health care system. First, we are further strengthening our focus on driving affordability. 2nd, we are creating a more advanced data driven clinical and care management model and third, we are simplifying the consumer experience with enhanced digital capabilities, designing innovative new benefit approaches. So let's begin with affordability. It's key to improving access, member satisfaction and ultimately how we'll drive market leading growth.
Affordability starts with getting consumers to the best site of care. Our goal is to ensure care is delivered in the most effective and efficient site, whether it's at home, virtually, at a local physician's office, in a surgery center or hospital. Our site of service efforts began years ago by moving a handful of surgical procedures from hospital outpatient settings to ambulatory surgery centers where they can be performed for nearly half the cost and often with better quality and experience. More recently, we've added a variety of imaging procedures to our outpatient programs. Now, we are rapidly expanding to additional high cost services with plans to increase the number of procedure codes, including those for hips and knees.
And site of service plays a major role in reducing specialty pharma costs as well. For example, in home infusion services cost up to half of what it cost in a hospital based setting. In 2020, we expect to save nearly $500,000,000 for our customers from site of service efforts, while maintaining consistent strong health outcomes. There is also a meaningful opportunity to drive greater affordability through new product and network designs. We're introducing products and capabilities that reduce out of pocket costs, particularly in commercial markets where cost can be the biggest barrier to access.
Products like our primary advantage plan, which has $0 cost sharing for primary care visits, virtual care and many essential drugs. On the network side, we know high performing providers deliver care at 7% lower total cost. Across our business, this is a $9,000,000,000 annual savings opportunity. Two quick examples drawn from our premium designated specialists. Orthopedic surgeons have 31% fewer procedure revisions on knee replacements and general surgeons have 25% lower complication rates for appendectomy procedures.
You'll see UnitedHealthcare increasingly engage with high performing physician partners who share similar philosophies around consistently delivering value through the AAAIM. Finally, we're investing in digital tools to reduce the administrative burden on physicians while improving efficiency across the system. For example, physician practice phone calls to us have decreased nearly 10% this year, thanks to these digital investments, making it more simple and cost effective for them to engage with us. And our payment integrity initiatives from Optum are expected to generate nearly $2,000,000,000 of incremental savings next year. So you may ask, with all this affordability work, what should we expect in medical cost trends?
Our top performing national account plan sponsors who generally adopt key solutions like clinical programs, consumer driven benefits, wellness solutions on average have trended slightly below 2% over the last several years. So it is possible to break out of the historic trend range, but health plans can't do this alone. Employers, individuals, care providers and others like big pharma all must work together to make smart choices. As we reduce consumer costs, we also make sure our members are getting great care. Our second area of focus is creating a more advanced data driven clinical and care management model that delivers a more personalized experience.
For millions of touch points, we and our network partners have every day, UnitedHealthcare has unmatched clinical information we compare with real time data from wearables and remote monitoring devices to customize a member's care journey and treatment recommendations. For example, over 31,000 Medicare members with congestive heart failure are enrolled in a new program that uses remote monitoring devices to monitor their condition and feed information into the nerve center. In combination with our other deep data sets, these devices trigger digital alerts and prompt their nurse case managers to call a member to develop a plan of care. The nurse will also inform their physicians their physician of the change in health status, schedule any appointments that are needed and coach the member through lifestyle behaviors. These types of services have shown a 97% patient satisfaction rating and a 65% reduction in 30 day readmissions.
Also, we are increasing physician access to real time patient information, putting it directly in their hands through their existing EMR platform, making it simple to seamlessly access highly relevant information when it's needed. We call this point of care assist where providers can verify a patient's benefit eligibility, estimate their out of pocket costs, refer the patient to premium designated specialists and identify gaps in care. The platform automates the authorization processes, offering often rendering approvals in real time, improving adherence to clinical protocols and reducing the cost of unnecessary services. We are scaling this capability quickly. Several 100,000 of our network practitioners will be using Point of Care Assist by the end of next year.
Now let's look at how we are simplifying the consumer experience by using a digital first strategy to engage consumers in new ways and reduce their healthcare financial burden. Consumers want a seamless experience to understand their health coverage and finances, find and price care, receive and pay for care and have one source of data for integrated health data. Through our most recent version of our UHC digital platform, we provide 28,000,000 people with the ability to launch a virtual visit. In 2019 alone, we saw a 60% increase, which will bring virtual visits to 500,000 by the end of the year. Because the majority of consumers only use the health system a few times a year, our digital offerings allow us to stay connected with them in other ways.
For example, 28% of consumers with elevated cholesterol levels who stay engaged on our Rally digital platforms for at least a year saw their cholesterol move to normal levels. Since 2016, we've paid over $1,500,000,000 in health related incentives through our Rally platform for everything from hitting a target BMI and blood pressure level to better managing stress. And as we close in on 500,000 people enrolled in Motion, our mobility incentive rewarding consumers for steps walked, their employers are seeing lower medical costs. Outpatient care is down 65% and inpatient care is down 29% among participating employees. That's why we're expanding the program to other healthy activities such as biking and swimming.
We'll never lose sight of our important social purpose as UnitedHealthcare seeks to achieve better health and affordability for the people we serve, one person at a time. Now I'd like to introduce my colleague, Brian Thompson, who oversees our Medicare and Medicaid businesses. I've worked with Brian for more than 15 years and it's great to have him in this expanded role. Brian is going to share how Medicare and Medicaid are delivering on core strategies I just discussed and what it means for our long term growth. Brian?
Thank you, Dirk, and good morning, everyone. Medicare and Retirement led by CEO, Tim Noll is dedicated to the health and well-being of seniors and other Medicare beneficiaries serving nearly 12,500,000 people today. Since 2015, we have captured 44% of Medicare Advantage growth. In 2020, we expect strong growth to continue by delivering greater value to our members through differentiated products, more personalized care support, a distinctive service experience and a multifaceted clinical agenda. Now when we met with you just last year, there was a lot of focus on the health insurance tax and at that time the moratorium on the tax as well as changes in CMS policy presented an opportunity to expand our 2019 benefit design.
While we did invest in benefits, we opted to take a longer term more disciplined view to ensure that we provide stability and cost, capabilities and benefits for our seniors. So in 2020, despite the industry wide financial pressures caused by the return of the tax, 8 out of 10 of our individual Medicare Advantage members will see stable to improving better clarity and more coverage. Our expanded individual Medicare Advantage footprint will reach 1,000,000 200,000 additional Medicare eligible people in 2020 and it will more than double the number of plans with $0 primary care co pays. Our Medicare Advantage seniors tell us staying healthy is important to them. Our wellness platform designed with Rally offers integrated programs and financial incentives for staying active.
And this year seniors are also enjoying new exclusive AARP cognitive health programs. We also believe our clinical engagement and service experiences are second to none. Our ability to provide personalized healthcare navigation with someone members know and trust remains the foundation of our navigate for me model. Since the program began just 2 years ago, we've scaled it to cover 1,250,000 people and we expect 2,000,000 people will be eligible in 2020, including all of our dual special needs plans members. Our House Calls program creates regular connections with people during times of wellness.
Over 2,400 advanced practice clinicians will provide house calls in 47 states conducting 1,000,000 850,000 home visits in 2020. These programs drive both reduced medical costs and higher retention levels. In fact, we've seen a 26 point increase in NPS from Navigate for Me and House Girls already has an impressive NPS rating in the 70s. You will get a chance to hear more about these programs at our showcases later today. Finally, we continue our relentless focus on quality.
