Ladies and gentlemen, Senior Vice President, UnitedHealth Group, John Penshorn.
Good morning. Good morning, everyone. Welcome. On behalf of my colleague, Brett Manderfeld, and the 58 other Senior Leaders from UnitedHealth Group that are here with us today, welcome to Investor Conference 2018. We are glad you're here. The conference continues to evolve. There are certain traditions that remain the same. One such tradition is that we will make forward-looking statements today. Those forward-looking statements involve risk. Actual results could materially differ. We have filed risk factors in our Forms 10-K, Form 10-Q, and 8-Ks with the SEC, and they are also available on the investor relations page of the unitedhealthgroup website. Additionally, we will use some non-GAAP metrics today, such as adjusted net earnings per share and EBITDA, and we will reconcile those non-GAAP figures to the most comparable GAAP figure.
Those reconciliations are included in your books at the back and also posted on the investor relations page of our website. The conference does continue to evolve. You have fresh books, updated Qs and As, business descriptions, main stage slides. If you're listening on the internet, welcome. There should be a digital package available there of similar material. The visuals you see here in the room may differ a bit from what you're looking at on the page, but trust me, the content is identical. We have brought back the technology showcase this year after a couple of year rest. We've got seminars this afternoon. I'll give you more information on how all of that is going to work as the day progresses. Let's start by putting in a foundation. Our foundation is our people.
Here to open our conference with some comments and forward-looking observations about our people is our Executive Vice President and Chief People Officer, Erin McSweeney.
Good morning.
Good morning.
Last year, I introduced you to some faces and some stories that represented the 260,000 team members of UnitedHealth Group. As you might expect, that number did not remain static for 2018. There are now about 290,000 of us, a net addition of 30,000. Through hiring and acquisitions, we brought in thousands of technologists and customer-facing team members and tens of thousands of clinicians. They joined us from all over the world, from some of the most respected colleges, universities, and companies in healthcare, technology, and beyond. They were attracted by our mission and by the unique opportunity that UnitedHealth Group offers to make a difference in the lives of others.
The question that might be on your mind this year is not who are the people behind UnitedHealth Group, but rather, how will we evolve our workforce to support the growth and the future of UnitedHealth Group? You've seen in the past, and you'll see again today, that we're committed to growing and expanding this enterprise. The engine of that growth, the growth that will be the theme that weaves through all of today's events and presentations will be people. Over the years, we've developed substantial competency in identifying and hiring and developing strong employees and leaders. As you can imagine, it's a complex human undertaking. You could start with the 24.6 million visits to the UnitedHealth Group career website, which translated into 2.1 million resumes that we received last year.
With the artificial intelligence that we apply that introduces candidates to roles that they might not have applied for but would be more appropriate for their skills and background. Our recruiting efforts take us to some of the same places that other technology-oriented companies go to Boston and San Francisco, to Dublin and Pittsburgh, Bangalore, and many more. UnitedHealth Group offers a distinct social mission. It sets us apart and makes us their first choice. What's also important are the jobs that we didn't have to create. Each year, innovations across our businesses allow us to automate more and more of the most repetitive tasks so that we can focus our people on the high-touch roles that bring the greatest value to them, to our customers, and to our members, jobs that call on their creativity and their compassion.
We're also incredibly intentional about how we develop and challenge our people so that they and our business are constantly evolving, distinctive, and thriving, and both are evolving to meet the needs of a healthcare system undergoing constant change. Over the last year, across our enterprise, employees took more than three and a half million hours of training. These online and classroom learning experiences ensure that our team members are equipped not just to perform well in their current assignments, but to prepare them for their careers of the future with us. For example, more than 1,500 of our colleagues completed intensive and challenging executive development programs. These programs are specifically designed to ensure that we have a continuously growing deep bench of future leaders.
Our Center for Clinician Advancement is dedicated to expanding the skills of our 85,000 clinicians, our nurses, our nurse practitioners, our social workers, our pharmacists, and it includes our unique physician leadership development program, a curriculum that we've built to enhance the managerial skills of our physicians to ensure that they too can lead our business. In technology, our Data Science University fosters analytics, machine learning, and artificial intelligence skills for the most experienced of our more than 20,000 technologists. Most important of all, however, I think, are the internal opportunities, the on-the-job experiences that stretch and grow our talent. Last year, more than a third of our newly created positions were filled by internal candidates.
The investment that we make in our people, the opportunities that we give them to develop their careers, and the mission that underscores all of our work, that is what will enable us to hire the people who will create the future of UnitedHealth Group. Why should all of this matter to you? Ultimately, when you invest in a company, you're investing in its people, in us. Thank you for your confidence in us and in our mission. Now I'd like to welcome David Wichmann.
Thank you, Erin. Good morning, and thank you for joining us today. We know your time is valuable, and we hope to make the most of it. As is customary this time of year, John Penshorn manages to pack a 10-pound meeting into a five-pound day. We've actually built in a modest break for you around lunchtime, but please don't think the less of us because of it. I want to thank you in advance for your interest and for your endurance. You'll hear a lot today about the capabilities of UnitedHealth Group. Ellen Wilson just captured the way I get to view them, through the capable hands and minds of our people. They are talented, committed, bound by a culture of shared values, behaviors, and beliefs.
It's their work that makes the difference in helping improve the health of the people we're privileged to serve, including those we see as most influential in shaping the future of healthcare, the informed, engaged healthcare consumer. We at UnitedHealth Group operate an open system, engaged with one of the most socially sensitive and enduring areas of human activity, the care we provide for each other. Operating an open system requires a creative, forward-thinking mindset, a company restless at its core, outward-looking and market-facing, adaptable and ever-evolving, determined, never satisfied, compassionate, yet quietly courageous and urgent to achieve its mission and vision for a better healthcare. A company with a distinctive set of core capabilities enabling its mission, helping people live healthier lives and helping make the health system work better for everyone.
We measure our performance in pursuit of this mission first and foremost by the impact we have on society, and the way in which we deliver better outcomes and greater value for people and a better healthcare experience for them and their doctors. In turn, that enables us to drive value and exceptional returns for you, our investors. Societal and shareholder returns and committed talent are just part of what you can expect from us. You can also expect growth in all forms each year and over time. Advancement in everything we do, more reflective and more impactful. Ever-improving NPS holds us accountable to that expectation. You can expect diversification across our portfolio of healthcare businesses, with nearly 50% of our 2019 earnings now coming from healthcare services. Businesses applying their collective strengths of Optum and UnitedHealthcare to serve market needs better together.
Innovation deeply rooted in our culture, now even more diversified in approach, both incremental and evolutionary, transformative and disruptive, open source through M&A and venture investment, and organic, including through robust research and development capacities. Leadership, both drawn to us and cultivated by us. You will see them today. Their individual strengths are only surpassed by the potential of their collective whole as a team. With diverse experiences and strengths operating as one. Since our meeting last year, UnitedHealth Group has reported exceptional results on each of these fronts, as it has over the years. Yet, as has also been the case over the years, not all of our businesses in 2018 are performing to their margin, growth, and NPS expectations.
When that happens, our businesses pursue intense structural change agendas until they achieve the type of consistent market-leading performance we expect every business to achieve every year at UnitedHealth Group. Indeed, we have yet to perform to our full potential as an enterprise, even while we deliver consistently strong financial results. For the 20-plus years I've been with the company, we have measured progress not only by the results we've reported in the moment, but in how our investments drive distinctive returns for society and shareholders in the future. Key to this progress has been an intense focus on building more strongly upon three core competencies in information, technology, and clinical insights. These have been foundational for our 44-year history, and they have served us well, positioning us to be a committed and distinctive healthcare and health technology company. Many of you have been attending these investor conferences for years.
What you have been observing is what comprehensive transformation in healthcare actually looks like in real time, driving toward value, benefits aligning to consumer access and high-performing health systems to better serve consumers, making it all more possible and consumer-responsive through NPS, integrating data and best scientific evidence across physician practices, and engaging consumers in their health. By the time the day is over, you'll get a good sense of our view of what a continued transformation could yield a decade from now. In fact, John Rex may even give you a number or two that far into the future. If you aren't satisfied with what he has to share, you could simply apply a 13%-16% long-term CAGR to 2018 as a baseline and arrive at numbers consistent with our own adjusted earnings per share expectations. That level of financial performance is what you should expect from us.
You can also expect we will deliver even greater societal return. At no time in our history has our work held more promise for the people we serve than right now. Look to us to be even more determined and restless as we pursue the forward views embodied in our operating plans and our ambitions to make a difference. What does transformative change look like in the future? Rather than talk hypotheticals, let me walk briskly through three examples of the kind of change well underway at UnitedHealth Group today. I'll start with our individual health record, or IHR, which we first discussed on this stage last year. Our goal with the IHR is to provide doctors and individuals with a deeply personalized 360-degree view of a person's health.
We provide each individual and their doctor or caregiver with a fully integrated, fully portable, real-time, and dynamic medical record powered by a proprietary medical ontology and best-known science, not dependent on any one system or network. Importantly, the IHR not only shows doctors and patients where they have been and where they are, but can suggest a path forward in the journey to better health. This agenda is a key element of our work to accelerate digital in healthcare, one of our five growth pillars. It also underpins each of the other four strategic growth areas we are pursuing. We will offer IHRs for free to all of the people in North and South America we serve with comprehensive benefits coverage because the technology will be key to improving health outcomes, lowering costs, and improving the patient experience.
We will drive this agenda alongside our other growth, clinical, and cost superiority, and simplification efforts. Building an IHR is complicated. It takes a company embedded in the transaction flow of healthcare, deeply competent at its core with information, technology, and clinical insights. Yet, as challenging as building it may be, that's just the first and arguably the easiest step, because the technology isn't the goal, and the information, while immensely useful and essential, isn't enough on its own. The real goal is engaging people and designing health systems and the proper value-based incentive systems and coverage mechanisms to better serve them. The knowledge produced by the IHR becomes considerably more powerful when used alongside and within other capacities in a meaningfully connected way to drive advancements such as building high-performance clinical practices, such as those we build directly through Optum Care or virtually through information-enabled premium physician designation programs.
Enhancing proven health engagement platforms like Rally, which now serves 21 million users. Driving interoperability by simplifying the distribution of information into the workflow of a physician's practice, like we are accomplishing with PreCheck MyScript. Improving health outcomes derived from incentive reward systems, including the over one half billion dollars we have paid to consumers and $17 billion of incentives and risk features of payment models available to care providers in 2018. Creating an effective closed-loop health information exchange centered on the consumer, one consumer at a time, something that's never been done before. This endeavor can only succeed in an environment guided by a mission and culture formed to deeply respect and protect personal and private information with the exclusive motivation to advance health system performance and the health of the people served.
We see the building of the IHR as one of the most transformative steps in significantly improving quality, eliminating practice pattern variation, and driving high consumer engagement in managing their health and modifiable lifestyle behaviors. I'm pleased to report the first of this deeply personalized data set with highly intelligent Next Best Action suggestions was released in beta form to three ACO partners earlier this month. Initial feedback has been positive. Notably, in just the first week, the IHR, in the capable hands of a qualified physician, positively altered the course of treatment for, if not saved the lives of two patients. Another physician was able to confirm a previously unmade diagnosis identified by the IHR's artificial intelligence, dramatically modifying the patient's treatment plan.
As a last example, a practice benefited from the pre-populated history of a new patient, eliminating the need to consume critical nurse time to build the history manually. Our goal of reaching the 50 million people we serve with the IHR is no longer a question of if, it's when. When will consumers and their doctors be using integrated technologies, aligned incentive, and interoperable clinical and administrative frameworks to the fullest extent to improve the quality, cost, and satisfaction of the care experience? Then you may find yourself immediately moving on to additional questions, such as the IHR sounds artificially intelligent. Is that possible? Is this an early sign of the promise of advanced technology and what it holds for healthcare? How will the clinical value of this large phenotypic data set and its capacities emerge?
Would a combination of this and genomic data lead to new clinical discovery and better management of serious health conditions? What impact could a closed loop exchange of information have on the effectiveness of clinical practice and demands for healthcare resources in the future? How far can and will UnitedHealth Group take this technology, unique data set, and business framework? The answers lie in what happens when the opportunities offered in each question meet the innovative capacities of our restless and determined people to realize the IHR's full potential. Those answers will come in the future, a better future we will work with others to advance. For our second example of transformative change, I'll turn to one of our other strategic growth areas.
Optum Care is reinventing healthcare delivery and growing as a business by growing more deeply in its foundational geographies, expanding into new markets, and evolving towards fully aligned risk-bearing capacities. Even as Optum Care currently serves the needs of its 14 million patients and 80 payers, we are building the nation's first comprehensive next generation primary and ambulatory care system. It is a system designed to deliver high-quality healthcare, a unique consumer experience supported by information and technology, and a distinctive total cost of care position on a fiercely multi-employer basis. Multi-payer basis, excuse me. To extend this model, we pursued a combination with DaVita Medical Group. We are actively working to bring this transaction to closure as quickly as possible. We have also signed an agreement to acquire The Polyclinic, a Seattle-based practice geographically complementary to DMG's The Everett Clinic.
