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Professor Christopher Leo

MAN 4720
25 September 2013
10-K Integration Project- Analyst Preparation Assignment: UnitedHealth Group Inc.
1. PESTEL Forces: Political
The Health Reform Legislation includes several provisions that will take effect on
January 1, 2014 and are expected to alter the individual and small group marketplace.
Although HHS issued proposed regulations in late 2012, these regulations are not yet
final. Key provisions include:(1) adjusted community rating requirements, which will
change how individual and small group plans are rated in many states and are expected
to result in significant adjustments in some policyholders rates during the transition
period; (2) essential health benefit requirements, which will result in benefit changes for
many individual and small group policyholders and will also impact rates; and (3)
actuarial value requirements, which will significantly impact benefit designs (e.g.
member cost sharing requirements) and could also significantly impact rates for some
policyholders. (UnitedHealth Group 10-K, 2012, Pg. 44)
The Health Reform Legislation is of great concern not only to UnitedHealth Group, but
also to the health care industry as a whole. Part of the reform has already taken affect, but
what is mentioned in this section is yet to be official. UnitedHealth Group anticipates an
alarming increase in costs due to the predicted changes in legislation over the next few
months and even years. UnitedHealth Group believes that health benefit requirements will
cause an upward pressure in the rates they charge, therefore affecting the end consumer,
which can either be an individual, or a series of group policy holders. Their reaction could
potentially cause an inverse affect in the retention rate of those whom are currently insured
by UnitedHealth Group. Since legislation changes in the near future will impact other
insurance companies as well, it is important to keep in mind that the company who has the
strongest competitive advantage and is able to sustain it for the next coming periods, has a
greater likelihood of surviving the turmoil of heavy regulations.

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2. PESTEL Forces: Economic
Our businesses participate in the U.S., Brazilian and certain other health economies.
In the U.S., health care spending comprises approximately 18% of gross domestic
product and has grown consistently for many years. We expect overall spending on
health care to continue to grow in the future, due to inflation, medical technology and
pharmaceutical advancement, regulatory requirements, demographic trends in the
population and national interest in health and well-being. The rate of market growth
may be affected by a variety of factors, including macro-economic conditions and
regulatory changes, including in the U.S. enacted health care reforms, which could also
impact our results of operations. (UnitedHealth Group 10-K, 2012, Pg. 42)
Macroeconomic factors, which are uncontrollable by United Health Group, can either
help the company prosper or recede. External economic factors are not limited to only the
United States. Such factors extend to other places abroad including Brazil through Amil,
which a business merged with UnitedHealth Group that provides health and dental benefits in
Brazil. In addition, high unemployment rates, which have occurred in the past, may decrease
the enrollment quantity and cause cancellation amongst current clients. Also, employers can
chose not to provide health care benefits to their employees in order to cut costs, causing
revenue to decline for UnitedHealth Group over time.
Considering that UnitedHealth Groups competitors can also face similar consequences, it
is imperative to develop a series of scenario analysis in order to be prepared for what may
arise. Scenario analysis serves as alternative paths the company can pursue, in case sudden
changes in the economy occur.

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3. PESTEL Forces: Sociocultural
UnitedHealthcare Employer & Individuals suite of consumer incentive products
increases individual awareness for heightened consumer responsibility and behavior
change across diverse client segments and funding relationships. Examples include:
Small Business Wellness, which is a packaged wellness and incentives product offering
gym reimbursement and encouraging completion of important wellness activities for
achieving health outcome goals. For large, self-funded customers, UnitedHealthcare
Health Rewards program offers a flexible incentive design for employers to choose the
right activities and biometric outcomes that best fit the needs of their population.
(UnitedHealth Group 10-K, 2012, Pg. 3)
The lifestyle of consumers is an important factor that UnitedHealth Group considers
within their services. Their Employer & Individual program offers a connection between the
consumer awareness of health care and how it is embedded in their daily lives. Educating
consumers about the health care industry is essential and can reflect in life expectancies
amongst the population in a positive way. For instance, the Small Business Wellness program
motives the employees of a given company, to acquire gym memberships along with
completion of other health-related activities.
When health insurance companies in the industry educate the public, they are attempting
a competitive edge over their competitors because consumers sense that the insurance
company actually cares for the wellbeing of society as a whole.