For the 2021 payment year, we expect members and plans to be 4 star or greater at 84%, continuing our consistently high quality scores earned organically. The diversity of our Medicare portfolio
The diversity of our Medicare
portfolio differentiates us in a competitive market by supporting coverage and care needs across many different offerings. Our group Medicare Advantage plans continue to deliver tremendous value. We offer a stable high quality 4.5 star solution which provides comprehensive benefits for retirees while limiting the financial risk and liability for our customers. Consistent group Medicare Advantage membership given a more modest new business pipeline. We continue to offer leading Medicare Supplement products.
In fact, seniors choose our AARP branded plans more than any other Medicare Supplement offering in the marketplace today. And lastly, Part D rounds out a full suite of product solutions for our customers. About half of our Part D population also has Medicare supplement offering. So these products are very complementary. 1 of our most popular high value Part D products is a plan we have with Walgreens.
And in 2020, we are building off the success of the co branded Part D plan by launching a new Walgreens Medicare Advantage Part D product in 24 states. In 2019, our Medicare business is expected to exceed $83,000,000,000 in annual revenues. Turning to 2020, given results of our annual enrollment period, we now expect to add up to 550,000 Medicare Advantage lives and when you include duly eligible growth from our community and state business, we expect to add up to $700,000 all in. For Medicare and Retirement alone, this growth translates into expected revenue of $92,500,000,000 to $93,500,000,000 representing more than a 12% increase year over year at the top end of the range. I'd now like to shift to our Community and State business led by our CEO, Heather Sanfroco.
Community and State is currently serving 6,000,000 people in 31 states and the District of Columbia. Now as we indicated at last year's conference, this is a business that has been challenged in a handful of states given the complex cities of and insufficient funding for a few of our programs. The financial performance of our community and state business continues to improve as we work with our state partners to ensure Medicaid rates are sustainable and we continue to reduce costs. We expect to advance our performance in 2020. The progress we are making is also evident in our ability to retain business and secure new contracts.
On the growth front, we are proud of the enduring relationships we've built with our state partners and our members. Since just 2018, we've secured new wins in Virginia, North Carolina, Louisiana, Arizona, Texas and most recently Kentucky. In 2020, the pipeline for new and expanded Medicaid opportunities includes bids in up to 15 states. There are plenty of growth opportunities, but we will be judicious in choosing states that provide adequate funding and have managed stable programs. Now with the combined strength of our Medicare and retirement and community and state capabilities, we are uniquely positioned to serve people in dual special needs plans, a population that often faces multiple illnesses and has many barriers to good health.
UnitedHealthcare now serves nearly 1,000,000 people in these plans and over the last 5 years, our enrollment has grown at over twice the rate of the rest of the industry. Of this population, only 2,000,000, 700,000 of the 11,000,000 are enrolled in a dual special needs plan today. Now by combining our analytic tools and extensive local market experience with complex populations, as well as our expertise in the social determinants of health, we're helping the high risk members who will benefit the most from our programs. For example, a targeted intervention program we did in one region led up to a 60% reduction in inpatient visits and a 31% increase in primary care visits. Turning now to our financials, our community and state business is expected to approach $44,000,000,000 in revenues this year.
We made the decision to exit 1 state, which along with state redeterminations are drivers of our decline in our 2019 enrollment, but we expect continued improved performance in 2020. Excluding our win in Kentucky just days ago, but with the addition of North Carolina expansions in Texas and our dual special needs plan enrollment footprint, we expect to add up to 450,000 new lives in 2020. Revenue is expected to grow by approximately 9% to around $47,500,000,000 So across our government sponsored benefit programs, we now expect to grow by nearly 1,000,000 people in 2020 and see a combined market opportunity of $700,000,000,000 of government spending not yet in managed care. Now, I'd like to turn it back over to Dirk for a review of our commercial and global businesses and closing comments. Dirk?
Thank you, Brian. Our individual and employer business led by CEO, Bill Golden provides health coverage to nearly 28,000,000 people and serves over 250,000 employers, large and small. The commercial business as a whole has many changing market dynamics, including the return of the health insurance tax, changing regulatory and policy issues and the continuing shift of membership from fully insured to ASO, but we will continue our disciplined approach to pricing. Our strategy in the commercial market centers on network design and affordability, expanding our portfolio of innovative benefit and funding designs, and diversifying our core medical offerings into the growing ancillary space. For an average family of 4, healthcare now costs approximately $20,000 a year.
That's simply too much, which is why we are leaning into our affordability agenda led by our network programs. We're aggressively pursuing the $20,000,000,000 of unwarranted cost variation in our commercial provider network. Simply because of which location you go to. Simply because of which location you go to. We'll get after that through increased transparency and site of service shifts to high performing providers.
We're also driving greater adoption of out of network programs with customers. Currently, not enough employers take advantage of our more aggressive discount programs that enable them to pay out of network providers at a benchmark rate indexed to Medicare. We expect to have more than 80% of our commercial membership on these advanced programs by the end of 2020, delivering an incremental savings of up to $500,000,000 Bringing down the total cost of healthcare will always be a major focus, but our future growth in commercial also depends on continuing to lead the industry with innovative consumer centric benefits. Products like AllSavers and Nexus ACO are beginning to gain considerable traction in the commercial markets as we close out the 2020 open enrollment season. Allsavers, which makes self insured underwritten plans available to smaller employers has become a growth platform for us with margins comparable to traditional group fully insured products.
It's designed so that automatic stop loss kicks in when claims are higher than expected and a refund is issued when claims are lower than expected, providing the financial predictability that employers want. We now have nearly 300,000 people enrolled in Allsavers and expect up to 150,000 new members in 2020. Our Nexus ACO product organizes provider networks differently to improve the alignment of cost and quality. The plan provides incentives for members to choose our highest performing care providers driving an 8% to 10% savings in medical costs. Employers also want an integrated set of benefits that are easier to manage.
That's a big reason why they are increasingly using the flexible and configurable services and network designs offered by our 3rd party administration business. We have become the largest TPA in the country with 5,300,000 members and membership has grown by 2,000,000 people in just the last 3 years. We're sustaining this growth by using strong medical management and innovative consumer tools to maintain high quality, financially sustainable healthcare solutions for employers. We also continue to simplify the consumer healthcare experience with a focus on a modern digital strategy. By mid-twenty 20, we'll offer a new virtual care plan which cost employers 8% to 10% less than a standard Choice Plus plan.
It will offer services like click to chat with an advocate who provides concierge support as well as virtual primary care visits and $0 co pays. Finally, we are expanding UnitedHealthcare's offerings and ancillary benefits such as integrated dental, vision, hearing and financial protection solutions. This is one of the fastest growing parts of our commercial business. We currently serve over 35,000,000 specialty members and expect to add 3,400,000 new members next year. This integrated specialty benefits model drives a 4% reduction in medical costs and improves the identification of unmet health needs.
For example, we identify people with diabetes 15% more frequently because of our ability to cross reference clinical data tied to medical, dental and vision screenings. For 2019, our employer and individual business is expected to approach annual revenues of nearly $57,000,000,000 and serve nearly 28,000,000 people. Our fully insured membership is expected to increase by 115,000 lives this year with self funded growing by 725,000. Dollars We continue to maintain pricing discipline and make rational trade offs between margin and growth. We expect both fully insured and self funded enrollment to decline in the Q1 of 2020 and then show growth later in the year.
This will result in revenues of up to $59,000,000,000 next year. I'd like to wrap up our business updates by providing brief remarks about our global business run by CEO, Molly Joseph. We have market leading benefits in care delivery platforms concentrated largely in Latin America, where we operate in 4 of the 6 largest markets, Brazil, Chile, Colombia and Peru. We serve nearly 6,000,000 people with medical benefits and more than 2,000,000 people with dental benefits. UnitedHealthcare Global also operates more than 50 hospitals and 225 clinics and ambulatory centers.