We look forward to serving the people of Seattle and the surrounding counties in the near future. Our third example, aligned to the ambitions of Optum Care, is our pharmacy business, Optum Rx. We are increasingly engaged in transforming pharmacy care services. What gets delivered, how it's delivered, and how it's paid for. We're doing that by advancing e-commerce, convenient local market dispensing and same-day delivery services, high quality, high value specialty pharma, including home and office-based infusion services, and whole person care, now with a meaningfully enhanced value proposition as we seek to transform the pharmacy care experience and value. Effective January 1, 2019, we are launching the nation's first ever scaled application of discounts at the point of sale to improve the value consumers receive, particularly the 60% of the U.S. adult population with at least one chronic disease.
We are also working within HHS, CMS, and FDA efforts to transform pharmacy practices by developing Part B, site of service, formulary, and other initiatives to remove barriers to bringing better healthcare value to people. We are engaged with forward-leaning pharmaceutical manufacturers on pharmacy bundles and bundled risk and a broader array of payment approaches than those offered by traditional PBMs. Business combinations in the third quarter further advanced our specialty pharmacy capacities in oncology, as well as added retail dispensary and tele-site capabilities to better serve the needs of the Medicaid population with behavioral health conditions. Advancing and extending our capabilities in this manner is essential to our goal of substantially improving pharmacy care services for people. We will be extending these models more fully to serve all payer types in the future.
All of these advances are a continuation of a multi-year evolution of our approach in pharmacy from the classic PBM model to a more modern whole person pharmacy care services business. Accelerating digital, reinventing healthcare delivery, and transforming pharmacy care services are just three examples of the kind of change well underway at UnitedHealth Group today. Our UnitedHealthcare benefits business applies these approaches and its own proprietary capacities to achieve broad and diversified growth from a foundation of competitive costs, distinctive quality, and market-responsive product and service offerings. These deliver stability, peace of mind, and value to the nearly 50 million people we serve while contributing to the growth of our business. You'll see these and other consumer-centric approaches embodied in new innovative benefit offerings, such as the Colorado Doctors Plan, Bind, Motion, Care Bundles, Nexus ACO, short-term limited duration offerings, and many others.
These benefit offerings are the entrée to high-performing healthcare on an integrated, systemic level, enabled all the way across by intelligence and supportive technologies, deeply aligned and accountable to achieving quality outcomes and efficient use of healthcare resources. Which in turn is accomplished through incentive designs that engage consumers and their doctors to take responsible Next Best Actions to get to the highest level of proven clinical interventions, and all of this while simplifying how people shop, schedule, receive, and pay for care. We apply these same designs and concepts in growing our global business, particularly as we deepen our abilities in South America. There, our integrated delivery systems, primary care models, and progressive use of information and technology are serving the unique needs of the people of Brazil, Chile, Colombia, and Peru.
Collectively, these are just a sample of the efforts we have underway to bring better value to society one person at a time, one health system at a time, through our deeply engaged and diverse workforce of nearly 300,000 colleagues around the globe. Firmly centered in a culture with the values of integrity, compassion, innovation, relationships, and performance. This exceptional and ever-expanding business model will yield ever-improving returns for society and a long-term earnings growth rate averaging 13%-16% per year for shareholders, including initial guidance squarely within that range for 2019, following per-share adjusted earnings growth rates of 27% in 2018 and 25% for each 2017 and 2016. As always, we will place particular emphasis on investing for the future each year in the next decade. Driving measured growth, structural cost containment, distinguished NPS, and sustained market-leading returns and transformational impact to society consistently year after year.
This would not be possible but for the substantial investments we make organically and through business combinations to serve the growth needs of the business three, five, and seven years out. This is a restless company, engaging now in transforming healthcare with a clear view of the future and with the resources and experience to evolve to achieve greater levels of healthcare value for people. Our strategies and capabilities are not founded in a single piece of isolated technology, a database distribution system, care capacity, funding mechanism, or any other narrow view of what it takes to make a durable and meaningful difference in healthcare. Rather, they reflect a deep understanding, market presence, capabilities, trusted relationships, and alignment to standards of performance people want and need from their healthcare. Better quality outcomes, meaningfully lower total cost of care, and higher levels of consumer satisfaction.
We are profoundly grateful to have this opportunity to help lead the transformation of healthcare for those we serve and to drive distinctive returns for both society and for you, our shareholders. Thank you. Now let's take a look at how we're executing on those objectives through our businesses, starting with UnitedHealthcare, led by Steve Nelson. Steve.
Thanks, Dave. Good morning. It's great to be with you again. I'm really grateful for the opportunity to represent the entire UnitedHealthcare leadership team and for the opportunity to share just a few of the ways UnitedHealthcare is becoming a more personalized healthcare company that delivers even greater value to the people that we serve. Our work is guided by our mission to help people live healthier lives and to help the health system work better for everyone. As we pursue that mission, we're creating long-term, sustainable growth by helping advance both social and economic well-being. We deliver upon these needs for the people, businesses, and governments that we serve through our relentless pursuit of the triple aim, better health, lower costs, and a distinctive, more satisfying experience. Let me start with better health.
We work with more than 1 million healthcare professionals and 6,500 hospitals to make sure people get the best care at the lowest cost. Doing that well requires both a sophisticated and a practical use of data. Every day, we translate fragmented data sources into simple-to-use information for both consumers and care providers. We're part of the healthcare information flow, and we can influence performance across several dimensions of the health system end to end. We use that data to identify health status, articulate the next best health action, and close gaps in care. For example, we've already closed more than 70 million gaps in care in 2018, up from 40 million last year, alerting people and their physicians to care they need, sometimes before they know about it.
Every time we close a gap in care, we improve health outcomes and help people lead their lives just a little more fully. At UnitedHealthcare, the next big advancement in using data to drive better health outcomes is in the individual health record or IHR that you heard Dave talk about earlier. This first-of-a-kind, fully integrated, and fully portable medical record will be created for 50 million consumers and accessible to 1 million care providers by the end of next year. We see a significant opportunity to harness not just the volume of data available, but the context and meaning of this data to deliver insights and recommendations to both consumers and clinicians. The IHR uses proprietary technology to marry individual pieces of health information spread across many platforms and databases and translates all that data into a smart, digitally accessible medical record.
A traditional electronic medical record focuses largely on streamlining internal business processes for facilities and medical groups. The IHR connects numerous EMRs, creating a unified and a secure source of truth for both consumers and care providers and unlocking the value of data that's currently trapped in today's fragmented healthcare system. That means that consumers have a much more complete personal picture of their health needs. Accessed through Rally, the IHR makes collaboration with an individual's care team more informed and management of one's own healthcare journey simpler. It also empowers care providers with connected, credible information at the point of care by enabling them to see a patient's interactions with other clinicians. We believe that the IHR will become a valuable workflow tool that helps healthcare professionals deliver exceptional care.
The powerful insights generated by the IHR will also connect directly to our Nerve Center, which is a virtual data hub that operates like a command center. Data from a wide range of wearables and connected devices continuously feed into our Nerve Center along with claims, clinical, and lab information. Boosted by machine learning models and algorithms, this gives our people real-time information and alerts and prompts quick action. We use the Nerve Center to manage chronic conditions, flag gaps in care, and be more predictive in the care needs of our Medicare population. We're just beginning to expand its use across all of our businesses. The IHR and Nerve Center are transforming our role from care administration to care navigation and real-time intervention, helping us become trusted partners to consumers and care providers.
Another way we're personalizing care is by putting data directly into physicians' hands right at the point of care. About a year ago, we launched PreCheck MyScript in partnership with Optum Rx. PreCheck is really building momentum and is proving to be a useful advancement for consumers. It provides real-time information about the drug options available to them and compares the cost of each drug based specifically on their benefit plan and formulary. This all happens while they're still in the doctor's office. By embedding the tool directly into a provider's existing workflow, we're creating a simple experience that gives patients and their physicians greater certainty about both costs and coverage. Our initial results show using PreCheck has led to physicians choosing a different, oftentimes lower cost drug about 20% of the time when an alternative is offered.
This means fewer surprises for consumers at the pharmacy counter and lower costs, saving on average about $80 per member on each prescription filled when an alternative is selected. Early data also show improved medication adherence rates. By the end of 2020, we expect 80% of UnitedHealthcare network physicians who use e-prescribing will have access to PreCheck MyScript. Creating PreCheck is just the beginning of our efforts to provide valuable information and services to doctors directly in their workflow so that they, together with us, can create a distinctive patient experience. As you can see, using data to deliver better, more personalized care is translating into better health for the people that we serve. Based on a data review, we know that in the Medicare population, people are actually healthier with UnitedHealthcare than they are without us.
Supporting better health must be pursued alongside efforts to lower costs as part of the triple aim. We're expanding the market's focus from network discounts to a more holistic view of total cost of care, driving more value for consumers and plan sponsors every day. The opportunity is significant. We aim to reduce medical and operating costs by a material amount, billions of dollars over the next few years, helping address the nation's health care cost burden. Let's look at two examples of how we're catalyzing the shift. The first is expanding the breadth of our value-based relationships to help us better manage the entire health care supply chain. Our care provider relationships are important to us, built on trust and collaboration. Our partnerships are opening new ways of working together and are bound by a shared definition of value. Value-based arrangements can take many forms.
We've seen the best results in both quality and savings come from progressive value-based features that focus on total population outcomes. Five years ago, just 40% of our $28 billion in value-based payments to physicians and hospitals contained these progressive features. Today, we're at 60% of $72 billion. We're going even deeper by tying an even higher percentage of the rising total to mechanisms that align to better outcomes at lower costs. Effective commercial ACOs deliver 12% lower costs than non-ACOs, and over 16 million UnitedHealthcare members now access care from a value-based physician, which helps improve the health of the people that we serve. Value must also extend to other parts of the health care system like pharmacy, labs, and medical devices. We're seeing strong initial results in these areas, too.
After only one year, we saw 27% fewer preventable hospitalizations among people with diabetes who use our preferred insulin pump. Using value-based arrangements as a foundation to create greater accountability among care providers will forge more connected care journeys for people. This deeper level of care coordination will come to life through a locally managed continuum of care, decreasing inpatient stays and unnecessary readmissions, improving people's health outcomes, and simplifying transitions between care settings. Transitions that span primary care, acute and post-acute care, all the way through to rehabilitative and home-based services. For example, among our Medicare participants, more than $4.4 billion in annual medical costs are associated with post-acute care. This places a big emphasis on better coordinating care once an individual leaves the hospital. Likewise, in our commercial business, we see that outpatient care is delivered in suboptimal settings nearly 20% of the time.
Helping both consumers and care providers identify and locate the best site of care presents an opportunity to reduce medical costs by nearly 10% over the next three years among commercial members accessing these suboptimal settings. Outpatient and post-acute care are just two of the many opportunities we have to make a transformative impact on the quality and the cost of health care. The third dimension of the triple aim centers on creating a distinctive, more satisfying experience for both consumers and care providers. When something is distinctive, people are more likely to go out of their way to choose and to be loyal to that brand. Achieving distinction in health care will require considerably simpler, and more personalized interactions and greater ease and support accessing care. This is not just talk. Real actions, real information, and real consumer-responsive tools.
UnitedHealthcare's digital strategy is a great example of how we're building a more distinctive experience. In our commercial business, we're using innovative new digital onboarding capabilities that make both plan selection and enrollment easier and more intuitive. Tapping into the power of the Rally platform, digital onboarding guides individuals at the time of enrollment, and it enables people to select relevant clinical wellness and financial programs that cater to their personal health goals, such as pregnancy support, behavioral health, and weight loss. This includes programs like Real Appeal, which is supporting weight loss with powerful results by using an engaging digital platform that produces participation rates up to six times better than traditional disease management programs. As you can see from the results, it's changing people's lives by lowering the conversion to diabetes, saving costs, and advancing loyalty with those that we serve.
We're also stepping up our support during the most confusing times for patients, care transitions. Our Navigate4Me program for Medicare beneficiaries embodies that commitment. Optum nurses are embedded with our UnitedHealthcare customer service reps, giving seniors in Medicare Advantage plans a single point of contact for their entire episode of care. We're helping people as they battle cancer, end-stage renal disease, diabetes, and many other conditions. For example, our navigators can ensure physical therapy and needed medical equipment are in place before a senior is sent home from the hospital. They also secure transportation to doctor's appointments and review coverage and expected costs with people, again before an upcoming medical procedure.
The compassion that our employees show in each and every interaction creates deeply personal and caring relationships with the people that we serve. Anticipated results from our Navigate4Me program include a more than 10-point NPS lift, more than 100 basis point increase in retention, and a solid ROI driven by a reduction in medical costs. This high-touch service has helped over 200,000 individuals with complex needs in 2018, and we expect to double enrollment in 2019. Navigating healthcare today is about so much more than just medical care. 80% of what influences a person's health happens actually outside of the doctor's office. That's why we're redefining what constitutes healthcare by removing social barriers such as transportation, food, and housing. Data on the Medicaid populations we serve confirm that people who are homeless require more healthcare.
