UnitedHealth Group Inc is a US-managed health and well-being company. Optum is one of its subsidaries and is its most active subsidiary in the UK healthcare market and with NHS contracts.
Unitedhealth Group inc was founded in 1974, originally under the name Charter Med Incorporated, by a group of physicians and other healthcare professionals. In 1998 it became the UnitedHealth Group inc and reorganised its structure into a group of linked businesses. It created Optum in 2009; Optum is now also split into a range of companies from healthcare commissioning, to pharmacy services, to IT.
UnitedHealth Group inc is an American healthcare company, ranked 6th on the fortune 500. Although based in the USA, its subsidiary companies operate globally; in the UK its affiliate Optum provides commissioning support to the NHS, an opportunity first seized after the 2012 NHS reforms. Optum has been involved in many contracts since; of particular note is its position on the Lead Provider Framework for commissioning support. It has connections to multiple Commissioning Support Units (CSUs) including the South, West, and Central CSU and a contract worth £150 million in Thames Valley and Wessex, providing commissioning support to 18 CCGS.
Unitedhealth Group is divided into two platforms: UnitedHealthCare - for health benefits - and Optum - for health services. Put simply the first deals with physical health care, primarily in the USA and not currently in the UK. Meanwhile the latter is extremely active in the UK and deals with services such as commissioning and employment and locum workers.
There is much interest over the links between Unitedhealth Group and multiple British politicians and prominent figures in the NHS.
The most notable link concerns the current Chief Executive of the NHS: Simon Stevens. Stevens, who was appointed to this role in 2013, is British, but from 2004-2013 was vice-president of UnitedHealth. In that role he became a founder member of a US lobby group - the "Alliance for Health Care Competitiveness" - explicitly trying to use TTIP to force state-run health systems, including the NHS, to employ private health firms from the US.
Another figure with ties to both the UK public and American private sectors is Nick Seddon, who was Special Adviser for Health from 2013-2016. Only 4 months after leaving the government role he became Executive Vice President of Optum. A policy change made by David Cameron’s government in 2014 meant Mr Seddon’s move to the private sector did not need to be vetted for conflicts of interest by a semi-independent advisory committee, as was previously the case.
David Sharpe was NHS England’s director of commissioning operation for the central midlands sub-region until in 2015 he left to join Optum as Senior Vice President for Growth Strategy in the UK. He still works at Optum to this day, most recently speaking at the Health+Care Commissioning Show about Accountable Care. United Health Group already operates 26 Accountable Care Organisations (ACOs) in the US.
Former GP Martin McShane, director for long term conditions and mental health for a three-year contract between 2012 and 2015, left his career within the NHS at the end of 2015. He then joined Optum as chief medical officer for clinical delivery.
UnitedHealth Group has previously invested directly in the UK primary care market, running 6 GP surgeries in Derbyshire, Leicestershire and Camden, however it had a controversial tenure and faced a lot of opposition. In 2011 it left this market and sold all 6 - and its GP provider company - to The Practice Plc. UnitedHealth's new plan was to refocus its UK business concentrating solely on commissioning support; this led to a rebranding and Optum entered the market, self described as "a health services and innovation company".
Optum’s strategy is now focused on working within the NHS on commissioning, organisation and data analysis, including pathway optimisation and prescribing software. The company was heavily involved with several CCGs on the Quality, Innovation, Productivity and Prevention (QIPP) scheme in finding savings.
Optum is now pushing its services to Sustainability and Transformation Partnerships (STPs) for the development of accountable care systems/organisations.
According to its website, “We currently operate 26 accountable care organisations in the U.S., and are supporting sustainability and transformation partnerships in the U.K. to manage population health risk and deliver care as an integrated group of providers.”
The company notes that it will help its clients (i.e., the NHS) to:
“Improve population health programmes and processes for maximum impact on the health of patients
Redesign, innovate and adapt to the changing needs of the population
Improve services and reduce costs in operations
Implement and optimise significant technology platforms which empower and support them to succeed in today’s healthcare environment”
In 2015, Optum won a place on NHS England’s Lead Provider Framework (LPF) for commissioning support services. Optum offers several services through this framework, including payroll and HR support services; primary care IT and communication services; financial management and accounting; organisation development/leadership development; transformation and service redesign experience; community and patient engagement; and policy, research and evidence-based medicine protocol development.
Optum gained a large amount of work as a result of the Quality, Innovation, Productivity and Prevention (QIPP) scheme begun in 2010. Work has revolved around optimising care pathways and saving money.
Projects include ones with London Trusts to identify opportunities for improvement and savings, focused on pathways for multiple sclerosis (MS), coronary artery bypass graft (CABG), and overall patient quality improvements.
In April 2015 Optum was awarded a contract by Public Health Dorset to provide a single point of access for health and wellbeing services, to help reduce the prevalence of chronic and long-term diseases in the area.
The company has also been involved with several CCGs under its “quick wins” programme to help CCGs address in-year financial problems. Optum works with the CCG to identify savings within existing contracts. According to the company in April 2016, it identified over £1.6 million of immediate efficiencies for Milton Keynes CCG and in 2017 was running similar programmes with North Derbyshire and South West Lincolnshire CCGs.
Optum has a large number of contracts for commissioning support with CCGs and other NHS organisations, gained through its presence on the NHS England's Procurement Framework.
Thames Valley and Wessex
On behalf of 18 Thames Valley and Wessex CCGs Optum has been managing 16 London contracts since 2009. Optum now manages acute activity although previously, both acute and specialised activity referred into London was managed by the Optum commissioning team.
The approximate total contract value for this acute activity is £50.6m.
Herts Valley CCG
In April 2016, Optum was commissioned by Herts Valleys CCG to take on the contract management arrangements of a portfolio of 15 London acute providers valued at £50m per annum.
The first contract awarded through the NHS England Procurement Framework was awarded in September 2015. The £9m contract will last three years and requires Optum to provide the full range of support services for two CCGs: South Lincolnshire and South West Lincolnshire. The value of the deal is less than half the budget allocated to the CCGs.
In October 2014, Optum was awarded a prime contractor contract to run an integrated dermatology service for Bedfordshire CCG. The contract was for three years and worth just under £6 million.
As prime contractor, Optum sub-contracted the clinical work, but retained responsibility for the finances.