While this business is still relatively early in its evolution, our global team is spending much of their time on 2 key areas. 1st, helping to improve the total cost of care in every market it serves, Whether it's advancing value based networks or deepening the use of evidence based protocols throughout delivery systems, we can play an important role in making healthcare more affordable for everyone. 2nd, coordinating benefits and care delivery strategies to improve value to consumers and health systems. This will include developing centers of excellence based on quality outcomes as well as administrative and system simplification to lower costs and ease of access. We are reshaping the business in Brazil where we continue to operate with a challenging economic backdrop, exiting products and network designs and maintaining pricing and network disciplines.
VEDMedica in Chile, Colombia and Peru, along with our Global Solutions businesses continue to perform well and grow. We're expecting to return to growth in 2020 with enrollment projected to increase by 125,000 at the top end of the range with a shift to lower priced products. Revenues are forecast at approximately $10,000,000,000 As we turn to 2020, the outlook for UnitedHealthcare is bright. We expect to increase enrollment by 1,000,000 people or slightly more at the top end of the range. This translates to top line revenue of $208,000,000,000 to $210,000,000,000 representing a 5 year compounded annual growth rate of approximately 10%.
This coupled with our relentless efforts to manage medical and operating costs drives our operating profit to a range of 11.1 dollars to $11,500,000,000 reflecting an increase of approximately 13% at the top end of the range. We enter 2020 with a clear picture of what we need to do to continue navigating a complex health environment and at the same time push harder and higher to deliver the value we can bring to people when we operate at our full potential. Relentlessly focusing on access, outcomes, affordability and experience, We know we have a lot to do, but with the talent, focus and passion of our people, we tackle this agenda with confidence and optimism. Thank you. Now I'd like to invite the senior leadership team of UnitedHealthcare to the stage.
Okay. I think we are ready to take your questions, UnitedHealthcare. Ralph?
Thanks. Ralph Jacoby at Citi. I just wanted to go back to the site of service. You mentioned the $500,000,000 of savings for customers. I guess my understanding is that's rolling out to your fully insured base.
So I'm sure there's out of pocket savings for customers, but wouldn't a lot of that benefit also sort of accrued to you? And then second question is just you mentioned I think 2% cost trend for employers and others that apply some of these services. So why don't more do it or why are we seeing sort of the commercial enrollment pressures at this point? Thanks.
So let me start with the thanks for the question. So first of all, let me start with the site of service question. Yes, it's about fifty-fifty between what those $500,000,000 in savings will annure to our ASO customers versus our fully insured customers. Over the long run, of course, that we'll price that back. But yes, that's about a fifty-fifty split.
Yes, as it relates to our ASO customers and why the top 50 or so have had such good experience, they do adopt all the programs that we talked about, the clinical programs, the rally, they invest for the long term, which is great. And some of the state based benefits, a lot of those are our fully insured population doesn't always have those product features embedded. So using the full spectrum of our assets and full spectrum of our products produces really those kind of good returns. As far as fully insured enrollment growth or enrollment, why don't you go ahead, Bill?
I'll also talk about, if you look at our self funded business, they can be laser focused on their particular risk base. So they can take data and capabilities and look at what the real drivers of their costs are. So they could be much more laser focused on going after what their trend drivers are. When you look at the fully insured business, it's really more of a portfolio management. You have a lot of state based benefit mandatory benefits that have to be applied there.
So you won't see the same performance from a trend standpoint. From the commercial standpoint, we continue to price be disciplined in our pricing of our product and our portfolio. We feel good about the second half of the year about where our products stand. We're optimistic as we head into 2020 2021 about the performance of the business.
Justin?
Thanks. Good morning. Question on your 2019 updated guidance. It's a minor change, but you raised your MLR outlook from 82.5%, give or take to 82.6%, given it's already the Q4 and given you're taking down your commercial cost trends, clearly seeing some positive signs there. Just curious what drove that MLR uptick in terms of what you're seeing in the business in the Q4?
Thanks.
Well, to start, the commercial trend is the commercial trend that we locked down on at 5.5%. As it relates to the MLR forecast that we have for the rest of the year, that's certainly when the range of it was a 0.1 different, not a huge difference from what we expected to be honest with you, Justin.
Yes, that's why we have a range. That's exactly right, Justin. So we purposely think about the business in a range of about 100 basis points and we're about 10 basis points above the high in the range.
Hi, Steve Willoughby of Cleveland Research. Two questions that I believe are sort of related following up on Ralph's question on-site of service. Just wondering if you could provide a little bit more color as it relates to what you're doing to address the out of network costs. How providers are reacting to those sorts of changes or things that you're implementing as well as the site of service changes, if you're having any feedback or reaction from your providers that you're working with?
Yes, well, I'll start that. So, no, I mean, we communicated clearly what we're doing from a site of service perspective. And as I said, some we've been doing this for a while. We have requirements within our network contracts to advise that type of change, and we sort of manage that effectively with the network providers. As it relates to out of network, one of the key things we do is sort of work with our big customers to get them to adopt some of the more aggressive out of network programs indexed to Medicare to essentially be able to say, all right, this is what we'll pay for this particular service.
So, yes, a lot of work with our big customers on having them adopt outlier cost management is what we call it protocols that are indexed to Medicare. And it's what we get paid to do in the marketplace. It's not always going to be popular with everyone, but in the interest of improving affordability for everyone, this is something which we think is a logical and rational action. And site of service is a key piece of it. I mean, as we look at many of our NPS results as far as sites of service for like hips and knees, we see that's where consumers want to go.
We look at the cost which are half. It's all the right thing to do in healthcare.
We get to Matt over here, please. Gary first, then we'll get to Matt.
Matt behind.
Sorry, I'll take it. Thank you. First, a clarification, then my real question. So for Brian, could you break out on the MA enrollment growth group versus retail?
Yes, for 2020? Yes. Yes, as we look forward, the vast majority of that is in individual. As I said in my opening comments, I would say the group business largely flat, maybe modest contraction, 25,000 lives or so, but the vast majority of that 550,000, I guess I would say more than all is in the individual MA space.
Got you. Thank you. My real question is, it really looks like the combination of your proprietary delivery network, your value based care contracting, the interoperability of your assets is driving this really virtuous cycle in Medicare and in the chronic care populations, your share gains in that business. But at least for 2020, not really translating to the commercial business with both risk and non risk down about 0.5%. So when you step back and look at that, is that a 1 year phenomenon you think driven by just some idiosyncratic issues with certain employers or is there a larger opportunity that you can address?
So I think the question is about membership and the growth in the government business, larger market opportunities, less penetrated versus commercial, which is much more mature?
Yes. So when I think about the commercial business and the opportunities that exist, we still have about a 14% fully insured market share growth in our market share. So there's opportunities there. If you look at our enrollment for 1onetwenty, we had a bit of a divot in some large customers, we've already talked about that. We feel good about our pipeline in our commercial business for our national account business, selling seasons right now, we are seeing a nice pipeline, we already have a nice win on the table for Onetwenty 1.
We're going to continue to take a disciplined approach to our pricing of our products, our services. We feel good about our product portfolio. We think we'll perform nicely into the end of 'twenty one to the beginning of 'twenty one.
Sorry, Matt, right behind you, Leslie. Thank you.
Thank you. Maybe I could pick up on what Gary is asking about there, which is on the large account losses. I don't feel like you've talked about that particularly. Can you address what have been some of the issues that have happened with some of those large accounts? And maybe as part of that also, why haven't the large commercial groups who should be the most sophisticated buyers seem to respond more strongly to the integrated offering that you have with OptumRx and United together.
You've had a lot of success with it. I'm just it's I would think that they would be the ones that would respond most strongly to that.
You want to start?