It also shows that when the homeless have access to stable housing, their health is managed more effectively. Because of this, we're partnering with states to help build more affordable housing for otherwise homeless people across the country. Our work together in one community is addressing unmet health needs and has reduced total cost of care for the individuals accessing our housing by more than 50%. Our transportation management service is helping people to get to the care that they need. Working with Optum, we have a deeply local network with thousands of community health workers, care coordinators, and clinicians who provide personal support. In the last 18 months, hundreds of thousands of the people that we serve have self-identified social barriers to care during these visits. By gathering and analyzing this information, we can more easily identify referrals to community agencies and government programs.
UnitedHealthcare has provided over 560,000 referrals to critically important social services valued at nearly one-quarter of a billion dollars for these individuals. It's creating a much stronger relationship with UnitedHealthcare, including NPS scores in the 70s, and it can help drive better outcomes and lower costs. One small example, Medicare enrollees with end-stage renal disease who lack transportation to their dialysis appointments are being connected to a rideshare service, reducing hospital admissions and life-threatening complications and cutting up to $5 million in avoidable medical costs each year for just this small group alone. The ability to recommend and track these types of referrals is such an important advancement that we've already begun working with the Federal Government to create a standard method for capturing social determinant data. This way, all health plans and care providers can document and use this information to support people's health beyond just traditional medical needs.
I've now covered UnitedHealthcare and how it's achieving the triple aim across all of our businesses. I'd like now to turn it over to my colleague, Dan Schumacher, President and Chief Operating Officer, who'll share a few innovative approaches to the development of new products and services. Dan will also provide a brief strategic overview and our 2019 performance outlook for each of our businesses. Dan?
Thank you, Steve. Good morning, everyone. Our commercial and government customers tell us they want products that are flexible, simple, and cost less. We are designing innovative solutions that deliver upon these needs and will fuel long-term growth. Through the ongoing investments we have made, our UnitedHealthcare Community & State business created an innovative high acuity care model that pulls together unique competencies across Medicaid, Medicare, and Optum. States are looking for plans that can effectively help care for the complex needs of this population. By combining advanced data and analytics, such as hotspotting, with the thousands of on-the-ground care coordinators Steve spoke of earlier, the traditionally fragmented system across medical, behavioral, and social is better integrated and is better serving the complex needs of this population. The high acuity Medicaid participants we serve through this model consistently score a 70 or higher in NPS surveys.
UnitedHealthcare has a unique competency to support this population while achieving cost savings for our state partners. UnitedHealthcare is also designing new products that are challenging the traditional commercial insurance market by bringing a fresh consumer and provider-centric point of view to health benefits. In January, we will introduce a new benefit product initially for self-funded employers designed entirely around the way people use the healthcare system, on demand. This innovative health insurance model is far simpler for consumers than conventional plans and delivers much greater certainty and clarity of both coverage and costs. The plan, called Bind, was built by asking the two questions people care about most with their healthcare benefits: Is it covered? How much will it cost? There are no deductibles or co-insurance, only co-pays.
Consumers essentially shop as they go, paying a much lower monthly premium and additional cost to receive flexible coverage options as they need. We think this new offering will appeal broadly to healthcare consumers looking for more price transparency and greater affordability. Next, let's take a look at how we're also driving innovation outside the U.S. In our Amil business, we are reshaping outpatient facilities into community health centers. In a country where people often turn first to higher cost hospital-based services for care, these health centers are driving more coordinated care and lowering costs through greater adoption of primary care services, favorably impacting our medical cost trend. We expect to double the number of people using these services in 2019. When the full assets of this enterprise are working together, we can drive meaningful change for the people we serve, which produces sustainable growth.
That includes partnering closely with Optum to provide consumers with a high value and better connected healthcare experience. Optum makes its services available to everyone in the markets it serves, but no one is integrating their full continuum of offerings at the local level as deeply or for as long as UnitedHealthcare. The unique value of this relationship is one of the driving forces behind our consistent market leading growth. Now, I'd like to turn to UnitedHealthcare's business performance and our 2019 outlook. As an enterprise, UnitedHealthcare has grown to serve an additional 16 million people in the past eight years. Over the last three years, we have grown by 50% or 1.7 million people in Medicare Advantage, over 850,000 people in group fully insured products, and more than 1.3 million Medicaid members.
In 2018, the business produced strong underlying revenue growth with the return of the health insurance tax having only a modest impact. Expected 2018 revenues of over $183 billion will have advanced $20 billion or 12% year-over-year. This strong enrollment in revenue growth translates to operating earnings of $9.1 billion, an advance of more than $600 million year-over-year. We see significant opportunities to grow as $1 trillion in annual U.S. healthcare spending is not in managed care today. Let's now take a closer look at our performance at the business level, starting with our domestic commercial business. We like our strong position, but we know there is more work to do to demonstrate the distinctive value we can bring to customers in this well-established market.
Today, our employer and individual business provides health coverage to nearly 27 million people and serves over 250,000 employers, large and small. This year alone, we added 25,000 new employer clients. Annual revenues are approximately $55 billion. More than half of all Americans get their health coverage today through the employer-sponsored and individual market, and this remains a very important sector. We will grow with an aggressive strategy focused on reinventing, transforming, and diversifying the commercial benefit space. That is why you heard Steve talk earlier about doubling down on total cost of care. Reinventing how we tackle medical and operating costs will be critical to winning in this market. We are thinking differently about the design of our products and our relationships with care providers and consumers. Because consumers' preferences for convenience, fast service, connectivity, and price transparency will upend the traditional healthcare model.
This transformation requires meaningful investments in digital capabilities that cater to these preferences. New product innovations that give consumers greater control over cost and coverage decisions will change the traditional insurance market. We will further diversify ways we can serve people through our commercial business by greatly expanding into sectors where we only serve a small part of the market today. This includes our specialty benefits business, which has become an integrated medical and specialty carrier with a whole person approach to care coordination, connecting eye care, dental, and hearing services, and financial protection products. We are also partnering with national consultants and local chambers of commerce to serve the new association health plans. We already have experience serving 16 association style plans today, and we expect to more than double the number of plans we participate in by the end of 2019.
Turning to our commercial 2019 outlook, we expect continued profitable growth in our employer fully insured business of up to 150,000 people, including growth in group fully insured offerings for the fifth consecutive year. Our employer self-funded enrollment is expected to return to modest growth next year. We expect a commercial net medical trend outlook in the range of 6% ± 50 basis points. This outlook reflects unit cost increases of around 4% and utilization of approximately 2%. Across our health cost categories, we expect trends to be relatively consistent. Employers who choose to take advantage of our full capabilities can see meaningfully lower trend rates with medical costs held flat or increasing in the low single digit %. Medicare continues to be one of our strongest growth stories.
We operate the largest business dedicated to the health needs of seniors and other Medicare beneficiaries today, serving nearly 12.5 million people or one in every five seniors. Annual revenue is expected to exceed $75 billion in 2018. We have accounted for more than 50% of total Medicare Advantage industry growth the last three years. In Medicare, we are focused on smart growth, a distinctive experience, and a more deeply personalized care model. This will allow us to offer competitive, attractive plan options in a program that is rising in popularity as 10,000 people turn 65 every day. Nearly five million of our Medicare members are in either group or individual Medicare Advantage plans. We deliver Medicare Advantage benefits at an average cost that is more than 20% lower than original Medicare. With our best-performing markets, 30% lower.
More than 90% of our Medicare Advantage members in 2019 will experience no increase in their premiums despite adding new benefits and increasing access to senior fitness and wellness services, virtual visits, and transportation for medical appointments. This is a population seeing a rise in the burden of chronic conditions, which calls for a more deeply personalized approach to supporting their care needs. Among our own Medicare members, 78% are living with one or more chronic illness today. You heard about the individual health record, Nerve Center, and Navigate4Me. These capabilities will create a distinctive experience and help our Medicare beneficiaries live healthy lives so they can spend less time in the hospital and more time at home with family. More than 50 million people nationwide will have a choice of multiple plans from UnitedHealthcare in 2019.
We are concluding another very successful open enrollment period, we expect our recent strong growth trends to continue, adding up to 450,000 people in Medicare Advantage in 2019 between individual and group offerings. In Medicaid, supporting people with complex care needs is our top priority and one of our biggest growth opportunities. Community & State currently serves 6.6 million people in 30 states and the District of Columbia and has annual revenues of nearly $45 billion. As Steve said, these individuals require high-touch, compassionate care, and help well beyond just medical needs. There are two key developments driving our Medicaid growth opportunity. First, states continue to face tremendous budget pressures. Spending on Medicaid is growing on average 5% a year, yet state revenue is growing less than 3%.
Second, 25% of the Medicaid population has multiple illnesses and face barriers to good health, representing about 50% of total Medicaid spending. These people generally are not served by managed care today. States need to find a way to control spending while at the same time serving the growing needs of an increasingly complex population. This is a group UnitedHealthcare is uniquely positioned to serve. For example, we are piloting a direct care model for people with higher acuity needs that is physician-led and delivered in a setting most comfortable for the individual, oftentimes at home. By having the physician guide interdisciplinary teams to create a single holistic care plan, we think we can reduce total cost of care for these individuals by 30%, the early results are encouraging.
We have seen a 44% reduction in inpatient admissions and 33% reduction in ER visits among people served by the direct care model. You also heard about the investments we are making in housing. For our Medicaid members in Arizona and Nevada who we placed in our housing, we saw emergency room admissions drop by 60%. Enrollment in our higher acuity plans has grown by nearly 20% annually since 2014, giving us the opportunity to bring our expertise in care management, data, and analytics to states and care providers across the country. We believe we've only scratched the surface of this growth opportunity. In Community & State, we anticipate growth of up to 150,000 individuals at the top end of our outlook.
Continued strong growth in dual special needs plans, expansion into markets like Alaska, and organic growth in markets is projected to produce growth of 300,000 to 350,000 people, offset by additional entrants in places like Iowa, Mississippi, and Nevada. Since 2014, we added more than 450,000 individuals in our dual special needs plans, growing to serve more than 750,000 across UnitedHealthcare. Finally, more than half of healthcare spending happens outside the United States, approximately $4.4 trillion, we serve less than 1% of the non-U.S. market. There is much to be learned from other countries' health systems and much we can offer to them. Grounded in an operating model that we like to refer to as think global, act local, we are well-positioned to bring our enterprise assets to individual countries and their people.
Today, UnitedHealthcare Global serves 6 million people with medical benefits and 2 million people with dental benefits. It also directly provides care to patients through 55 hospitals and approximately 225 clinics and ambulatory centers. Including the services provided to multinational employers, our health and well-being solutions span 130 countries. Annual revenues are approximately $10 billion. Each country's health system differs, most face similar challenges: access, affordability, and quality outcomes. UnitedHealth Group is well-positioned to bring the coordinated assets of its enterprise to these global markets and take what we learn abroad in both benefits and care delivery and apply it here in the U.S. In UnitedHealthcare Global, we anticipate health benefits enrollment growth approaching 150,000 individuals in 2019, with organic growth in Brazil as well as Chile, a market we entered through our Banmédica acquisition earlier this year.
We continue to see meaningful advancements in our performance over time through medical cost management, through the complexity of care provided in our medical facilities, and continued focus on operating efficiency. We tie all this together at the UnitedHealthcare enterprise level, we have a very strong foundation to build upon in 2019. Focusing on creating more value for consumers while mitigating costs for those who pay for care, we will continue to drive strong growth with a range of 700,000-1.2 million additional people in 2019. Revenues are expected to be $195 billion-$197 billion, advancing nearly $12 billion-$14 billion with growth across all four of our UnitedHealthcare businesses. Strong growth in enrollment and revenue translates to expected operating profit in the range of $9.8 billion-$10.2 billion, reflecting growth of 8%-12% year-over-year. We enter 2019 with momentum and optimism.
We have big ambitions for our company and for the contributions we can make to the healthcare system. We remain focused on serving one person at a time as a deeply personalized healthcare company. Our vast resources and capabilities are powered by the passion of our employees and will help advance both the social and economic well-being of those we serve. Better outcomes, lower costs, and a distinctive, more satisfying experience. That is UnitedHealthcare. Thank you for the opportunity to review this ambitious agenda with you today. Steve and I would like to invite our colleagues on stage for Q&A.
The survey says you love Q&A. We've got expanded Q&A this morning. We're going to start with a segment here with UnitedHealthcare. We've got four mic runners. Who would like to appear, please? Can't see with the lights. It looks like it's A.J., as my eyes adjust.
Trying to be incognito there. I want to pick up on something that Dan said in his comments. Your commercial cost trend is 6%, but if people took advantage of the full array of everything United has to offer, it would be flat to low single digits. I'm curious, what are the deltas that get you from 6% to low single digits to zero even, when someone adopts the full array? Tell us a little bit about the discussion you have with employers and why they don't choose to pursue that.