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4. PESTEL Forces: Technological
Connextions is a growth, retention and service solutions company meeting consumer
distribution needs in the health care market. Through a combination of technology,
campaign management and customer service, Connextions has developed a consumer
relationship management and sales distribution platform. Services offered include call
center support, software, data analysis, certified insurance brokers and trained nurses,
which allow health care payers and providers to acquire, retain, schedule, refer and
manage large populations of individual health care consumers. Connextions is also an
enabler of health insurance exchange solutions, with private exchange business today.
(UnitedHealth Group 10-K, 2012, Pg. 9)
Connextions assists companies in the health care market to create richer experiences with
their prospects by increasing conversion rates and lower costs. Connextions provides services
through their specialized software used to analyze data, which serves as a tool that can assist
insurance companies perform up to speed. It is to the benefit of UnitedHealth Group to be up
to date in the latest technology advancements within the health care industry, and take full
advantage of its benefits in order to not fall behind. The rapid changes in technology can be
overwhelming, but in order to make use of the companys resources for efficient operations,
UnitedHealth groups ability to adapt to such changes in the industry can be reflected on the
quality of health services that the end consumer receives.
5. PESTEL Forces: Environmental
This section is silent within UnitedHealth Groups 10-K for 2012. Upon further research
outside of the 10-K, information regarding how the company portrays an environmental
friendly business atmosphere was found on their company website. Their green business
practices include paperless options for both employees and customers, educating employees
of green office tips, teleconferences to reduce travel pollution, shredding policies for
recycling purposes, turning off monitors over night to save energy, and allowing
telecommuting. UnitedHealth groups attempt to embed green business practices also helps

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with costs reductions. Cost reductions were not reported in the 10-K as being a consequence
of environmental practices; therefore it might not be of large significance to the company.
(Environment." UnitedHealth Group)
6. PESTEL Forces: Legal
The Health Reform Legislation mandated the expansion of dependant coverage to
include adult children until age 26; eliminated certain annual and lifetime caps on the
dollar value of certain essential health benefits; eliminated pre-existing condition limits
for enrollees under age 19; prohibited certain policy rescissions; prohibited plans and
issuers from charging higher cost sharing (copayments or coinsurance) for emergency
services that are obtained outside of a plans network; and included a requirement to
provide coverage for preventive services without cost to members (for nongrandfathered plans). (UnitedHealth Group 10-K, 2012, Pg. 12)
The requirement set by the Health Reform Legislation to include dependants to have
coverage until the age of twenty-six, is an example of changes in the law that apply to the
health care industry. Abiding by the legal requirements is imperative to all companies in the
industry; otherwise they will not be allowed to perform business. Reforms that are yet to be
made official should not be considered legal until the government publicly announces them
to be law. UnitedHealth groups ability to adapt to the law compared to its competitors can
prove its strength in the health care industry, and potential customers can perhaps find this
attractive.

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7. Porters Five Forces: Current competitors
As a diversified health and well-being services company, we operate in highly
competitive markets. Our competitors include managed health care companies,
insurance companies, HMOs, TPAs and business services outsourcing companies,
health care professionals that have formed networks to directly contract with employers
or with CMS, specialty benefit providers, government entities, disease management
companies, and various health information and consulting companies. (UnitedHealth
Group 10-K, 2012, Pg. 17-18)
Clearly from the statement above, UnitedHealth Group operates within a highly
competitive industry. Insurance firms are not the only companies that United Health Group
competes with. As mentioned in the 10-K, UnitedHealth Group also competes with health
care professionals, HMOs and more. This force needs special attention to track over time
due to its high level of competitiveness.
We compete with other companies on the basis of many factors, including price of
benefits offered and cost and risk of alternatives, location and choice of health care
providers, quality of customer service, comprehensiveness of coverage offered,
reputation for quality care, financial stability and diversity of product offerings. In
particular markets, competitors may have greater capabilities, resources or market
share; a more established reputation; superior supplier or health care professional
arrangements; better existing business relationships; or other factors that give such
competitors a competitive advantage. (UnitedHealth Group 10-K, 2012, Pg. 28)
Products and services are substitutes as mentioned from the excerpt above. Cost and risk
alternatives are alternatives in which the end consumer has the choice of selecting from one
service to the other. This existing factor equates to high rivalry in the health insurance
industry. In addition, UnitedHealth Group clearly states that its competitors portray
capabilities, which broadens their market share indicating that the competitors are roughly
large in size as well. It is important to keep in mind that such capabilities that competitors
explicitly show, can distinguish the competitive advantage from one company to the other.