Yes,
I'll start. Yes, well, I would say from a national accounts perspective, Matt, I would like to see I do think we have a total cost of care value offering and sometimes national accounts they buy just on network discounts. And in those situations, those buyers are less apt to pick United. As it relates to total cost security, yes, I think we have a great value proposition. I think our synchronized value proposition with OptumRx is good.
I think as we think about our total care proposition, as I mentioned before, the biggest customers that fully adopt our programs, they do quite well from a trend perspective. So a lot of the national accounts business tends to change hands over time. And as Bill said, we're off to a good start for 2021. We like what we've seen so far in the selling season. So I'm optimistic.
We have a question in the back, please.
Hi, thanks. Good morning. Steve Valiquette from Barclays. From Page 21 in the slide deck, you provide that breakdown of the commercial cost trend components. It does look like for the 2nd year in a row, you're projecting a higher pharmacy trend in 2020.
To me, it's a little bit surprising since in a election year could be more modest brand inflation, etcetera. So maybe just curious if you could provide more color around what's driving that higher pharmacy trend in 2020? Thanks. I'll just give you the generalities, largely
it's related to specialty drugs and that's the biggest driver of it. A lot of specialty drugs are coming on the market and that's what we manage and John talked to you about what he was doing to manage in that area. We're going to continue to do that, but it's largely specialty driven.
Sarah, did you have a question earlier? No? Okay, good. A. J?
The guidance has the Medicaid business getting to the low end of the target margin as you progress through next year. Can you just give us a little flavor on how much of that is based on what you have in hand today? Are you looking for updated rates from reverifications? How is that process going? How much of the updated rates for reverifications have you gotten?
And how much remain to be worked out roughly?
Heather?
Sure. So we've been marching towards that target margin that we've talked about through the year and we continue to stay steady towards that. And what I'd say about as we work towards that is a combination. As you know, the rate cycles are sort of through the year. So we see we are working right now on oneone rates for the businesses that are in the oneone rates.
We feel good about what we're seeing in general around rates matching acuity of the population. That's with basic trend, risk adjustment for select populations and then the impact of redeterminations, which is member eligibility changes in some of our programs. And so as we look towards 2020, we see we're continuing to stay focused on rate advocacy for our states continuing to grow in the states that you've seen and continuing to push towards that target margin. So I feel good about that, as we go into 2020 that we're headed towards that and we'll meet those margins.
Becky, do you have somebody over there?
Thanks. Stephen Algonquin Sachs. Just a question on the fully insured outlook. I just wanted to make sure I heard that right. So it will step down in Q1, but then grow over the balance of the year just in enrollment.
Kind of curious what drives that and whether you're approaching the market any differently for new business versus renewals? And then what gives you all the confidence that you'll get the growth later in the year?
Yes. We're not approaching the business really any differently than we have in years past. We continue to be disciplined. We're excited about the products that are resonating in the market. I think you'll hear a little bit more in our breakout today about some of the products we're introducing.
We're looking at the market in a very stabilized way. So when we saw that how we were performing for January and then we looked at what our pipeline looks like for the rest of the Q1 and into the Q2, we feel good about where we're going to be as far as a commercial fully insured business.
All right. I think we have time for maybe two questions here. Kevin?
I just want to go back to the commercial trend conversation. You guys again talking about the lower end of your range. But it is just interesting that this year we've seen a lot of managed care companies report elevated MLR for various reasons. At the same time that we're seeing some hospital companies that have struggled to grow volumes for the last couple of years, all of a sudden reporting record volumes. And so I just really wanted to understand exactly what you're seeing on trend?
And if there's anything that you can do to help us understand if what you're seeing is in some way influenced by the management tools you're seeing, so that trend actually is rising, but you're having an impact on it to keep it at the lower end of what you're seeing or whether owning the providers is allowing you to do this. So just really wanted to understand, because it seems like what you're talking about from a trend perspective really is different than what some of the data points we're seeing from providers, surveys, things like that.
So I
think there are 2 questions in there. What is trend doing? And then also how the care ratio is changing based on business mix and performance by business?
Yes. Well, let me start. I've read the same reports that you've read and actually we have what's called a trend management report or TMR, which basically outlines our trends for all three lines of business. And it shows basically what our admits are, shows what our length of stay is, shows what our bed days are. As I look at that report for August, I would say it was mostly down.
So, yes, we may be a little bit of an wire with respect to how things are going from utilization perspective. As I think about our ability to manage costs more broadly, I think we've got some very good tools and matter of fact Optum does a big part of it. We recently transformed our clinical operation where we moved our inpatient, our prior authorization, our post acute, Optum takes care of that for us and we've increased our payment integrity assets as well. We just acquired Equion. So there's a lot of things that we've done to manage utilization.
And you folks have probably already seen, we've had some dust ups in the marketplace with some hospital providers about some of the stuffs some of the network rates that we want to get going forward. So I think what I would tell you is, yes, we may be a little bit of an outlier, but I think it was largely because of some aggressive action and some continued focus on costs.
Do you have any data about trend in markets where you have an integrated provider OptumHealth type situation versus in markets where you don't have that provider base?
Outside of Medicare, we really partner with
I can't say that where we operate with OptumCare, we have our best metrics really across the board, not only including utilization metrics, but satisfaction, our strongest value products and readmission rates, etcetera. But that's not a new trend. We've endured with that sort of success where we share arrangement with OptumCare for a long time.
All right. Our final question from Sarah, please.
Thanks. So I feel like every year you guys roll out more clear statistics on the savings from the programs that you're doing. And this year they're pretty compelling as is the difference in the cost trend that you're seeing from really engaged employers versus the not engaged risk employers. So what is the pushback that you're getting now that you have a clear cost trend differential that you can demonstrate? Why are they resisting?
And how close are we getting to the point where the evidence is just so overwhelming that even some of the smaller midsize employers say, that's a great investment, go ahead and do everything that you can do to help us manage costs?
Well, there I'm assuming you want me to take that. So there is definitely a clear distinction when we deal even in our smaller and middle market business with our self funded clients, they tend to take more of an ownership of the medical costs. So they work with us very closely on identifying what the trend drivers are, the real opportunities to try to bend that trend. Our fully insured customers, while we do embed many of those programs, it's really a portfolio of business and they tend to be on the smaller side. So their business is a little bit more volatile.
You can get 1 or 2 high cost claimants in and that can drive just a much different trend than kind of managing it on a more kind of an annual basis. So I think that's really what the biggest differences are is that really when you look at again state mandates and all the other pieces that come along with a fully insured portfolio, it's just a little bit more challenging than what a self funded middle market customer or large group customer can do to really attack the trend drivers in their particular group.
All right. I'd like to thank the UnitedHealthcare team. And I think we'll move on to the final part of our session, please. Thank you all again for your thoughtful questions. The final portion of the main stage will be focused on UnitedHealth Group.
And to hear more about our outlook, I'd like to introduce Chief Financial Officer, John Rex.
Thank you, Brett. Good morning all. Great to see you here today. I appreciate you making the time to spend time with us. I did before I walked out, I did confirm with our analytics teams that it was indeed still morning.
At some point when I attended the first one of these as an analyst, I started to worry the name Investor Day underestimated your time commitment. But I found it to be a good use of time then as I hope you all do today also. I also hope you found it useful to have a little extra time with the materials this morning. And since you've been able to wallow around in the numbers already, I'll spend a little more time providing a sense of how we look at this business and a bit less time walking you through a PowerPoint slide. For those of you who are planning to use this segment for an app, I deeply apologize.
I want to talk today about measurement and the connection between how and what we measure with how we think about the growth and the future of our business and its broad mission. At some level, we're all in the measurement business, professionally and personally. This image on the screen is one of the most meaningful and exciting kinds of measurement any of us see as kids or as parents. And in my household, these marks last for years on some chosen wall or door jam, a symbol of growth and progress. They're an integral part of the shared family story.