Sure. Thanks, A.J. As we think about our trend, the guidance that we provide, obviously, how people approach that varies carrier to carrier because there isn't a common definition. What we endeavor to do through our trend guidance is really to show what is our core trend, then we work to normalize that over time so that you're really looking at the underlying consumption and use patterns and changes in that. If you actually looked at our trend on an absolute net effective basis that incorporated all of our product mix and so forth, you would see a number that's materially lower. In terms of the relationship between our core trend and our net trend and some of the things that drive differentials, obviously, decisions around product attributes are critically important.
If you think about whether or not an organization is willing to narrow a network, if they're willing to have a gated product feature that orients around primary care initially, how they think about addressing out-of-network reimbursement, whether or not they're willing to put their employees in certain circumstances based on the programs that they're willing to support. All of those things contribute to differentials between what a core trend would be and then what a net realized trend would be on an employer basis.
Maybe just to follow up, if I could. Given the strong economy and almost no unemployment or very little unemployment, are you seeing employers in your commercial discussions start to get worried about putting more and more cost-sharing on employees yet? Is it still business as usual?
I think it's a broad range of answers that are unique to each company and each market segment, frankly. Obviously, on the lower end of the continuum, there's more sensitivity to price as a principal buying criteria. As you move up in the market, they value other things beyond that. As the labor market has tightened, depending on the employer, there's more or less willingness to have greater participation on behalf of their employees.
Dan, some of the product innovation is around affordability, some of the things you referred to in your speech.
Yes, absolutely. We are seeing nice take-up as people look to take advantage of some of the innovations that we're making. I think Dave and myself both referenced a few of them. Surest is one, our Colorado Doctor's Plan, our UnitedHealthcare NexusACO offering, which stitches together our highest performing ACO partners across the country, Primary Advantage. Those are some of the examples of products that people are interested in and taking advantage of, either introducing alongside a more traditional offering or in a full replace capacity.
Becky, how about here, Anna?
Yeah. Hey, thanks. Following up on the medical cost trend, can you give us a sense for your projections or scenario planning for a potential recession, both on trend and then membership growth along offer rates and moves and shifts to Medicaid as well from commercial?
Jeff, any economic projections?
I'm not going to go there. Our trend outlook is based on what we currently see as economists looking into 2019. That's about all I'd offer on that.
One follow-up, if I may.
We had a Medicaid piece of that, and the question about Medicaid, did that relate to the, Anna, to the enrollment in state programs?
Yes. That's correct. I think some of the Medicaid plans have been projecting lower growth. Might that actually spike growth? Yeah.
If people come out of Medicaid into the workforce.
Heather?
Sure. As we look at the Medicaid programs across the country, we see variation state by state, but generally, we see our state customers, and we talk to a lot of our state customers looking at things just like that, preparing for how to serve more individuals with limited state budgets. You heard us talk about that today, where we see the cost of healthcare increasing. We think we're well-positioned across those states to, as individuals may potentially in a recession shift to Medicaid, to be able to serve those in flexibility around benefit design, how we make sure that we're looking at the total cost of care and really driving value for our customers. I think we've seen those ebbs and flows over the years. As we look at Medicaid reform, we're prepared for as those individuals may shift in.
We think that we're uniquely positioned to be able to serve those members with unique capabilities between Optum and UnitedHealthcare. I think whether they're in the commercial line of business or they transition into Medicaid in a recession, we're able to serve them with our unique capabilities.
I would just add on the Medicaid population, there's several ballot measures about expansion. There's new governors. There's a new outlook, I'd say, on expansion and appetite to look at that again. I think that's an opportunity, in addition to different kinds of populations with more complex conditions. It's well-recognized at this point that it's a better way to serve them and manage Medicaid. States are also looking. There continue to be growth opportunities in the Medicaid area outside of what I would serve clear core economic drivers as well. It's more almost about care and managing a limited state budget.
Thanks so much.
Thanks. Someone over here, please. There's a hand up, Fran. Looks like Peter.
Thanks. My question's really for Brian. Brian, when we look at your projection for Medicare Advantage growth for 2019, sort of between 8% and 9%, compare that to this year where it's sort of 12%. You're projecting a lower growth rate in Medicare Advantage in a year when the health insurance fee is going away versus coming in a year when the government is projecting a faster growth rate. Can you talk about what's going on in the commercial, I'm sorry, in the competitive environment in both group and in the individual space that's causing you to be so much more conservative in your projection?
Sure. Thanks for the question, Peter. We're really encouraged and pleased with our positioning for our growth in 2019. I think it signals another really strong year, really the fifth strong year of growth for us. As I said at our last conference call, I look at the long-term industry growth rate really to reflect itself inside 2019. We've suggested more an 8% to 9% growth rate for the industry overall. We do believe that our positioning here in growth in 2019 will contribute some share gain. I think a point of context that I want to provide for you is as you actually look at the organic individual growth inside that range, in 2019, it's actually more growth in organic individual in 2019 than it was in 2018. We had an acquisition in Louisiana.
The growth in the group pipeline was a little higher, about 50,000 higher in 2018. As we've talked about before, that's a little more varied from year to year. Really pleased. A stronger advance in what you suggested is a more competitive environment, which we are optimistic about for the industry wide. Feel really good about our positioning as we look to 2019.
To be 100% clear, accelerating growth in 2019 on individual retail Medicare Advantage.
Yes. Year-over-year, we see that accelerating from about 300,000 in 2018 to 300,000-350,000 in 2019.
Thank you. Leslie, do you have someone over there? Right behind you.
Good morning. It's admittedly off a small base, can you talk about the impact of utilization mix on cost trend given United's initiatives to roll out primary care and ambulatory clinics and telemedicine? I guess how do you anticipate that impacting MLR and utilization over the next handful of years?
Steve, do you want to start that?
I think it's a valid point as we think about how we're moving care from the inpatient setting to outpatient and a variety of settings that I think we do. Our ambition is to drive down the cost of the trend, and we've talked about going after total cost of care. That's really how we think about it. You have to put what you just said in context of total cost of care approach, and that would also include how we think about value-based arrangements with our providers, too. I think all those things working together, our ambition is to reduce the total cost of care and bring down trend. I referenced by billions of dollars in my remarks. That's how we think about it.
It's pretty hard at this point to put a number on that exactly, but we're ambitious about it, and we recognize that need and that opportunity. I think we'll continue to talk about this and keep you updated as we go through that process. Anything to add?
One area I'd just add is to the point around total cost of care that Steve made, and inside that, a really important focus area for us to your good question around site of service and where things are happening and how care is shifting and underlying consumption patterns underneath that. Site of service is a clear focus for us. As you look in the commercial business as an example, the reality is there's about $22 billion of unwarranted variation associated with the site of care. We are aggressively going after that and going after it in many different ways, ranging from product features and attributes through reimbursement structure as well as incentives.
One incentive program that we put in place that's had some powerful results is in partnership with Optum, and goal trying to orient around moving surgeries that can more appropriately be done in an ambulatory setting. Moving over to SCA and other like ASC facilities. As a result, we've been able to drive savings of about $5,000 on average per surgery, and then we're able to importantly reinvest some of that savings back into the surgeon's comp so that we're actually becoming the highest payer for people that are making the right choices in healthcare, which is our ambition. All right. Let's squeeze two more in. Becky, if you could get Lance, and Brenda, if you could bring it up for Josh, please.
Yeah. Question on sort of an economic downturn follow-up. For Medicaid, if you're looking at 2019, I appreciate the guidance you gave, how would you look at 2019 contrasted with maybe a multi-year outlook? What I'm interested in is the impact on expansion opportunities of high acuity growth, et cetera. The other aspect of that is, were we to enter into an economic downturn, how do you see, and this is more probably for Dan and Jeff, how do you see commercial medical costs reacting to that, given the fact that you've got Affordable Care Act protections in place? You've got preexisting conditions, you've got safety net programs that maybe didn't exist before. Just interested in if you see commercial acting as negatively as maybe it would in prior downturns. That's it.
There was a lot there, Lance.
Medicaid outlook.
Yeah.
How does commercial act in a recession?
Heather, why don't you start?
Sure. Actually, I think you said it well. The way I think about it is, put a recession aside, we're already seeing changes in Medicaid, right? We're seeing them today. We're seeing individuals, we're seeing the high acuity individuals that we talked about today, increasingly moving into managed care. That's a result of, again, state budget pressure and the fact that all the services we talked about today are very difficult to provide in a fee-for-service environment. We see states moving those more complex individuals into managed care so we can provide those social supports, the housing, the transportation, and the integration with behavioral health. Then from the expansion standpoint, as Steve mentioned, we saw a lot of activity in this election cycle.
Whether it was by ballot or whether it was change in administration and governor, they might be more sympathetic to a Medicaid expansion. I think when we think about 2019, what we see is a healthy pipeline. We see it through procurements in new business and re-procurements of existing business. We see them carving in these additional complex populations. I think expansion's going to take some time to play out because a state takes some time to move that membership in. You may not see that. I don't know that we're going to see that specifically in 2019. Then I think as we look at a recession, again, as I mentioned before, we're sort of prepared for however our state customers are looking for us to serve those members.
Let me drill that all the way in. When I hear that, what I think to myself is revenues grow faster than membership because of mix shift towards higher acuity populations.
We're already seeing that today, where we're seeing revenues because these high acuity individuals are high revenue, but also high need and high touch.
Dan, commercial?
Sure. I've gotten that question in the context of do people use before they lose? Is there a surge or do you see a decline because people are concerned about having to seek employment and not wanting to go through an elective procedure, as an example, leading into that, as well as how do the social systems that we've now got in place that provide a greater safety net for people and less need to perhaps consume before they leave. Put it all together, if you look back to the last recession and what happened, we saw medical costs decline pretty dramatically, right? Then they've stabilized off. They leveled off for a time.
As we think about it, there may be some use before people wear off, but at the end of the day, the savings associated with lower consumption because people are sharing a greater burden of the cost and having to deal with deductibles and so forth. The net of that is lower ultimate costs in the end.
last question. Brenda, up here front, please.
Hi, thanks. Question really for Dan on the commercial side. As you think about benefit design changes, it feels like there's been a little bit of a slowdown in that pace of change that you've seen in employer groups, maybe even a plateauing of deductible changes, et cetera. I'm curious what that does for the UnitedHealthcare business, and then, as you think about the future, I know you mentioned Surest as a good example, what are the next set of tools or ideas or thoughts around how you're going to help your employer customers and partners really continue to bring down trend?
first question, in terms of what we're seeing, changing the obligation of the underlying employee and the shift in increase in deductibles year-over-year, that's relatively consistent. The pace of change of that has been stable. The way that we've been able to address employers that want to make different buying choices is really extending our product portfolio along that price value continuum. Creating compelling high-value options at lower price points for people, things that some of them I mentioned earlier, like a Primary Advantage, which is one that really emphasizes high-value access points to the healthcare system, de-emphasizes those places that are less value, and then creating an overall higher value proposition without necessarily having to change deductibles and so forth at the pace you might have expected to get that kind of outcome.
As we look forward, you think about our complete customer base and so forth, we've got an amalgamation of consumer-directed and high deductible back through open access and HMO and even some indemnity. It spans a broad continuum, and I think the next evolution for us is how do you get certainty around people's obligations as well as what's going to be covered. Surest is a great example of how we're trying to address the uncertainty that comes with co-insurance and some of the other traditional levers that reside inside the benefits. A real emphasis around higher value access points in partnership with high-performing care providers. The Doctor's Plan in Colorado is one example, and we can happily go talk about many of these this afternoon in the employer and individual seminar, too.
I'm going to broaden this answer just a little bit because we've got a lot of commercial employers in Brazil. That's a U.S.-centric answer. Molly, how are people in South America, I got to broaden myself from Brazil, how are employers in South America looking at value and what are you doing to advance value in the commercial benefits marketplace in South America?
Thanks, John. We really see some of the same powerful drivers that Dan talked about with modern product designs. Those are actually our healthiest and fastest-growing products throughout Brazil, which is broadly an employer market. That's really a buying off of value type of decision. There we have a really powerful competitive advantage in our owned delivery assets. We'll take those modern product designs and integrate them with both our owned hospital high acuity care resources as well as an increasingly broad care coordination model really built off of our primary care centers. In that, we're offering employers and individuals more value, and that has been the healthiest growth part of the market for us and more broadly.
Thank you, Molly. Thank you for UnitedHealthcare. We're going to move to the next segment, Optum. You guys. Introducing Andrew Witty, Executive Vice President of UnitedHealth Group and CEO of Optum.
Good morning. It's a privilege to speak with you and to represent Optum at this conference for the first time. What drew me to Optum was the inspiring way our talented team of 150,000 professionals lives our mission to help people live healthier lives and help the health system work better for everyone. Thanks to their dedication and hard work and our growth momentum continued throughout 2018. I'm delighted today to confirm we're on track to meet our commitments for the year with revenue of more than $101 billion and earnings of $8.1 billion. Looking ahead to 2019, we're projecting to grow to between $111 billion and $112 billion in revenue and between $9 billion and $9.2 billion in earnings. We believe we're well positioned to continue growing for many years to come. Today, the addressable U.S. market for Optum is over $800 billion.