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8. Porters Five Forces: Threat of new entrants
Our business is regulated at the federal, state, local and international levels. Our
insurance and HMO subsidiaries must be licensed by and are subject to the regulations
of the jurisdictions in which they conduct business. For example, states require periodic
financial reports and enforce minimum capital or restricted cash reserve
requirements. (UnitedHealth Group 10-K, 2012, Pg. 21)
Government regulations play a large role when it comes to potential threat of new
entrants. Financial reports, minimum capital or restricted cash reserve requirements are
examples that companies in the health care industry must abide by in order to operate. If new
insurance companies attempt to enter the market, they will face a challenge to also follow the
requirements set by the government. If given companies fail to comply, the threat of new
entrants for the health insurance industry diminishes.
Health plans and insurance companies are also regulated under state insurance
holding company regulations. Some state insurance holding company laws and
regulations require prior regulatory approval of acquisitions and material
intercompany transfers of assets. (UnitedHealth Group 10-K, 2012, Pg. 15)
It is clear from UnitedHealth Groups 10-K that strict company regulations apply to all
companies within the health care industry. All new companies who wish to enter the industry
are subject to prior regulatory approval before entering. This indicates an advantage for
UnitedHealth Group and other health insurance giants in the industry, compared to the new
smaller insurance companies.

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9. Porters Five Forces: Power of suppliers
"Significant merger and acquisition activity has occurred in the industries in which we
operate, both among our competitors and suppliers (including hospitals, physician
groups and other care professionals). Consolidation may make it more difficult for us to
retain or increase our customer base, improve the terms on which we do business with
our suppliers, or maintain or increase profitability. In some markets, certain health care
providers, particularly hospitals, physician/hospital organizations or multi-specialty
physician groups, may have significant market positions or near monopolies that could
result in diminished bargaining power on our part. (UnitedHealth Group 10-K, 2012,
Pg. 28)
The merging of suppliers may complicate the relationship between UnitedHealth Group
and their respective suppliers. Such consolidations may indicate a change in procedures
between the suppliers and UnitedHealth Group, potentially increasing the power of suppliers.
It is clearly stated in the 10-K that some health care providers in the industry may have
significant market positions or near monopolies which suggest that their supplier power is
beyond the control of UnitedHealth Group, as well as other health insurance companies in
the industry. If UnitedHealth Group maintains strong relationships with their large networks
of providers including hospitals and physicians for sustained periods of time; the companys
client loyalty will strengthen.

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10. Porters Five Forces: Power of buyers
As the commercial market becomes more consumer-oriented, individuals are assuming
more personal and financial responsibility for their care, and they are demanding more
affordable products, greater transparency and choice and personalized help navigating
the complex system. The consolidated purchasing capacity represented by the
individuals UnitedHealth Group serves makes it possible for UnitedHealthcare
Employer & Individual to contract for cost-effective access to a large number of
conveniently located care professionals. Individuals served by UnitedHealthcare
Employer & Individual have access to 91% of the physicians and other health care
professionals and 95% of the hospitals in the broad UnitedHealthcare Network.
(UnitedHealth Group 10-K, 2012, Pg. 3)
Buyers are demanding affordable pricing for their health care expenses; therefore having
the power to choose the health insurance company that best fits their budgets. The industrys
products differ depending on the insurance company but for the most part the bottom line,
which is health care solutions, is the same across the industry. UnitedHealth care
demonstrates an advantage in the industry due to their immense network access of 91 percent
of physicians and 95 percent of hospitals through their UnitedHealthcare Employer and
Individual health care benefits plan. With buyer power increasing, it is imperative for
UnitedHealth Group to be able to provide affordable health care benefits.
11. Porters Five Forces: Threat of substitutes
Certain conditions could adversely impact our ability to increase premiums or result
in the cancellation by certain customers of our products and services. All of these could
lead to a decrease in our membership levels and premium and fee revenues and could
materially and adversely affect our results of operations, financial position and cash
flows. (UnitedHealth Group 10-K, 2012, Pg. 31)
UnitedHealth Groups 10-K dictates the threats of their industry competitors but does not
specifically mention the threat of substitutes. They do however state the possibilities of
current members canceling their memberships or a decrease in new members enrolling. This
suggests that the biggest threat the health insurance industry faces is for consumers, including
individuals and employers, to prefer not to pay for health insurance or simply pay out of