But as you know, single point in time measurements don't tell much of a story. They're a snapshot, a moment, useful as far as they go, but static. For example, to simply observe that UnitedHealthcare and Optum today each represent about half of our earnings only gives you a relative size of sense of the size of the 2. But then consider just 10 years ago, UnitedHealthcare comprised over 3 quarters of earnings and it has been growing at an 8% compounded annual growth rate since then. When we bring in elements like this, the static measurement begins to tell a dynamic story.
Our company consists of 2 strongly growing and healthy businesses and we have a favorable strategic balance across the enterprise when pursuing opportunities and managing risks. Let's stay with size for a moment. We expect UnitedHealth Group revenues to exceed $260,000,000,000 in 2020. Though this only suggests we're large, but that isn't really how we think about ourselves. Set this against expected U.
S. Healthcare spending in 2020 approaching $4,000,000,000,000 and an additional nearly $5,000,000,000,000 occurring outside of the United States. Suddenly, when measured against that scale, dollars 260,000,000,000 in revenues doesn't seem so large at all. Instead, another story emerges, one of almost unbounded opportunity for growth. Let's look next at cash flow, certainly one of the most basic measures for any enterprise.
For us, it extends well beyond a basic financial metric. It also tells us about people and how well people in the healthcare marketplace are responding to the ways we are trying to make their healthcare and the health system better. It speaks to the vitality of the business, competitive ability, the precision and effectiveness of our services and innovations and so many other elements. Importantly, it tells a story of our opportunities to build and serve more deeply for tomorrow. It is what enables us to return substantial and increasing amounts of capital approaching $10,000,000,000 this year to those of you gathered here today.
It's forward leaning in the nearly $4,000,000,000 we will invest in 2020 alone in support of new products, innovation, data, technology and de novo business development. And of course, this company's highly developed competency of deploying cash flow to make strategic acquisitions is very much a story of building for the future. We think of M and A as open sourced innovation. And our footprint allows us to increasingly join with organizations and teams to add unique capabilities adjacent to existing ones, crossing multiple business lines. A recent example is Genoa, which brings compassion and sophisticated management to the people who need it most through its 499 community pharmacies.
It connects not on just pharmacy care, but also social and medical needs. In the next week or so, we'll be opening number 500, just a few miles from here in Queens. Other times M and A deepens and broadens existing capabilities, such as the payment integrity business of Equion, which when combined with Optum Insight serves 22 of the top 25 health plans in the U. S. And lastly, these additions are often comparatively quite small, Bringing a unique new capability or technology, we look to further develop, strengthen and ultimately scale.
We measure the performance of these acquisitions with penetrating multi year look backs, holding ourselves to high standards of rigor and returns, well in excess of the cost of our capital. But we also have to weigh the intuitive feeling about joining with a new group of people with whom we share ideals about improving healthcare. On this topic of people, our single most important asset. There are many ways to measure a workforce and its performance and we use them all. There's one measure that says something about our advancing direction and future opportunity.
We now have over 130,000 clinical and technology interests compared to just a very few years ago. And interests compared to just a very few years ago. So the importance of this measure for us isn't the static view of today, but it's what it says about our future. The growth in clinical and technology professionals is very much a story of the coming decade, where our focus is and how we will grow and serve. Now back to measurement.
I'd like to briefly pace through some of the classic metrics we know are important to you. I'm not going to read through them all but share with you what we look at in these areas. With the full year 2019 for instance, I'll just note that our strong finish to this year is expected to yield adjusted net earnings per share approaching $15 or growth of just over 16%. Not every year is always in our long term 13% to 16% growth range. Over the past decade in many years, our earnings growth has been higher and a few years lower, which is why it is a broad long term objective, but we're pleased to deliver again this year within this range.
Our commitment over the long haul is to organically grow adjusted earnings per share percent to 11 percent with an incremental 3 to 5 points of growth derived from our capital allocation activities. And as we look to the decade ahead and beyond, we are confident this performance will continue. Looking at 2020, the overall numbers and expectations you have seen reflect our growing confidence in the momentum of the business. You heard Dave mention at the opening session that Optum will deliver just over half of enterprise after tax earnings in 2020. A static measure perhaps, but an important first time marker on that door jam of growth.
And Anders' comments today tell a story of the opportunities ahead for a business which is really just getting started. Consistent with the conversation on the Q3 earnings call, our initial view of 2020 is for adjusted earnings per share growth in the 13% range after considering the $0.50 impact of the health insurance tax. Within this, about $0.15 is due to the absence of the 2019 tailwind that's realized in commercial business that has other than a December 31 year end. And the majority or $0.35 is the in year 2020 impact related to the non deductibility of the tax, primarily in Medicare Advantage. This tax is a good example of how what gets measured matters.
Some would say it's simply measure tax revenues. We think the real measure is how it impacts all Americans who are paying for care. For example, it adds an additional $500 to the cost of care for a family of 4 and will be the single largest driver of trend for people in 2020 without advancing quality. Regarding 2020 cash flow, you may find it interesting to note, we expect over half will be generated by our expanding services based businesses. You might keep this important measurement in the back of your mind as you look at how we continue to evolve and grow our businesses to be both dynamic and sustainable.
As you would expect, our effective tax rate rises in 2020 due to the non deductibility of the health insurance tax, which has about 3.50 basis points of impact. Absent this, the effective tax rate would be similar to this year. The medical care ratio is reduced by the 140 basis point mechanical effect which occurs with the reintroduction of the health insurance tax. Additionally, business mix is a factor due to continued strong growth in serving government health programs in both Medicare and Medicaid. Taken together, we expect our 2020 care ratio to be 81.7 percent plus or minus 50 basis points.
Our full year 2019 expectation of 82.6% implies a 4th quarter 2019 MCR in the 83% zone consistent with our outlook. As it pertains to commercial insured trend, we start 2020 with an expectation for 6% plus or minus 50 basis points compared to 20 19 trend, which we now expect to be 5.5%. The component ranges are similar to what we have shared with you in the past and are primarily driven by unit cost. This measure does seem to get considerable mind share, especially with this audience. But I would just note it is comprised of trend on just 7,000,000 of the nearly 40,000,000 domestic full medical members we serve.
It excludes individual, commercial self funded and importantly Medicare and Medicaid benefits. And more broadly, it is not fully representative of the value and positive impact this enterprise brings to the people we serve and the health system at large. For example, you heard Dirk highlight the fact that self funded employer groups who adopt most of what we offer have been running trends of 2% or lower for a number of years. And trends in our growing Medicare and Medicaid Benefits businesses have run-in the low single digits for many years. Further widening our lens to capture a more complete view, we've shared numerous examples of the high quality outcomes and meaningfully lower cost profiles delivered by our highest performing OptumCare practices.
And as you've heard over the course of this morning, we are deploying tremendous resources to deliver higher quality and consistency at lower and more sustainable costs. That is what you should expect from this enterprise. We continue to be vigilant about our own operating costs. In 2020, after accounting for the health insurance tax and the mix impact of our growing services businesses, our operating cost ratio improves by 40 basis points from ongoing and accelerating productivity efforts. And you can expect these efforts to continue.
One other note on costs. We have many resources to use here. It is essential these resources be used to improve care while at a lower cost to the customer. So turning back to the deeper measures we analyze. The raw cost ratio doesn't tell the full story.