Through our broadening set of assets, we have the potential to impact much of the over $3 trillion U.S. market for healthcare in the future. We also see opportunities to leverage our assets in similar ways across the world, greatly expanding our long-term addressable market. I'm pleased today to discuss how Optum will make the most of our opportunities and achieve our full growth potential. We branded our business Optum seven years ago and have spent about two decades before that developing a distinctive set of core capabilities, and these capabilities remain critical to our future strategic direction. It starts with a foundation of data and analytics and the deepest proprietary data sets in healthcare. These are continually integrated, enriched, and organized to help consumers, patients, providers, and plan sponsors make better healthcare decisions. We call this Optum IQ.
Second, we bring deep clinical expertise, including as a leading provider of ambulatory care across the U.S., with strengths emerging in several geographies to manage the full health of patient populations. In pharmacy, we're bringing increased clinical acumen to over 65 million consumers, including a dedicated effort to manage high-cost specialty drugs. This year alone, we will manage about $40 billion in specialty drug spend, an increase of $5 billion since 2017. We are dramatically expanding the proportion we directly dispense to patients. Along with our growing footprint in local care and pharmacy services, Optum Insight extends our presence inside the system with a third core capability, embedded technologies that hospitals, health systems, and benefit sponsors use to move critical information and make the system more interoperable.
As we serve every part of the system with these capabilities, we aspire to improve experiences and outcomes for everyone we serve while reducing the total cost of care. It's a critical focus considering the challenges facing healthcare broadly over the next decade. We all know the U.S. population is aging, today, 86% of U.S. healthcare spend is generated by people with chronic disease. By 2030, the number of people with three or more chronic conditions will grow to 80 million, up from 30 million just in 2015. The average cost of care for these patients is seven to 14 times higher than in those who are non-chronic. These are very sick people, but fortunately, there is a growing surge of new specialty treatments and drugs to help them. Unfortunately, these treatment and drugs come at very high prices.
In 2017, one-third of pharmacy industry spend was generated by specialty drugs. Estimates now show that that will grow to almost half of all spend by 2020. Today, we help our customers address their challenges through an array of services and solutions. We increasingly view these as components that we can now further integrate to more comprehensively serve and impact the future of healthcare. By bringing our components closer together, we'll deliver the full potential of Optum to the marketplace. We're starting to do just that around three major opportunities we have to impact the total cost of care over the next 10 years: reinventing local care delivery, advancing chronic care management, and transforming pharmacy care services.
There may be no better place today to see our potential at work than in our most advanced Optum Care delivery groups, where we take full financial risk for patient populations and deliver exceptional results. Our locally branded WellMed practices in Texas and Florida manage both patient care and risk for 370,000 Medicare patients. That is up by 220,000 over just four years. Care is led by primary care physicians who take a holistic approach to coordinating each patient's care journey with a focus on proactive preventative medicine, especially for those with the most acute need. Clinical information is connected and integrated around the patient to inform and guide decision-making. WellMed's approach raises the bar on health outcomes and cost savings. In our Texas practice, the number of inpatient hospital admissions is 42% lower compared to traditional Medicare in the Southwest Central region.
Last year, 95% of patients said they would use WellMed again, satisfaction further indicated by an extraordinary NPS in the high 80s. These results reflect the high-quality personal care each patient receives from their WellMed care providers. In addition to WellMed's success with Medicare Advantage patients, we are also proving this approach works across commercial fee-for-service populations. Riverside Medical Group in northern New Jersey serves 230,000 patients, 70% of them are from commercial plans. In 2017, Riverside ranked number 1 in New Jersey for lowest cost per patient among larger medical groups. The progress of WellMed and Riverside and other more mature practices provides valuable learnings we are applying across our entire Optum Care network. Increasingly, our practices connect with other Optum capabilities like House Calls, Optum Insight analytics, and connectivity points, of course, Optum Rx pharmacy care services.
This gives us natural leverage points to improve the clinical performance, this model will be further enhanced as we continue integrating to deliver greater transformative impact. We recognize, though, that the medical group is only one part of a local care system, we are excited to realize our potential to create state-of-the-art local ecosystems in select markets across the country. This is how we are working to reinvent local care delivery, with data-informed advice embedded in the clinician's workflow and organized with far less administrative burden. At the same time, we expand at the local level. We have a nationwide opportunity across all of our customer channels to advance chronic care and more comprehensively help patients improve their overall health. This will support the goals of both our own care practices and those we serve across the system.
Care providers and benefit sponsors of all kinds, most importantly, patients will benefit from this. We will leverage Optum IQ to provide insight and options for clinicians informed by more comprehensive data, including genomics, behavioral insight, and real-world evidence. With the benefits of the individual health record platform that Dave described earlier becoming increasingly central, we will guide chronically ill patients to condition-specific end-to-end compassionate care along their journey and use advanced technologies to dynamically update care plans, ensuring we always direct them to the Next Best Action. We will continue to invest in building out our expertise in artificial intelligence and advanced technologies to put more actionable insight into the clinician workflow. Make no mistake, this is hard to do in a fragmented system, we are making strong progress.
A growing number of hospitals and clinics use Optum Performance Analytics to help them provide the most effective and appropriate patient care. Our Next Best Action tool helps Optum nurses ensure the sickest, costliest patients get the attention that they need. It delivers analytics-driven insight we use to engage patients and their care providers in the best path forward, helping close three times more gaps in care than traditional approaches. Again, this approach will be critically enhanced through the development and rollout of the individual health record. Through Optum technologies, we are already directly connected with over one million healthcare professionals within provider organizations. Today, most of those connections improve administration. Increasingly, we plan to use them to help provide guidance directly to clinicians as they care for their patients.
Through these existing Optum pipes, today we provide insight on ER visits, hospital admits, medications, diagnostic imaging, lab results, and more. We expect demand will grow as we move forward to deliver even deeper clinical support information. With these advantages, combined with learnings from our more advanced Optum Care markets, we'll be able to deliver superior patient cost and outcomes for broader populations. Already today, we take condition-specific risk in behavioral health, transplants, skilled nursing patients, and musculoskeletal, to name just a few. But in the future, we envision taking direct responsibility for care of patients, including risk on the financial and quality results across a much broader array of chronic disease. There's never been a more dynamic time in the pharmacy space during my 30 years in this industry.
In this environment, Optum is strongly positioned to help manage chronic disease and the total cost of care through rigorous management of high-cost specialty medications. During the past five years, we have built out an innovative pharmacy care services model focused on achieving the lowest net drug cost, synchronizing patient experience across pharmacy, medical, and behavioral, and driving simplicity for the over 65 million consumers Optum Rx serve. We take a much more clinical and connected approach than traditional PBMs, creating a holistic view of a person's health needs using our deep data sets and, of course, analytics. This helps us to effectively intervene at the pharmacy over the phone or through digital devices and guide people to resources that improve prevention and adherence, close care gaps, and improve overall wellness.
Previously, we have shared how this approach helps our clients realize savings of approximately $130-$190 per member per year, depending, of course, on the scope of Optum Rx capabilities they use. Today, clients who have fully adopted our synchronized programs are achieving medical cost savings of $240-$300 per member per year. Nowhere is this approach more important than in the management of specialty drugs most prevalently used by chronically ill patients, especially when you consider the rising cost of these biotherapeutic agents. The development of our BriovaRx business, along with the addition this year of Avella Specialty Pharmacy, deepens Optum Rx’s capabilities for serving the needs of chronic patients through improved access to limited distribution specialty drugs, particularly in oncology. Infusion is one of the most complex and expensive procedures, and site of care has a major impact on patient experience and cost.
We give patients the option of receiving these treatments at home, which contributes to our infusion program's overall Net Promoter Score in the high 60s. Optum Rx and Optum Health are in the early stages of a new effort to deliver infusions at select MedExpress care centers. Alternate sites bring savings potential of 30%-50% per infusion when compared to a hospital outpatient setting. We are also working across the drug supply chain and the health system to realign the interests of everyone involved in the decisions impacting pharmacy care. Importantly, the drug manufacturers, care providers, sponsors, pharmacists, and consumers. This includes pursuing new and innovative pricing and risk-based contracting models.
You should expect to see us pilot some of these new approaches during 2019 as we aim for a long-term balance between needed pharmacy innovation and the ability of consumers to benefit from that innovation at a fair price. We also note new regulatory approaches that signal openness to using proven private sector tools to drive savings for government-supported benefit plans. Our pharmacy and specialty expertise can provide significant value in Medicare Part B. You can get a sense of why we believe Optum is in a well-positioned situation for growth in the years ahead, especially when you think about our capacity to drive greater affordability by integrating our distinctive capabilities and deploying them more broadly.
When you think about how we can create a better performing system by leveraging our data and touchpoints to deliver superior results, both through our local care delivery organizations and broader national customer relationships. I've laid out a broad aspiration for Optum. There are many challenges ahead before it all becomes a reality, and it can only happen in collaboration with everyone we're privileged to serve and partner with. We're committed to this path and look forward to aligning and applying our capabilities to their fullest potential. As we do, we intend to expand on Optum's track record of revenue and earnings growth. Finally, advancing a more integrated Optum will allow us to provide a simple, lower cost experience for consumers one person at a time.
That's why the Net Promoter Score is so important, because it keeps us accountable for the experiences we provide and deliver to the 125 million people that we serve. They deserve nothing but the best from us. The people of Optum are all in. They're energized to improve the performance of the health system, and I'm energized by the spirit that they bring to our mission. Because the execution and performance of our operating businesses are critical to fulfilling that mission, our CFO, Timothy Wicks, will highlight our progress and results for 2018 and share in more detail the outlook for next year. Tim?
Thank you, Andrew. I'll provide a brief overview of the financials for our three businesses today, Optum Health, Optum Insight, and Optum Rx, including how they have continued to advance our mission this year. The expanding capabilities and innovations of these businesses are foundational to the vision that Andrew just laid out. I'll finish by tying all of the financials together for you. Through Optum Health, we engage consumers to help them achieve better health, manage complex conditions, and receive high-value care through the growing Optum Care ambulatory care platform. One of the ways we track our progress is by looking at the number of unique consumers we serve, as well as the revenue we generate per consumer. As we look ahead, more growth will come from increased revenue per consumer. Optum Health expects to end 2018 with 93 million consumers served, with average revenues per consumer increasing 11%.
In 2019, we project growing the number of consumers served to 95-96 million with increasing average revenue per consumer up 11%-14%. Optum Health has continued to advance the value it delivers to individuals, care providers, health plans, and benefit sponsors on both the local and national level. Andrew spoke to the growing impact and potential of Optum Care, and today we serve over 14 million patients through primary care practices, surgery centers, urgent care, hospitalists, and nurse practitioners. Optum Care currently has 36,000 aligned physicians and 8,000 advanced practice clinicians. In the past five years, we've more than doubled the number of care providers and expanded the number of payers we work with from 20 to nearly 80.
In 2019, we will continue to advance the value-based ambulatory care, leveraging the superior performance and best practices of our most mature local physician groups, and increasingly, the data and technology of Optum Insight in serving multiple payers and their members through global risk-taking arrangements. For Optum Medicare Advantage members, 99% are in 4-star or better plans for the 2019 payment year. Looking forward, the pending combination of Optum Care and DaVita Medical Group will bring together two leaders committed to compassionate, coordinated, value-based care. We continue to develop our capabilities in managing post-acute care, which offers meaningful opportunities to substantially improve outcomes and reduce the total cost of care. By applying artificial intelligence to our big data, we are optimizing post-acute site of care decisions and driving a 10% reduction in hospital readmissions.
This year, we also partnered with Sound Physicians, a growing 2,500 physician practice that manages care for patients in hospitals and post-acute settings. Sound gets patients home earlier and healthier, decreasing the length of hospital stays by 15% and saving more than $13,000 every time a patient avoids readmission. For millions of consumers across the country, Rally continued to emerge as a digital front door. Providing consumers with simple ways to access health information and healthcare when they need it is core to Optum's strategy and vision. Rally has grown to 21 million users during the past year, providing a capable digital foundation for deploying future innovations. Through House Calls, we will make 1.4 million home visits this year to help patients stay on their care plans and close gaps in care, including closing nearly 2.2 million gaps in care for Medicare Advantage participants.
More holistic patient care is one key to better health outcomes at lower cost. Optum Behavioral Health is expanding access to mental health services with a growing network of 190,000 care providers and options including virtual visits. In 2018, they added 92 new clients and half a million consumers. Through these examples and many more, Optum Health plays a critical role in the strategy and aspiration that Andrew laid out. Today it is just scratching the surface of the current market for the U.S. market opportunity for its products and services. Turning to Optum Health's 2018 performance and the outlook for next year. In 2018, Optum Health's expected 34% operating income growth rate is driven by an anticipated 18% increase in revenue to $24.2 billion, combined with a 120 basis point improvement in operating margin to 10.1%.