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pocket. Threat of substitutes is high when the price of paying out of pocket for health costs is
more attractive than paying for health insurance, which can vary depending on the
consumers income.
12. SWOT Analysis: Opportunities (external)
We have recently acquired and may in the future acquire or commence additional
businesses based outside of the United States, increasing our exposure to non-U.S.
regulatory regimes. (UnitedHealth Group 10-K, 2012, Pg. 17)
UnitedHealth Group clearly has intentions to expand its horizons abroad to other markets.
This opportunity for the company offers an even greater market share than they already
obtain. Extending their service to other countries translates to more regulations to abide, but
with the potential to grow in emerging markets it may be an attractive opportunity for
UnitedHealth Group. In fact, they have already tested the waters abroad with Amil located in
Brazil.
In 2012, UnitedHealthcare International acquired Amil, which provides health and
dental benefits to over five million people and also operates 22 acute hospitals, as well as
specialty clinics, primary care, and emergency services across Brazil, principally for the
benefit of its members. (UnitedHealth Group 10-K, 2012, Pg. 7)
Amil can bring a range of opportunities for UnitedHealth Group. Providing health and
dental benefits to a large consumer base abroad, is as important as maintaining a large
network of providers. Five million people affiliated with Amil were reported in 2012.
Monitoring the growth of Amil over the next years can help UnitedHealth Group determine if
expanding its business abroad will provide a competitive advantage in the long haul.

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13. SWOT Analysis: Threats (external)
We base the premiums we charge and our Medicare bids on our estimates of future
medical costs over the fixed contract period; however, many factors may cause actual
costs to exceed what was estimated and reflected. These factors may include medical
cost inflation, increased use of services, increased cost of individual services, natural
catastrophes or other large-scale medical emergencies, epidemics, the introduction of
new or costly treatments and technology, new mandated benefits (such as the expansion
of essential benefits coverage) or other regulatory changes and insured population
characteristics. Relatively small differences between predicted and actual medical costs
or utilization rates as a percentage of revenues can result in significant changes in our
financial results. (UnitedHealth Group 10-K, 2012, Pg. 20-21)
UnitedHealth Group gathers estimates of medical costs to set their premium prices and
depends on those predictions to perform at its best. Unfortunately, UnitedHealth Group
cannot anticipate external threats such as inflation, large-scale medical emergencies
epidemics and more, because such factors are out of the control of the company. Other health
care insurance companies in the industry will face similar consequences when external
threats emerge. It is important for UnitedHealth Group to be prepared for such threats that
can potentially affect the company; otherwise it will create a disadvantage compared to its
competitors. As mentioned from the excerpt above, small differences between predictions
and reality can have disastrous consequences if not managed adequately.
16A. Overall strategy:
We are helping individuals access quality care at an affordable cost; simplifying health
care administration and delivery; strengthening the physician/patient relationship;
promoting evidence-based care; and empowering physicians, health care professionals,
consumers, employers and other participants in the health system with actionable data
to make better, more informed decisions. (UnitedHealth Group 10-K, 2012, Pg. 1)
UnitedHealthcare Employer & Individuals portfolio of affordable products drives
value to consumers with lower-cost products, innovative designs and unique network
programs that guide people to physicians recognized for providing quality and cost
efficient care to their patients. These approaches are designed to deliver sustainable
health care costs, enabling employers to continue to offer their employees coverage at
more affordable prices. (UnitedHealth Group 10-K, 2012, Pg. 4)