We probe to see what is really going on and how we are improving the health and well-being of the people we serve. For example, with post acute care, almost 1 in 4 patients who transition to a skilled nursing facility are readmitted to an inpatient setting within 30 days. Through our enterprise capabilities that harness our big data assets, we can now assist physicians in matching the best facility to highly specific individual patient needs. As a result, we are seeing up to a 12% reduction in 30 day readmission rates and a 6% reduction in length of stay. Or consider the nearly 400,000 people this year we will guide into or provide with housing, nutrition or transportation support.
Overall costs come down, quality of life and overall health improve meaningfully. These are among the other critical measures we look to understand the full story. Measurements also give you a sense of priority. About a decade ago, we embarked on a long term effort to shift culture of the enterprise, how we behave to be more oriented and balanced around explicit values, including relationships, innovation, compassion, integrity and performance. This meant both within the company and the people we engage with externally.
It's a complex journey. We're still on it and never expect to fully arrive as our mission is on ever higher ground. This is where the Net Promoter System came in as an extremely useful measurement. It tells us how we are doing in the judgment of those we serve, not how we're doing by our standards, but theirs. Consumers, physicians, health plans, everyone, their yardstick, their judgment.
So consistent as our narrative may be and some would even say pervasive, when we talk about measuring NPS, it should tell you something profound about our priorities. And our commitment to reach an NPS of 70 by mid decade should also tell you the importance we place on serving others. One final thought on measurement before we open up for Q and A. Now this may be heretical for a Chief Financial Officer to say, and indeed I may lose my Excel spreadsheet privileges for a year. But some of the elements most important to the future of our enterprise are the ones we actually can't measure.
The things that resist quantification and calculation, Traits like the compassion that walks in the door with 1 of our nurse practitioners on a house call to a Medicare Advantage member. The understanding of a customer service representative walking patiently through a parent's billing questions or the design team that's trying to simplify that bill. The positive health impact delivered by the primary care physician who now gets to spend more time with her patients. Or let's even step back just a few hours to where this day began. With Nurse Practitioner, Jerlea, who welcomed you here this morning, providing care, building relationships and giving voice to people with the most serious health needs.
This is how we serve 1 person at a time. It is the unmeasurable desire of the 325,000 people of this enterprise to improve care, to make it work as people want it to work, to make it more affordable and simpler. Even my vintage HP 12C calculator can't put a number to what inspires them. But this is what drives our organization and the performance you can expect to see for years to come. Thank you very much for your time today.
And now I'd like to welcome Dave, Andrew and Dirk to the stage to begin the UnitedHealth Group Q and A session.
All right. We're ready for your questions. Steve?
Thanks very much. Very helpful presentation. I guess the first question I'd love to hear John maybe from you a little bit about is just the 13% to 16% growth you all target every year. Could you sort of help us assess the sustainability by maybe deconstructing it? How do you think about where the component pieces of that come from an algorithm, if you will?
Maybe just a separate question, maybe related, maybe not. The commercial medical cost trend, while you guys are stressed, it's only on the 7,000,000 members. It's only coming above the midpoint once in the last sort of 18 years. And so is there a conservatism? Is that the discipline we see in your pricing that sort of helping you get there?
I don't know if that's related or if you'd separate those comments, but those would be the 2 questions I have. Thanks.
So let me start with the 13% to 16%. And the deconstruction is really a model that the company has had for some time in terms of how we get to that mix of growth and our confidence in attaining that growth. So 8% to 11% over time is what we would consider to be organic results of the businesses, 8% to 11% growth in those businesses and then we supplement that with capital allocation, which has been a long hallmark of this company for several decades in terms of effective capital allocation, which we look to add those 3 to 5 points of additional growth to our over time. So that's really how we get to our 13% to 16% and which gives us the confidence we have as we look out into the future. And as I sat here today actually over on the side over here all by myself, listening to these presentations and thinking about the growth prospects for each of the individual businesses and the growth of businesses that haven't been around that long such as Optum, that's part of what gives us the confidence in being able to sustain that as we look out to the decade ahead.
On the cost trend comment, and so can you rephrase the question? So it was on the outlook for 2020 on the 6% on the commercial cost trend, is that?
More just observing that sort of in the last 18 years, it's only coming above the midpoint one time, 2,008. And so is there just this inherent conservatism that sort of helps you get there or how should we be thinking about that?
I would call it our deep respect for medical costs, deep respect for medical costs in terms of how those might develop over time and in a way looking for that never fully counting on the impacts to come through. We certainly want to strive to always deliver better. Dirk talked about the many efforts going on in his business. But yes, your point is 1, we do understand how medical costs can fluctuate and look out to try to incorporate a view that doesn't get ahead of potentially things that we may not even know about, a new drug coming into the market, some other element that might appear?
It's really a range that we work with at this distance at this time of the year. And so as we get more comfortable with it over time, you'll see it firm up and hopefully firms up positively, so that 2,008 doesn't happen again. That's an important part of how we ensure that our pricing stays in excess of underlying trend.
All right, Lance please.
Yes, a question on the political environment out there, not so much asking you to predict political outcomes, but really
Thank you.
Yes. Looking at how are you looking at your capital deployment priorities given maybe a long term pressure if you go all the way back and you think of 'eight, you think of 'twenty and 'twenty eight or whatever. How are you modifying your capital deployment priorities? And then I'm interested in how you keep the Board assessed as to potential policy scenarios? And in what role the Board has in meeting with legislators and just the overall environment as politics becomes more and more important to us?
Sure. If you don't mind, I'll take those in reverse order because I think they cascade better. First of all, the Board asks us to prepare a strategic plan and then we generally are looking out somewhere around 5 to 10 years as part of that conversation. The reason why it's only 5 to 10 is just because healthcare has these fairly narrow windows and political movements can be part of the changes that we experience overall in the business. But as part of that exercise, they ask us to plan in a multidimensional way.
So that could be everything from traditional financial planning, which you would expect us to pursue. And that includes the deployment of capital and where our priorities might lie, which I'll get to in just a moment. But they also think about competition, about new entrants, pressures that we may feel more broadly from the broader marketplace, our people strategies as well. How are we going to source the talent that we need to respond to the growth of this more diverse business every year, things of that nature as well. And then obviously a big large component of that is also thinking about the political environment, how policies will shift over time and do those differ between different administrations over that timeframe.
Obviously, we never get into a position of predicting. And I think as you've seen with our business, we've been able to grow, diversify, prosper regardless of administration, regardless of of the economic environment over time. You may see small lifts and dips, but not nothing I would characterize as being of great significance. Inside that planning process, we look at the excess capital that we excess cash flows that we produce over that timeframe and then we think about how we allocate that capital. And as we look out 5, 7 years or so, maybe even as much as 10, but let's just stick with a range of 5 to 7, we would see the highest amount of that capital continue to be invested in diversifying and growing the business, and in particular on the services front with Optum.
You can see with the pace of growth and the platforms that are being developed there, whether it be the OptumCare platform, which has been where our priorities have lied for the last 8 years and I would suggest our priorities will lie for the next 7. But you also see the introduction of new service models to John Muir Health and others, which require some level of capability development and deployment as well. So that is where the preponderance of a capital go, but we are still acquiring at UnitedHealthcare as well. We acquire capabilities, market presence. And some of the acquisitions we do and deploy at Optum are first to serve UnitedHealthcare's needs and then more broadly the rest of the market.
So I'd say think about it as at least 2 thirds of the capital being deployed to continue to build Optum and about a third or so being used to build UnitedHealthcare who as you probably noticed last year acquired some self funded TPAs as well as some risk bearing capacities as well. Do you have anything to add?
No. Okay. Kevin?
Can you talk a little bit about the pricing environment? You talked already about Medicaid, but maybe commercial and Medicare Advantage. It seems like a few times today you talked about disciplined pricing on commercial and commercial membership being down. Just want to understand if there's something that you're seeing out there from a competitive perspective. And then when it comes to Medicare Advantage, you talked about keeping your benefits stable or improving 80% of the time.