For 2019, we estimate Optum Health revenue will grow 14%-18% to a range around $28 billion, with operating income increasing 17%-21% to a range around $2.9 billion, and an operating margin between 10% and 10.7%. Optum Insight leverages our deep proprietary data, now encompassing nearly 240 million lives, spanning claims and clinical and analytics to deliver powerful services and solutions that make the health system smarter, more efficient, and more interoperable. As you know, contract revenue backlog is a key metric we use to assess sales performance and gain visibility into future revenues. We will carry strong growth momentum into 2019. At the end of this year, we expect Optum Insight to have a revenue backlog of $17 billion, a year-over-year increase of over 13%. Next year, we project growing this backlog to $18.5 billion-$19 billion, growth of 9%-12%.
Last year at this conference, we had just combined with The Advisory Board, adding significantly to our relationships with health systems nationwide. As planned, The Advisory Board has expanded its impressive research and its advisory capabilities from its core provider base into the payer and life sciences segments, and it is contributing to the customer value Optum Insight provides. Optum360 continues to simplify administration and the revenue process for four out of five hospitals and their patients. For those who use the full suite of Optum360 services, we now manage $65 billion in annual billings. We are actively investing in the future and expanding capabilities in leading technologies, including artificial intelligence tools like neural networks, machine learning, deep learning, as well as blockchain and genomics, all with a focus on reducing the total cost of care and improving health status.
Optum Insight is the engine behind solutions like Next Best Action, as well as our work to embed critical insight across administrative and clinical decision points in healthcare. Looking ahead, we see sizable growth opportunities in the healthcare analytics, technology, research, and consulting marketplace. In both the technology showcase and seminars today, you will gain more insight into how Optum Insight solutions and services power much of the distinctive value produced across UnitedHealth Group. In 2018, Optum Insight revenue is forecast to grow 13% to $9.1 billion, and we expect to generate $2.2 billion of operating earnings, up 22%, with a 23% operating margin that expanded 180 basis points in 2018. This reflects strong growth, a continued mix shift to higher margin technology products, and cost discipline.
In 2019, we expect Optum Insight revenues to increase 10%-15%, to a range of $10 billion-$10.5 billion, with $2.4-$2.5 of operating earnings up 11%-16%, and an operating margin between 22.9% and 25%. A closer look at Optum Rx, which uses the consumer's most frequent touchpoint, pharmacy, to align their pharmaceutical and medical needs. Through 250,000 consumer interactions each day, we advance our aspiration of improving experiences and outcomes for everyone we serve while reducing the total cost of care. One way we track the progress of Optum Rx is the volume of adjusted scripts. For 2018, we expect the total adjusted scripts of 1.335 billion, growth of 3% from one year ago.
In 2019, we expect adjusted scripts of 1.37 billion-1.39 billion, up 3%-4% in a market that is flat. Through our point-of-sale discounts, plan participants realize meaningful net cost savings averaging nearly $150 per utilizer per year. In 2019, we will support these pharmacy discounts for approximately nine million members. Steve Nelson mentioned PreCheck MyScript and how it makes prescribing drugs simpler for doctors and patients and more cost-effective. After launching with UnitedHealthcare in 2017, we have introduced it to other health plan clients across the country, including Independence Blue Cross and its nearly one million plan members. You heard Andrew also refer to our expanding value-based arrangements with drug manufacturers. We pay for drugs that work, not for the ones that don't. We currently have 17 such arrangements covering drugs that treat some of the most serious conditions, with more arrangements in development.
We also continue to invest in our own pharmacy channels to expand fast, convenient home delivery of medications, just as consumers have come to expect in the digital retail environment. In addition to adding Avella Specialty Pharmacy this year, Optum Rx combined with Genoa Healthcare and its more than 400 pharmacies in behavioral health centers across 46 states. This will help us better meet the needs of people with behavioral health and substance use conditions and help the payers we serve further reduce healthcare spending. While expanding its impact and capabilities, Optum Rx continues to add new customers while also retaining existing customers and serving them at higher levels of quality. As we consider the health system needs and opportunities that Andrew spoke about, Optum Rx remains strongly positioned for continued growth and market leadership.
In 2018, Optum Rx expects year-over-year revenue growth of 9% to $69.3 billion, and we forecast $3.5 billion of operating earnings, up 14%, with an expected 5% margin driven by strong growth from our own pharmacies and our services businesses. 2019 Optum Rx revenues are expected to grow 7%-8% to a range of $74 billion-$75 billion. We expect operating earnings of $3.7 billion-$3.8 billion, up 4%-7% year-over-year, with an expected 4.9%-5.1% margin. I'll close now with our Optum-wide performance estimates for 2018 and our outlook for next year. As Andrew shared, we expect total revenues of $101.2 billion for 2018, up 11% year-over-year, $24.2 billion from Optum Health, $9.1 billion from Optum Insight, and $69.3 billion from Optum Rx before eliminations. This is growth of 18%, 13%, and 9%, respectively. Our operating earnings are expected to reach $8.1 billion, up 21% year-over-year.
This reflects both the continued benefit from our scale, an improved mix of business, and the significant progress we have made in our cost control programs. You can see this in our operating earnings growth and in our 8% operating margin estimate. Looking to 2019 now, we will further integrate our core capabilities in data and analytics, clinical expertise, and embedded technology to more comprehensively serve our customers and modernize the health system. We will also continue to drive greater internal efficiencies, which has been a priority for the last several years. We expect to continue making progress on our internal cost and efficiency discipline, and that impact is reflected in our guidance ranges. We will continue to pursue external growth opportunities that are tightly aligned to our mission and aspiration, with strong discipline around the returns on the capital we deploy.
Next year, we expect total revenue in the range of $111 billion to $112 billion, an increase of 10%-11% over 2018. We expect our 2019 operating earnings to grow 11%-13%, to a range of $9 billion-$9.2 billion. As we continue to execute on our mission across Optum, we look forward to expanding on our contributions to the health system and society and building on our growth momentum for many years to come. Thank you again for your time today. Andrew and I will now welcome our colleagues up to the stage to take your questions.
Thank you, Tim. Let's start over on this side of the room. Tom. Fran. We've got a couple people right here.
Thanks a lot. Good morning. Just one question on Optum Health. I think the business outlook, well, not necessarily 2019, but I think long term, depends a bit on M&A, I see why that would be necessary to grow that to, I think, the size and scale you guys think about long term. Could you give us a general sense how regulators are evaluating M&A? How do they look at market share by sort of provider, nature of the service, or how are they thinking about the interplay with UnitedHealthcare? Anything on that front just to help us wrap our head around the long-term outlook there.
John?
Yeah. I think our focus is providing value to the people that we serve. That's something that we bring to any conversation, whether it's a regulator of that nature, regulators of others, customers on any dimension. In those conversations, we strive to demonstrate the value that we deliver to people. There is
A terrific opportunity to continue to grow these businesses. They are small, actually, in the scope of the U.S. health system and the global health system. I don't think we feel foreclosed on M&A in any fashion. Next question, please.
Thanks. Just on the M&A piece, could you just help break out organic versus inorganic at Optum all in, and then just give us a sense if DMG is included or excluded in that number, or timing around that? Thanks.
As we look at both in 2018, and you look at our growth rates in 2018, it's a pretty insignificant difference in terms of organic versus the additional growth from inorganic. As we look at 2019, very similar story. Inorganic and organic are essentially right on target with one another, and there is no estimate in 2019 for DMG in the guidance we've provided.
Our forecasts for all parts of UnitedHealth Group include revenues from transactions which have closed. There is no projected closure in any of our revenue figures, and the transactions that have closed over the last 12 months are fairly modest in size relative to our revenue base, which is why throughout the company, the numbers are pretty well on top of each other. Another question from the far side of the room. Okay, we'll rotate back over here. David in the front row, please. Becky? Thank you.
Hi. Thank you. After a period of fairly intense finger-pointing at the pharma supply chain in the debate around drug pricing, it seems that CMS has actually afforded PBMs or the pharma care service providers some opportunities for leveraging their skill set, Part B and Part D. I'd be curious what you believe the current kind of discussion state of play is in Washington about PBMs and the supply chains' role in drug pricing, in bringing in drug pricing.
Yeah, I'll ask John to add a couple more comments in a second. Clearly, like you, we're watching carefully as various pieces of information, guidance, proposed regulatory changes start to emerge from the administration. We've seen that kind of moving through this year. I think as a general point, I would say that they are creating a potentially positive environment for us to be able to use the tools that we know work in parts of the government book of business, which historically have been closed off from those tools, Part B being the most obvious example of that. That, I think, is really centrally critical for ultimate cost control of the U.S. marketplace because there is so much of a shift in the underlying volume of patients because of aging, because of chronicity, into exactly that space.
If that part of the marketplace doesn't become a more competitively priced environment, we're storing up enormous challenges for the system going forward. As we look at those things coming from government, we're encouraged, and we think we can play a very useful role in that process. I think actually it demonstrates the way in which a PBM like Optum Rx has really evolved its capabilities to be a very multidimensional contributor to trying to manage costs down. John maybe add a couple of comments to exactly how we do that.
Sure. I think overall, we share a common objective with the administration around the concern on drug affordability. We share objective around trying to drive to a lowest net cost and improving total cost of healthcare. Through the process over the last few quarters, we've been able to share our perspectives with legislators, regulators, and administration around the tools that we can bring to the table to help address those same concerns. I think there's more openness to figure out how we leverage those tools that we've done so successfully in the commercial market into the government space. I think there's a lot of opportunities as you look at site of service, as you look at using step therapy and other types of tools in the Part B program, looking at aggressive tools around how you look at having one drug versus two drugs in a category. I think there's a lot of opportunity for that, and I think there's additional potential for our business.
Quick follow-up. Can I follow up on that real quick, John? On the point-of-sale rebates, I think you're moving to point-of-sale rebates for your insured population in 2019, and in prior comments you said you were maybe a little disappointed in how your employer customers didn't follow that as aggressively as you thought. Have you seen any movement on that?
I got to broaden that. UnitedHealthcare is a customer of John Prince's. UnitedHealthcare adopted it. You make it broadly available on the market. Can you take it from that context?
Sure. We've been advocating for passing on the rebate value at the point of sale for consumers for a year and a half in that process. In 2019, we're going to have 9 million members that will actually have access to that, and the value that is delivered from a consumer perspective is about $150 per eligible member per year. Significant value, good uptake. I think 9 million we're very pleased with.
Thank you. Any question back over here, please?
Thank you. Could you talk about the split that you expect in 2019 between the externally generated revenue and the internally generated revenue, the inter-segment revenue. Maybe we can see the eliminations at an overall level, but how do we think about that distribution changing or maybe staying the same across the different Optum segments?
I would say across the segments, it's in the high 30s as far as what the external revenue generated is. You've seen as Optum Health grows, what we would expect to see is the externally generated revenue would continue to grow accordingly. I would say, with respect to Optum Rx, had a few nice health plan wins. A lot of that will be reflected in terms of our external growth. I see it continuing to grow across all three segments.
The only thing I would add is, as I look at 2018, each of the segments will be growing at double-digit external revenue growth rates, and we'd expect that to continue in 2019.
Thank you.
Back here, please, Brenda. Sarah?
Thanks. If we look at the Optum Health guidance on the high end, it looks like up to 60 basis points of margin expansion, and the PMPM growth rate is 300 basis points higher than last year's growth. Pretty impressive there. Can you talk about the drivers? How much of that is the new initiative on connecting specialty medical mentioned in the first section? How sustainable is this? Is this an initiative that's like a one-year step up, or should we be seeing accelerating growth in margins and top line?
Go ahead.
We're pleased with the margin performance in Optum Health in 2018 and looking into 2019. Our long-term guidance remains in that 8%-10% range, and you're going to see fluctuations. It's really a balance. We make investments as we bring on a medical group or open a de novo surgery center or urgent care clinic or stand up a new government program through Optum Serve, so there are investment cycles. As markets or programs reach maturity, they have higher margins. There's also a balance between our risk-based business and our more fee-for-service or ASO business that have different margin profiles. We'll expect it to fluctuate, and our long-term guidance remains in that 8%-10% range.
Thank you. In the back, please. Can't quite see who that is. Maybe Sean?
I shouldn't have said in the back. It's Gary Taylor, JPMorgan.
Hey, Gary.
I was really intrigued by the comparison between WellMed and Riverside, where you showed a pretty similar reduction in hospital utilization. It kind of turns on its head this concept that MA should be a much more target-rich environment because of the overall utilization pattern. One, could you tell us where that opportunity is that you were highlighting in the commercial population at Riverside? The second part of the question is, as many of the other health plans are trying to advance value-based care initiatives on their own, are those efforts always complementary to what your practices are doing, or are they sometimes get in the way?