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UnitedHealth Group is composed of two business platforms: UnitedHealthCare for health
benefits, and Optum for health services. (UnitedHealth Group 10-K, 2012, Pg. 1) Combined,
both businesses portray an array of tactics that contribute to the overall strategy of the
company. As per their statement in the 10-K, the companys goal is to help individuals access
quality care at an affordable cost. Companies that operate at a minimum cost while still
maintaining fair value are considered cost leaders in their industry. On the other hand, when
firms are value-oriented through superior quality, they are pursuing a differentiation strategy.
(Rothaermel 142) Meanwhile, an integration strategy is a combination of both, at the
business level. By analyzing the two excerpts of the 10-K from above, it is evident that
UnitedHealth Group pursues a balance between both value and cost. (Rothaermel 155)
UnitedHealthcare Employer & Individual is a subdivision of UnitedHealthcare from
UnitedHealth Group, which provides health benefits to employers and individuals in the
nation. They focus on low cost products while also maintaining innovation mainly through
the usage of their large, unique network. The value and cost drivers of the integration strategy
includes quality and innovation, amongst other factors.
Maintaining an integration strategy does not necessarily mean that UnitedHealth Group
must be the lowest cost producer and the highest value creator simultaneously. It actually
depends on the capability of the company to create value while maintaining costs at a margin.
(Rothaermel 156) The financial reporting in 2012 of the company clearly dictates an increase
in revenue and a slight increase in cost. UnitedHealth Group stated that their costs for 2012
did not rise as much as they had predicted. This translates to the fact that investment in
innovation has lead to an increase in client count thereby rising revenue. Financial statements

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portray real numbers; they show the historical data regarding the performance of the
company. (UnitedHealth Group 10-K, 2012, Pg. 45-46)
Creating the largest economic value in the industry compared to its competitors is the
goal of a company seeking an integrative strategy. Referring to the second quote from this
section, UnitedHealth Group states that their approach is designed to deliver sustainable
health care costs, which is crucial to manage in the health care industry. With competition
being high in the health insurance industry, having low costs is not the same as actually
maintaining them for prolonged periods, especially with government regulations changing
through time. Cost reduction does not always lead to price reduction, but from the 10-K,
UnitedHealth Group states that one factor does lead to the other. By delivering sustainable
health care costs, it will enable the employers whom are insured by UnitedHealth Group to
lower the prices they charge to their employees. (Rothaermel 157)
Maintaining an integrative strategy is not a simple task, especially in the health care
industry. UnitedHealth Group has been honest to the public by mentioning in their 10-K
potential increases in costs due to the upcoming changes in the health care regulations.
UnitedHealth Group in fact mentions that an increase in their costs, would lead to an increase
in the premiums charged to their customers. (UnitedHealth Group 10-K, 2012, Pg. 41)
The changes in health care regulations may serve as a test of survival within the
industry including increases in costs for insurance companies. The company that is capable
of managing the transformations of the health care industry will ultimately maintain its
competitive advantage.

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Works Cited
"Environment." UnitedHealth Group. N.p., 2011. Web. 17 Sept. 2013.
<http://www.unitedhealthgroup.com/Social Responsibility/Environment.aspx>.
"Financial Reports & SEC Filings." UnitedHealth Group. N.p., n.d. Web. 10 Sept. 2013.
<http://www.unitedhealthgroup.com/Investors/FinancialReports.aspx>.
Rothaermel, Frank T. "Business Strategy: Differentiation, Cost Leadership, and Integration."
Strategic Management Concepts. N.p.: McGraw-Hill, 2013. 142-57. Print.
"UnitedHealth Group." CNNMoney. Cable News Network, 2013. Web. 10 Sept. 2013.
<http://money.cnn.com/magazines/fortune/fortune500/2013/snapshots/3147.html?
iid=F500_lp_arrow2>.