That's actually something we saw broadly speaking this year, even though the HIF came back and that's different than what we saw in 2018 when the HIF came back last time. So it feels like that might be more competitive as well. So just love to hear your thoughts on pricing in those two products?
Yes, I think we have good insights on our trend forecast, which is number 1 related to that and that we're deeply respectful of medical cost structure as we discussed here on the commercial. The only trend number we give is the commercial insured group risk trend, but we have obviously the same disciplines across the board. It's a little easier in the government program space because the inflation is less on a unit cost basis overall. But we have strong disciplines across the board. Dirk, do you want to touch on that?
No, no, I would say if you go back to what I said in the commercial trend to begin with and the commercial business, yes, sure, there's pockets of competition all over the place. What we're going to do is we're going to price to our trend and be disciplined about that. I go back and I give you a long term perspective on the growth on our business is sort of the underlying. If you look from 2010 to now, I mean, we've grown 7,500,000 members organically over those 10 years. And we've done that in the same vein as where we've had this, what I'll call pricing discipline.
So I think it's a long game with respect to growth and I think that certainly showed up in Medicare Advantage this year. Those stabilized benefits, you saw the growth numbers that Brian talked about. There's some fairly significant growth on the board there and the government businesses across largely because we've had stable benefits over time and that pays off.
Can I just do a follow-up there on the Medicare side because it seems like everyone's saying Medicare is going to be their growth business? So everyone's going to be growing above average in Medicare for the next 5 or 10 years. I mean, how do you think about your ability to A, do that and B, do that while maintaining margins? It seems like with all this competitive pressure, margins have to come down at some point if you're going to continue to grow above average?
Yes, I think well, between I think Brian did a nice job of laying this out. Between last year 2019, let's call it last year and this coming year 2020, we're going to see a bit of a shift in terms of the overall growth of the business, which should reflect to you a certain discipline around really 2 things. 1 is about how we offer our benefits to seniors, meaning keeping them consistent, keeping our networks consistent, the pharmacies they access, pharmacists, their drug formularies as consistent as possible. It's important when you're working with that population to maintain our baseline ingredient to growth. But as you I think you also know that they start with the foundation of a pretty large gap in terms of coverage off of the fee for service program.
So there's an opportunity to continue to enhance the benefits to close that gap, so seniors have the full coverage that we believe they deserve. So that is one thing. At the same time you have to be very disciplined around staying ahead of your cost structure in that business, which means in part for Medicare Advantage, you have to have some really strong capacities to manage your cost structure and the utilization in particular. And when we get to the showcase, this is one of the areas I really want you to spend some time with. When you look at Genova Pharmacy and you think about what the impact of that unique asset is on the cost structure of Medicaid, you'll come to realize one of the reasons why we are strategically advantaged.
When you look at the other two showcases, they're both focused on our clinical engagement strategies around serving these complex populations. I think you'll come away with the understanding that it's this information and technology enabled clinical insights driven into the hands of our people that then manage care on a very hands on basis and is very distinguished. And because of that, we've done our own studies and I'm sure everybody has these, but we believe we maintain in the Medicare market a strategic cost advantage visavis the competition because of the capacities that we have as an organization. So staying deeply respectful of costs and staying ahead of it, maintaining the consistency of benefits and premiums and other offerings in that category is important. That's one of the reasons why you saw us have a relatively soft MA season this year in 2019.
And we don't like being 3rd, that's fundamentally where we landed for the year. But over time, I think you'll find that we will continue to grow and outpace the market.
And like any other rational business person, we're going to continue to invest in the MA product. Dave mentioned specifically about things like the nerve center where we manage the most complex populations, but also house calls. It's a great attribute to be able to help our Medicare Advantage product. That is key. Our STARS capabilities, we focused on that.
We've had a good year there as well. So I would say as we continue to invest in an area which where we think there's growth from a secular trend perspective as well as it's a great product. So investing is crucial.
Not to belabor this too much, but we also have the example that OptumCare sets in managing these complex populations and then apply that same kind of learning synthetically in terms of network composition and otherwise at UnitedHealthcare. So it is a it's and as Brian said, it's their highest performance, so UnitedHealthcare's highest performance in serving the MA populations is where they have an intersection with the OptumCare in that local market. No surprise, they work dynamically together to try to optimize the performance for the senior. And to the extent that we can apply that more broadly, where we don't have direct ownership or direct affiliation with clinicians, I think you'll continue to see the business become even more distinctive. A.
J? A. J. Is right down here.
Obviously, the focus today is on the domestic market, but several times in the various presentations you guys have sized the global opportunity. It's been almost 2 years since Bammedica. That seems to have gone very well. What's the company's appetite for looking at other international deals? There's been some discussion over the years about Pacific Rim, Europe, whatever.
Any comments on maybe moving into those markets? What's your thoughts?
Well, we're still very interested in global, But I'd suggest to you that our approach is on a very measured pace. As you know, the very much the largest healthcare market in the world is right here in the United States of America. And it's important with this very large and growing end market that we optimize our performance here first. And we have a nice foundation in South America today and we are very pleased with how Banmedica has performed consistently over the 2 years that we've owned it. And we are kind of half pleased with the performance of Brazil, very pleased with our people.
They do a very good job, but Brazil has been a lot more volatile for us than we expected from multiple different dynamics. Because of that, I think you can appreciate that we would be cautious about diluting this management team across multiple time zones and geographies at a time that's so critical for the United States and frankly for South America. So as it stands, we're going to really work that out, make sure that Brazil is operating effectively and going through a transition, which I think we'll see play out through the 2020 timeframe and leading into 2021. And then I think it's that would be a good time for us to assess whether or not we would pursue an additional market. That's not to say that the activities underneath the company that are going on in the company are anything but being very curious about these other markets and exploring them, evaluating them, positioning our business so that if we choose to move into them, we'd be ready to do so with great confidence.
Okay, please.
Two questions for me. I'm going to start off with my first question on behalf of bondholders here for John. John, maybe if you could please talk about the balance sheet. And Dave has covered the capital deployment priorities, but maybe if you could talk about your commitment to single A ratings. And then secondly, maybe if you could talk about the needopportunity for doing a transformative deal for UnitedHealth, considering the vertical integration deals that are happening in the market?
You are granted you're very well positioned. But if you could maybe talk about looking out 5 years from now, if you see a need for a big deal?
Sure. Maybe I'll start first. Highly committed to our the ratings that we have and maintaining those ratings we have, deeply important to us. You can see where we landed the 3Q in terms of a debt to cap ratio with some transactions that were in there. We expect that we by the time we complete this year that we'll be back down in the 40% zone in terms of debt to cap ratio, which is where we want to maintain our commitment to run over the long haul and having it down in those ratings that help sustain the types of ratings that we have, so deeply committed to that.
And what was the second part of your question? Deal. Transformative deals. So I think if you look over time at this company, most of our transactions have been comparatively small. When I think about the scope of it, there have been a number of transactions, none of which are have been extremely large.
Our single largest transaction ever was $13,000,000,000 and that was reasonably larger than any of it that we had done at that point. So most of the things that we are interested in, I would put in the measure of often more greenfield in terms of how they're impacting people. They aren't necessarily well developed businesses. So you will see the vast majority of our activities are more in areas that we think we can grow, develop, scale across our business. That's been the case for a while and that's my expectation that it would continue to be the case for this company and how we operate and where our interests really lie in terms of the types of services capabilities we want to bring to the people we serve.