Sure. Gary, I think Riverside is a great example in the fee-for-service market where there's an enormous opportunity for value improvement that's very similar to what we do in a senior population with something like a WellMed, which you're probably more familiar with. It has to do with having a value-oriented medical group that's going to think more about proactive preventative care, spending more time with the chronically ill, as Andrew and others have referenced this morning. It has to do with having a wider, more open access to be available as an alternative to going to the emergency room for care that's going to be appropriately delivered by the physician. It has a lot to do with appropriate referrals, and thinking very clearly about the specialists who practice evidence-based medicine and are going to practice in the right setting of care. Riverside's achieved great outcomes.
They're not the only ones within Optum Care. You're going to hear this afternoon, we have a seminar, and we'll feature New West Physicians and Dr. Ken Cohen, the CMO there, will talk about what we're doing in Denver, and many other markets. Gary, Medicare Advantage is a very structured and mature form of risk-taking. It's often an initial focus for us as we shift into global capitation. Our impact on admits, ER visits, and total cost of care, though, can be very powerful and commercial, and we have a variety of ways to get paid for that benefit we create.
Kevin here in the center, please.
It's the other Kevin. A couple quick questions on PBM. First, you talked about 4%-7% growth next year. I know you picked up a couple specialty pharmacies, I think it was in the third quarter, via M&A. I'm just curious if there was any other kind of key wins and losses that we should be thinking about there behind that 4%-7% growth.
Overall, we've had really strong growth this year. We've had almost 9% growth in 2018. That's all organic. That is strong sales, strong retention. Maybe look over the last three years, we've had net retention in the 98% and higher. Over that period of time, we've had a strong sales season. As we look into 2019, we've been a net winner in the market. We've retained our clients, and we've also had some significant wins in the health plan space, in the government space, in union space, and also some marquee wins in the employer space. We're going to have some good momentum in the external sales. Also in the owned pharmacies, like specialty infusion, we're growing about two to three times the market. We're actually having good tailwinds from that perspective. That's our expectations as we go into 2019.
If I could just follow up here for a second. On the margin side, it's been a while since I think Optum has given updated targets on growth and margins by segment. The last I remember on the PBM, I think, was 3%-5%. You've been operating close to the high end of that range or at the high end of the range for the last few years. Just curious if there's any update to that margin target, or do you think this is a reasonable run rate?
Timothy Wicks, maybe?
I can take it, unless.
Sure.
No, the margin targets that we've historically published, 3%-5% in the PBM, 8%-10% in Optum Health, 16%-20% in Optum Insight. Those targets are set. As time goes on, we said this before, we'll continue to see investments as we grow for the future, and those margins will fluctuate up and down. As far as updating our margin targets, we won't be doing that.
Last question for this segment to Peter, please.
Excuse me.
Actually, if I can squeeze in a couple here. The first one on Optum Insight, the backlog's slowing down a little bit in terms of the projection. Is that a slowdown in longer term contracts or shorter term contracts? Then the second question is on the clinic business, the urgent care business. We've seen an explosion of urgent care centers over the last five years, and you guys have great growth in MedExpress participating in that. Some of that business comes from physicians as opposed to just emergency rooms. How has that impacted your view on capital allocation to buying doctor practices versus building urgent care clinics?
I want to start by refreshing the numbers. If I was watching your presentation, I think backlog's up 13% this year.
Right.
Nine to 12% for next year.
Right.
Correct.
Okay.
Correct.
Thank you for the question. With regards to our backlog performance in Optum Insight, we're actually quite pleased with how the year has played out. Double-digit growth rate every quarter year to date, forecasting to complete the year at $17 billion of backlog, as you pointed out. It's important to note that $17 billion of business that we've been able to generate. If you look at the composition of that backlog, it represents pretty much the broadest portfolio of the capabilities that we bring to market within Insight. Everything from revenue cycle management to our state government business, the work we do for health plans around payment integrity and risk and quality work. Really a nice healthy representation of the portfolio of our business, principally driven off of managed services to answer your second part of your first question.
While we do have wonderful success selling our core technology products, it's really the managed services, those longer-term contracts that fuel the bulk of that backlog growth.
I'd say more broadly on your capital allocation question, we're going to continue to invest and expand our pharmacy care services platform. We're committed to our care delivery platforms, SCA, as well as other local care delivery assets. We'll continue to invest in Optum IQ data and analytics to be able to bring that value proposition alive in the marketplace, to be able to have our products be more usable and more intelligent for our customers to drive greater value.
Just to finish off that point and in the context specifically of the urgent care, I think we don't really see that as a zero-sum game in terms of maybe some business came from a medical group to urgent care. We see it much more as building out a network of contact points for consumers and patients to interact with us and develop a much more comprehensive geographic solution. Exactly the focus that you heard us talk about and drive toward. We think that will give us much higher ultimate leverage on total cost of care, releasing significant value. For us, we don't really look at it as an individual line. We look at it much more as the building up of a comprehensive set of offerings.
Thank you.
All right. Thank you, Optum team. We'll move to a UnitedHealth Group segment, putting this together, Executive Vice President and Chief Financial Officer, John Rex.
Well, good morning.
Good morning.
Yeah, that's totally not going to do it for me. Good morning.
Good morning.
Good. Great to see you all. Great to see you here. In about an hour, we'll be transitioning to our showcase. There, you're going to get a glimpse into some of the advanced technologies we're applying to modernize health systems. We hope these demonstrations provide you with a strong sense of the opportunities and potential we see for this enterprise as we look ahead to the next decade. Planning for the showcase caused my own thoughts to leap ahead. As a company, we're already far into the next decade, refining our strategy, navigating change, and laying a foundation for success in a rapidly evolving healthcare environment, even as we execute on the fundamentals today. In fact, the future is the real reason you've committed your capital to this enterprise.
While I'll get to the normal review of this year's results and next year's outlook, that's not really where I should be starting. Instead, let's jump ahead a decade and let me welcome you to Investor Conference November 2028. While the years have flown by, not a one of you looks a day older. Our revenues surpassed half a trillion dollars a few years earlier, and we're pleased to have achieved our long-term earnings growth target of 13%-16% over the last decade. Yet we still comprise a relatively small portion of total U.S. healthcare spend, and even a smaller portion globally. As a result, our growth outlook has strengthened and our momentum continues to build. There are now over 70 million seniors in the U.S., and over half are participating in Medicare Advantage.
UnitedHealthcare, with a strong focus on consumer satisfaction, growth, and retention, has a private Medicare business that is running north of $150 billion in revenue. Seniors in these programs have meaningfully better health outcomes. The number of regions in which our costs run 30% or better than traditional Medicare has expanded multiple times since 2018. Optum Care is $100 billion a year business. We made significant progress in building out local geographies with primary care-led, integrated ambulatory systems that remake the patient and caregiver experience with NPS scores well into the 80s. Operating margins now consistently run at or above the high end of targets. State governments are pleased with how we help reduce pressures on their Medicaid budgets and greatly improve the health of their people. The dual special needs population is now mostly in managed care, whereas in 2018, it was underserved.
Their healthcare deeply integrates with other social needs, such as transportation, nutrition, and housing, greatly expanding the addressable market. As a result of these expansive trends, the sector revenue growth rate has meaningfully outpaced membership growth over the past decade. For us, state programs are now more than a $100 billion a year business. Our share of the addressable market at well under 20% suggests continued room for significant growth. You'll recall that in the mid-20 teens, Optum began the transition from traditional PBM models to a pharmacy care services approach. Sitting here in 2028, that looks like a wise move. Specialty pharmaceuticals are a much larger component of the market. As a result of our early investments in precision medicine, our ability to deliver better outcomes and value to people greatly expanded.
We adopted and expanded the dispensing and healthcare hub model, which combines the best of physical engagement and e-commerce approaches. We deliver more medicines to our customers within one hour of prescribing than any other e-commerce company. Savings from our synchronized approach are far advanced from the levels we described to you back in 2018. Optum Rx as a business surpassed $100 billion a number of years ago. If you are a UnitedHealthcare employer customer, most of your employees now select premium providers whose outcomes are demonstrably superior and the total cost of care meaningfully lower. The traditional core employer market remains the largest single source of coverage in the U.S., high deductible plans have become less prevalent than a decade ago. Our individual and specialty benefits business is now multiples of where it was then with double-digit margins.
The Optum Insight knowledge and technology businesses continue to grow strongly. Our investments in artificial intelligence and machine learning are greatly expanding the impact for the global customers we now serve, regardless of a particular country's healthcare funding mechanism. Operating margins in this business continue to be among our strongest. Globally, the growth of the addressable market is strong. We are creating hundreds of billions in savings for these customers worldwide through the application of modern approaches and vastly more precision in how, when, and where resources are applied in health systems. We have continued to make measured investments outside of the U.S. since 2018. Our global business is now positioned to emerge as a more significant component of the enterprise for the next decade. Our leading positions in South America in both the care provider and the benefit businesses are consistent, still growing contributors in 2028.
Our learnings translated into creating opportunities to serve healthcare systems in other countries also. The overall global business is now multiples the size it was 10 years ago. As we reflect on the decade from 2018 to 2028, there are some other important ways in which we measure progress. We can demonstrate that if you are a UnitedHealthcare member or an Optum Care patient, you are healthier, your experience in the health system is better, and you spend less time in the hospital and less money than others. If you are an Optum clinician, you are more satisfied with your practice of medicine. You're spending more time with patients, and due to the greater value delivered, you earn more than clinicians in other practices. Our operating cost positions create measurable customer value.
Our NPS consistently averages over 70, and we see a quantifiable shift in customer and client retention and care provider trust. While the majority of growth has been organic, we continue to deploy capital into strategic acquisitions, utilizing a portion of the several hundred billion dollars in cash flow generated over this past decade. We've also continued returning capital to shareholders with a consistently growing dividend and share repurchase plan. Back here in 2018, I can tell you that this potential for positive change is what energizes our 300,000 colleagues today. It is in part why we know delivering on 2018 and '19 commitments is critical. None of the future we envision happens without strong execution in the present.
Let's take a look at where we stand today. We expect UnitedHealth Group revenues in 2018 to be approximately $226 billion, advancing by $25 billion or 12%. Total company operating earnings will grow 13%, with UnitedHealthcare rising 7% and Optum growing 21%. Adjusted net earnings per share approaching $12.80 will have grown 27%. We expect operating cash flows of $15 billion-$15.5 billion, about 1.2 times net income. These figures accommodate a range of timing for government program receipts. Our balance sheet remains strong. We ended the third quarter at a debt to total capital ratio of 38.9%, and our interest coverage ratio is about 14 times. Overall, while we performed well in 2018, we're not satisfied. The consistency of performance across our businesses isn't where it needs to be, and our overall execution must continue to improve quarter after quarter, year after year.
Looking to 2019, we expect adjusted earnings per share of $14.40-$14.70, an increase of 13%-15%. Expected top-line growth in the 7%-8% range produces consolidated revenues of $243 billion-$245 billion. For UnitedHealthcare, continued growth in Medicare Advantage is a key contributor. At Optum, growth at Optum Health, in particular the care delivery businesses and at Optum Rx, are among significant factors. We see Optum's unaffiliated or external business growing in the double-digit percentage range in 2019, consistent with its position of serving customers throughout the health system. We look for UnitedHealth Group operating earnings to rise 9%-12%, with all of our underlying businesses growing. Optum earnings are expected to increase 11%-14%, and UnitedHealthcare operating earnings are expected to rise 8%-12%.
For UnitedHealthcare, the pre-tax earnings year-over-year growth rate is moderated somewhat by the deferral of the health insurance tax. At some point over the course of 2019 and 2020, revenue and script count may be affected by the timing of any potential transition of the Cigna pharmacy business from Optum Rx. However, we do not expect this to impact our earnings outlook. The cash flow generating capabilities of our businesses remain strong. We expect to grow operating cash flows by about 15% to a range of $17.3 billion-$17.8 billion, about 1.3 times net income. We will continue to have a strong balance sheet and ample capacities. We expect to make major advancements on costs over the next several years. We're targeting billions of dollars of medical and operating cost reductions over a multi-year period, all with a sharp eye on NPS.
Cost savings will be invested as greater value for customers, advancing capabilities and innovations like those you will see today, driving further growth and high retention. The deferral of the health insurance tax in 2019 is a positive step for consumers. This tax adds billions in cost to the system and limits access and benefits for the most vulnerable Americans. We continue to advocate for its permanent repeal. The tax deferral does impact some key ratios in 2019. Removing tax-related customer billings from revenues effectively raises our medical care ratio by 140 basis points. Business mix and other factors partially offset this, producing a care ratio of 82.5% ±50 basis points. The tax itself comes out of operating costs, which is worth about one percentage point on our operating cost ratio, bringing it to 14.7% ±30 basis points.
Finally, the deferral of the nondeductible health insurance tax decreases our effective tax rate. As a result, we expect a tax rate of about 20%-20.5% in 2019. As I noted, our businesses will generate operating cash flows of $17.3 billion-$17.8 billion. Within this, we will invest over $2 billion in CapEx. Further, we will continue to deploy significant sums for organic innovation, much of this, which does not reside in CapEx. The list is long, and you heard a number of these referenced over the course of the morning. These investments are what position us to have the impact on the health system Dave described. As dividends are the purview of our board of directors, for this presentation, we show the current level of about $3.5 billion.