And why don't you give just a little recap of how much we spend and how many transactions and what the average is, because I think that's
Yes. So, over the course of this company, really, we've spent about $70,000,000,000 or so in capital, which pales in comparison to some of the transactions that you've seen over time, right? So that's over several decades of time. And so you're getting an average transaction value that's down in the kind of very low level in terms of the average transaction that we go into. It's unusual for us to be in multiple billions typically in transactions.
I would tell you even in the OptumCare business and Andrew can speak to this well in terms of the pipelines that developed there. That is more greenfield opportunity. Andrew, you spent a ton of time there.
So we have an extensive pipeline in CARES. Obviously, we closed DMG during this year. That's really an outlier in terms of the scale opportunity that we see. It's worth we probably have more than 100 targets in that pipeline. Worth understanding it probably takes 3 years from a practice showing some interest in moving toward risk, which for us is a real precondition of joining OptumCare all the way through to something actually becoming consummated.
The other thing I'd say, I mean really to the point of vertical integration or no, I think there's a lot changing in the way healthcare is being evolved in the U. S. Right now, largely driven around the insights that you can really generate from a data and the kind of analytic power you have and that allows you to move away from some of the preconceived assumptions of how the system has been formed historically, right, which has been just to be blunt, pretty bricks and mortar orientated, institutionally orientated. That makes loads of sense if you don't have the capacity to really do personalized network design or personalized care projections. If you move toward a world which is much more personalized in the way you think about it, the kind of asset development that you might want to build around that journey might look very different from the legacy structures which have been built really designed on a 1960s, 70s, 80s view of the world.
So I think for us, we're led really by how do we get the best insight into managing that risk cap, I talked earlier is a big driver of our opportunity. We think gives us the best angle of attack on bringing down cost driving quality. How do we do that at a personalized level first and then what do we augment around what we already have to make that journey as good as possible, as efficient as possible and at the highest possible quality. That's the real power of this company because with the scale of the data, our ability to really drive really meaningful insight, really take advantage of new technologies, whether it's machine learning, Key thing about machine learning, it's only as good as the number of times you test the machine. So having more data, more transactions, more volume makes your machine learning much more likely to be accurate more quickly than others.
Those become the drivers of how we think about adding in acquisitions or capabilities to the company.
So as
you can tell from that our average transaction size well under $1,000,000,000 over time, well under $1,000,000,000 They are very small in Andrew's world, but those are the kind of markets we're developing and that's really where we see our opportunity.
So think about us as more of an assembler of market presence and capabilities putting them together and at the series of the actions that we take are transformative as opposed to a big large transformative deal are transformative. Just those tend to be very highly sized, but don't necessarily get the kinds of returns that we've grown accustomed to as we deploy capital for M and A.
We have time for one more question. I think Matt, yes, please.
Thank you. A fairly narrow question. As you look at Medicare Advantage, you've had a lot of success with the duals. And do you think that the dual special need product is the platform for penetrating the 11,000,000 duals? What do you want to see policy wise change if anything for that population be adequately served?
I'll start and you can finish. From a I don't know that we really need a whole lot of policy changes with respect to the dual population, other than the fact that the states and the federal government to continue to support doing the right thing, which is to continue to work in a public private partnership with the private sector to bring the value that we've been able to bring to that population on multiple dimensions. They oftentimes are underserved, so we can meaningfully change the experience and the quality of their life. Oftentimes are spread across way too many physicians, so we can help to hone that so that their care is much more coordinated and getting better outcomes. And then the combination of those 2 things helps us to provide a much more competitive cost structure, saving states and the federal government money, which I think is essential output of good sound public private plan policy between government and the private sector.
So I would like to continue to see that move forward. We have found that government broadly both domestically as well as federally is very receptive to ideas that influence or improve our performance on all three of those dimensions and we would continue to bring our ideas forward and hopefully see them adopted and that continue to be a robust market for us.
Yes, I think as just to add on, I think from a policy standpoint, no, I don't think we need anything. As you look at our capabilities in this area, we have the clinical capabilities, we have the administrative platforms. As I think about how we set up the structure of our government programs business, we have Medicare and Medicaid being managed under one roof. So I think there's a from a structural standpoint, we're well served and we're well served, we'll be able to serve this group well in the future. So not really much on that regard.
The Q and A portion has completed. I'll turn it over to Dave please for some closing remarks. Thank you all.
So great team, hopefully you appreciated this morning's main stage presentations. And what we tried to put forward for you today is to give you a sense of what makes UnitedHealth Group distinctive, and there's a few key takeaways from that standpoint. First of all, you can count on us to continue to grow and diversify this business broadly across multiple different dimensions. You can see a bias towards how we deploy capital while maintaining a fiscally responsible balance sheet, deploying capital more so into the Optum business. It's a very restless and adaptable company.
It has maintained those features for its 45 years of existence all the way from its very early entrepreneurial days until today. And the whole idea around all of this is to work with others to lead the next generation of healthcare in America and across the globe over time. Hopefully, you found that our results for 2019 and our initial expectations at this distance for 2020 were strong and we're committed to doing more. And in particular around those areas where we had low performing assets or businesses like in Medicaid, like you see in Brazil with a meal and trying to enhance the growth responsibly of our commercial insured markets business as well. We have a lot more to show you today.
We've got showcases, which I strongly encourage you to spend some time with and think about Gerly when you do so and how that information technology and clinical insight enabled highly compassionate caregiver reaches the marketplace and enables us to be able to grow and prosper in the most important markets in healthcare today, those that are growing the fastest and are already a large end market. And then we have other components inside there around Genoa. I don't think you've had a chance to really see Genoa yet and fully understand it. It's opening its 5 hundredth pharmacy here in New York City later this month. So we're excited about the what it brings to the seriously mental ill communities and mental health communities broadly.
And then we have seminars later today and actually I'm very excited about our seminars and we have them on 5 policy our 5 growth platforms. We have a policy political seminar, which I was asked last night whether or not we were going to hear any commitments coming out of that or any new thoughts and I can assure you that there will be no brave new commitments or communications coming off of that, certainly not for me, that's for sure. We dealt with that in the Q1 of this year. So that will be but I think it will be good to get a refresh and they will do some prognostications about what policies might find their way into law over time. And then we also have a piece on our R and D and technology as well.
So these are pretty fascinating discoveries that are underway and deployments of technology across the business. So I think you'll enjoy them. I'm very excited about our seminars this year. I think that the content and quality of them is stronger than they've ever been. And then I want to encourage you also, after you go to the showcase, you'll come back for lunch and seated with you will be 1 or 2 of our representatives.
They're going to be narrower in scope than what you're used to with us. So just recognize that they may have a higher number of I don't know kind of answers, but it will be good for you to kind of see the consistency of the quality of the resource that we have. It's good for you to get to know them because by knowing them you know us and that's important. So I'd like to now invite Cheryl Skolnick, who is our Executive Vice President of Strategic Relationships across UnitedHealth Group up to the stage to share more details about what you're going to see this afternoon. Cheryl?
Thank you so much, Dave. Well, thank you very much to Dave and to all of my many, many colleagues who worked with me and with Investor Relations on presenting this material, developing it for you today as well as all of the activities for the rest of the afternoon. We very much appreciate your participation in this as well as your feedback. Tomorrow at noon, we are going to be releasing our investor conference survey. As you know, we measure everything.
You've been told that a number of times today. And what we measure especially is your satisfaction with the content, with the timing, with the pacing and the materials that you've seen so far this morning. And so we will take those comments into great and serious consideration. We would very much appreciate your response by the time the survey closes, which will be Monday, December 16, when the survey will close at 5 p. M.
Central Time. In case you didn't notice, our company is based in Minnesota on Central Time. For those of you here in the East Coast, that will be 6 p. M. And speaking of closing, we want to thank all those on the webcast today for their participation virtually, but this does close our formal webcast portion of our program.
Thank you very much for joining us online.