The dividend has advanced at a strong double-digit rate each year since we initiated at a meaningful level back in 2010. We expect to repurchase between $4 billion and $5 billion of stock during 2019, consistent with longstanding practice. Taken together, we expect to return to shareholders about 45% of 2019 cash flows from operations. The final important use of capital for us is strategic M&A. UnitedHealth Group has a long history of successful value-adding business combinations. Going all the way back to the 1990s, when a young Dave Wichmann was running the M&A group, not that I'm saying my boss is old, but we look for capabilities that can be leveraged. We bring through synergies in both growth and costs, we look for strong, well-managed businesses that are leaders in their industry segments, often with talented executives who want to stay and grow further with UnitedHealth Group.
During 2019, we will continue to make advances with the businesses we acquired this year. Early in 2018, we acquired market leader Banmédica, expanding our South American benefits and care delivery presence to Chile, Colombia, and Peru, countries with growing middle classes and government support for private healthcare. Next was our partnership with Sound Physicians. Sound is expert in managing acute episodes of care, bringing together interconnected disciplines, and optimizing site of care. We also combined with Peoples Health, a leading senior-focused and very high-quality managed care plan in Louisiana. Finally, we acquired Genoa and Avella. Both build upon the strong advancements we are making in our pharmacy care services model. Our acquisition of DaVita Medical Group has not yet closed, but when completed, will bring to Optum Care excellent clinicians, strong patient and payer relationships, and additional capacities in local markets.
You can expect continued capital deployment in the decade to come. The disciplines of how we use capital to deepen, diversify, and add value for the people we serve and for shareholders are highly developed and embedded in the DNA of this enterprise. In summary, we had a strong 2018 and are energized about the opportunities to serve, grow, and strengthen our businesses further in 2019. A sharp focus on the year ahead is a critical commitment. For us, the even greater motivation is achieving sustained multiyear growth in both serving people and in earnings and cash flows. I'll finish by taking one last look at that 2028 investor conference. Yes, we're still sitting here in this Sheraton ballroom. Not everything has advanced. We are still talking about how much there is to accomplish.
UnitedHealth Group will still look like a young healthcare company, and healthcare needs globally will still be great. This view of a better future and our commitment to positively impact health care are tangible for us. It's why we're here. It is the guiding force, honor, and responsibility for all 300,000 of us every day. We know it always has to start with one person, one customer, one partner, one investor at a time. That is the only way we can truly help people live healthier lives. Make health systems work better for everyone. Thank you. Now I'd like to invite my colleagues to the stage for the UnitedHealth Group Q&A session.
Thank you. First question up here to Kevin, please.
All right. You addressed most of my 2028 questions.
Thank you. Got that model cleaned up. 2038?
Maybe go back to Dave. In your prepared remarks, you mentioned that United's growing very well right now. Not every business that you have is operating at both the optimal growth rates and the optimal margins. Can you just maybe go through the seven business lines, if we put international as the fourth UnitedHealthcare business line, and go through each one and say which one, where you see the opportunity to accelerate your growth from where you're growing right now, where you see opportunity to show margin improvement from where you are right now?
Good question, Kevin. Thank you for it. It was multidimensional in the way I characterized it. As we think about NPS, we've made striking performance improvement over the course of the last 18 months or so. The place I'd like to see us improve even more, and I think you can see it in terms of the way the healthcare markets are evolving broadly, is around our consumer NPS scores. While we see them growing nicely in the area we want them to grow the most, which would be in clinical delivery and the places where we interact with consumers at the most sensitive levels, they're not even across the board. We see our greatest level of variation in NPS in that regard. Our teams are deeply committed to really addressing that concern overall.
Second place I'd say is really on growth. I mentioned this in our second quarter call where our growth is a bit uneven and frankly, there's just a little bit of frustration around us bringing our value proposition in particular to the large employer-based market where growth has evaded our company for the last number of years. This is why you see us getting after total cost of care initiatives in a much more dynamic way. You'll see that also in terms of our overall competitiveness on our operating cost structures as well, really to get after that market beyond just the innovative approaches that we've had in the past and also service offerings. In terms of our margin performance across our businesses, you saw the Optum ones.
They're spectacular. We're seeing very strong growth rates, and many of you are probably wondering what they're going to do now that they're at the top end of their ranges overall. I might suggest we'll continue to push on that as time passes. Very satisfied with the work that's been done. Frankly, in 2017 leading into 2018 and also throughout 2018, I think those businesses have done a very nice job of advancing. If you go into the health benefits business, I guess the place that I'd point out the most would be in our Medicaid offerings. If I had to be even more deliberate about that, I think we've done very well on the LTSS and dually eligible populations. We've struggled really with managing our margins on the TANF populations.
I don't think we're alone in that regard, but I think it is definitely an area where we need to see some improvement. Our teams have been working diligently on that for a good part of 2018, excuse me, and I think you'll see them continue to work that agenda throughout 2019 and get their margins restored to the level of expectation, that 3%-5% level that we expect that business to perform long term.
Thank you, Kevin. I see a hand in the back. It's dark back there. I'm not going to try to call by name.
Thanks. Scott Fidel. Question, John, just on the growth capital guidance for the $6.5 billion-$8 billion. Can you talk about how that would be biased between UnitedHealthcare and Optum, some thoughts around how that's weighted across the segments?
Sure. Over the past number of years, of course, what you've seen is there has been a bias of growth capital or M&A capital into a lot of the services businesses of the company. That's just where we've been focused, where a lot of the market has been, that has been the focus of it. I will tell you, though, as a company, when we think about growth capital, the businesses compete for growth capital. Every business leader in this organization has that as a significant part of their agenda and mission in terms of eye on the marketplace, eye on opportunities, and bringing those opportunities forward. There is a relative amount of healthy competition across the businesses for those. We evaluate them on total returns of enterprise. We evaluate them on how they can pull across the full enterprise.
I think a number of the combinations that you've heard about today, you can see clearly how they pull across multiple segments. Those are always very interesting to us, where we can expand growth opportunities across multiple businesses. In some cases, some of these you saw today impact both Optum and UnitedHealthcare businesses. Increasingly important place for us to put capital work. I will tell you, it's partly about where we are in the different development stage of these opportunities and how we evaluate them. I won't get over prescriptive, but it certainly has biased to services the past number of years, I would expect that to continue to be the case.
Okay. Could I just ask a quick follow-up just on the MA enrollment guidance as well, just in terms of how that would be split between individual and group in terms of the growth for next year?
Can we have a handheld for Brian Thompson, please?
Sure. Thanks for the question. That range of $400,000-$450,000, look at that at about $100,000 for the group business and the remainder of the $3,000-$350,000 in the individual.
Thanks.
Thanks.
Thank you. Are there any questions on this side? Up in the front, please. Thank you, Fran.
Mona Eraiba from TCW. Question to David about the Medicaid. I think you mentioned that the TANF margins are low. What was the finding over the last year when you evaluated the business? The other thing also related to Medicaid, it seems like that's the area that membership and more contracts are coming into it. I think it was mentioned in the presentation about the housing of homeless, et cetera. Is that separate payment from the contracts, or is it part of your contract with the states? How do you see the whole area of Medicaid evolving? Thank you.
Yeah. Sometimes we get paid for it. I'll just take the last part first, and then I'll take the first part last. Sometimes we get paid. It actually gets contracted for us. Sometimes, when we have frequent flyers to the ER or hospitalization, mainly to get a warm bed or a square meal, we're placing those individuals into affordable housing on a very deliberate basis. The intent there is to obviate the frequency upon which they access the ER as well as a hospital largely for shelter. It depends on the circumstances, but you'll see us do that both ways. In terms of the Medicaid market, it is robust. It is growing. We expect it to continue to grow, and as I think Heather nicely pointed out, we expect the market to continue to expand, but it'll happen over time.
Unlikely to see any further expansions in 2019, but as we roll into 2020, 2021, we may see additional markets begin to expand on a more robust basis. The key opportunity that we see in that market and where we, I think, perform the best is when we're responding to those with the most complicated conditions, the most complex, the dually eligible, the LTSS populations. We perform very well serving those populations financially, because not only do we provide a very strong value proposition to the state, but our clinical coordination capacities and our management of these conditions help the patient, as well as allow us to earn a suitable return on the work that we do. As it relates to TANF in many respects has become a rate-taking market.
There are arrangements whereby you have to be in TANF in order to be able to serve the LTSS and the dually eligible populations in a given state. Because of those dynamics, I think that the market has just lost attention to really making sure that they're balanced in terms of the way in which it earns return on all the populations that are served in Medicaid. What we're doing is we're just inserting greater levels of discipline. First and foremost, we recognize that our state partners are under intense pressure around their budget. We have to focus on driving more high-performance networks, stronger clinical programs, and things that help to manage costs as low as possible while providing strong quality and outcomes on behalf of the patients that we serve.
At the same time, we have to be strong advocates to ensure that the rates that we receive are actuarially sound and suitable for the work that we're doing. That's where you see us paying a fair amount of attention.
Yeah. Let's come back here to Justin.
Thanks. I have a question on the individual health record for David. A couple questions here. One, from a monetization standpoint, I know there's cost savings that'll clearly be associated with it, greater customer satisfaction, all that. Is there a way to monetize this, especially as members might move away from UnitedHealth Group, their employers might move away from it, does it port with them? Secondly, in terms of populating that health record, can you tell us about what you've heard from the provider community in terms of providing records into that, even other health plans as these populations move around that would potentially populate it? How is that going to work?
Yeah. It's a great question. We don't have all the answers to all those great questions at this stage. As you know, the health system is, I think Andrew described it's a challenging system, and in particular around movements of individual from one coverage to the next and from one doctor to the next. What we're trying to do is to begin to solve that problem. I think what you're going to get out of the IHR is a much more higher compliance to evidence-based medicine. I think we all know that there's a strong correlation between better outcomes and compliance with evidence-based medicine and lower cost. Hits two elements of the triple aim as we see it. I see it as a foundational element, and I try to keep it there, that it's a foundational element.
It's a contributor towards the other things that we do. I think it's an essential part of us driving a differentiated cost position and structure in the market, hopefully that allows us to grow and prosper our business at an even more accelerated pace. I do see us as being able to extend that into other areas over time. I'd like to leave it to the collective creativity of this group and us as well. As we pass through time, I think you'll see us enter into and find ways to really contribute to society as well as to grow our business as we evolve down on that journey. As it relates to whether this would be offered to others on a multi-payer basis, the answer to that is absolutely yes.
This is something that we designed because we think it has an opportunity to structurally change the cost structure and clinical outcomes that healthcare provides. Our intent would be to offer it broadly. We'll start with UnitedHealthcare and frankly, a number of the Optum Care entities as well, because that's the area we think it can demonstrate the greatest results. We'll begin to offer it over the course of time to other of our health plan and other payer customers throughout the U.S. and frankly, abroad as well.
Dave, I'm going to ask you, got any closing thoughts as we wrap this session?
Sure. Well, first of all, hopefully, this was a helpful session for you. We've spent about three hours here this morning trying to baseline you on UnitedHealthcare, Optum, and UnitedHealth Group as well. Hopefully you found that to be a good use of your time. As you progress throughout the day today, we move into a view of just some of the technological and service advancements that we've made in our business, these are things that will pay off well into the future of our enterprise. It'll just give you a sense of just a fraction of what we have underway across our business. This afternoon, I strongly encourage you to go to one of our eight seminars, because those seminars will deepen your understanding in areas of interest that you individually may have.
Hopefully, you also walked away with this being a representation of the 300,000 restless people at UnitedHealth Group. These people are deeply committed to achieving a mission, a mission that's very near to them, to helping people live healthier lives and helping make the health system work better for everyone. That two-part mission is a singular mission shared by UnitedHealthcare, Optum, and UnitedHealth Group, we aim to achieve it. The last thing I'd say is that on behalf of our board of directors who are in the front two tables here today and this leadership team, we thank you for your support. If you like what you see here on stage and throughout the balance of the day today, you can pat yourselves on the back as well because this is all part of your doing.
It's your capital, your support that allows us to do the things that we do, and we want you to know that we're very grateful for that support, as well as the number of insights that you provide us each and every day. Thank you. Thank you for your support of UnitedHealth Group. We look forward to spending the balance of the day with you today.
Thank you, Dave. Your capital, your support, and your surveys. The last thing formally here is the conference survey that comes out. We are very attentive to this. I am grateful for the high response rate that we've had in the past. Whether you're on the web or whether you're here in the room, you're going to receive a survey shortly, and we take into serious consideration the comments and suggestions that come in on that. The payoff for you for finishing that short survey is a 2019 investor conference that is responsive to your interests and needs. This closes the formal portion and the webcast. Thank you for joining us online.