“The left hand doesn’t know what the right hand is doing.”

That’s a business-ism that gets lobbed by disaffected employees at every large company. Even the not-so-large.

But UnitedHealth Group isn’t just big. It calls itself a member of the Fortune 7. It’s one of the largest health insurance companies in the US, and it expects to pull in at least $277 billion in 2021 revenues.

But most pertinent to this report: UnitedHealth Group has more than 1,000 subsidiaries.

One oblivious left hand unaware of its counterpart’s movements just isn’t an adequate metaphor for a company with UnitedHealth’s scale.

I’m tempted to launch into a long-winded reference to Greek mythology’s 100-armed, fifty-headed monsters, the Hecatoncheires. These were the lesser-known brothers of the Cyclopes, and the ancient Greeks blamed them for earthquakes and tidal waves.

Maybe: “The 42nd head doesn’t know what the 83rd arm is doing.” Catchy, but, no. That still fails to hint at the kinds of complexities that arise in a holding company with 1,000 subsidiaries, many with near-autonomy and overlapping purviews.

Despite all that, in a few years’ time, UnitedHealth Group will be responsible for some earthquakes and tidal waves in digital health. The company is beginning to make bigger and bigger moves in this arena, and now is a good time to keep (a couple hundred) eyes on them.

This report is decidedly an outsider’s view of UnitedHealth Group’s digital health initiatives.

To help whittle down this giant company, I’m going to start by focusing on two key people who have had an outsized role in shaping digital health at UHG. If we can understand a little bit about how they think about and approach digital health programs, we might have a better chance of guessing what comes next.

Larry Renfro: Optum’s top digital health dealmaker.

First up: Larry Renfro. He currently serves as the Managing Partner of Optum Ventures, UHG’s relatively new venture fund. Up until 2017, however, Renfro was the CEO of Optum, and he also led growth initiatives for the wider UHG organization.

This is a good place to briefly touch on UHG’s two key companies: Optum and UnitedHealthcare.

Optum is UHG’s services platform. Sometimes employees describe Optum’s role as “making the wider health system work better,” vs. UHG’s other group, UnitedHealthcare, which is the beneficiary business. Optum’s biggest subsidiaries include a PBM called OptumRx, a provider business called OptumHealth (53,000 aligned or employed physicians and 1,400 clinics), and a data and analytics business called OptumInsight. Many of Optum’s digital health services go-to-market through the OptumHealth business unit.

Optum is much more than these three businesses though. As Renfro explained it back in December 2016 when he was CEO:

The Queen Mary was a massive ocean liner that traveled a transatlantic route from the late 30s through the 60s (and has since been docked in Southern California and converted into a hotel). Renfro’s framing is a much more positive spin on my Greek mythology reference above, but the sentiment is similar: Optum is not a monolith. UHG isn’t either.

As these giant companies compete more directly with digital health startups, this is important to keep in mind: Your competitor is not a $277 billion-a-year behemoth.

Under Renfro’s watch (2011-2018), Optum was positioned as UHG’s growth engine. It likely still is today. Here’s how Renfro put it back in 2016:

Renfro said that prior to Optum’s formation in 2011, UHG had acquired about 40 companies to form it. In his first five years at Optum’s helm, Renfro said he acquired 60 more companies. Here’s Renfro again, describing UHG’s general re-investment strategy and Optum’s M&A sweet spot back in late-2016:

In late 2017, Optum launched a new $250 million fund, Optum Ventures, to invest in early stage digital health startups. Renfro took the helm as Managing Director. Five months later, Renfro stepped down as Optum’s CEO to focus on Ventures, which ballooned into a $600 million group of funds with a global purview, but he continued to lead growth strategies at the wider UHG organization. During his tenure at Optum, the company grew from about $29 billion in annual revenues to around $100 billion.

Optum Ventures has made more than two dozen investments since its launch three years ago.

Optum Ventures’ original partner and co-founder, A.G. Breitenstein explained on a podcast in 2018 why Optum decided to create the fund:

Here’s how Optum Ventures sees itself, according to Breitenstein:

We’ll get into more specifics on this later, but Renfro’s group at Optum Ventures took the first steps that led to UHG’s big digital health acquisition in 2020: AbleTo, which it bought for a reported $470 million. Optum Ventures had invested in AbleTo, and Renfro’s son Stephen Renfro (who also works at Optum Ventures) sat on AbleTo’s board. Following AbleTo’s acquisition, it remains unclear exactly how its services fit in with other behavioral health programs at UHG, including its similarly positioned Sanvello business unit.

While Breitenstein pointed out the challenge of disrupting from within, that hasn’t stopped UnitedHealth’s R&D team from trying. Let’s learn a bit more about UHG’s homegrown initiatives.

Deneen Vojta: UnitedHealth’s top digital health builder.

While Renfro’s comments above make clear that Optum is a prolific acquirer of businesses, UnitedHealth Group is often cast as an organization that prefers to build rather than partner. But it clearly has an appetite to buy and then build atop acquisitions, too.

One person who helped forge that reputation is UnitedHealth Group’s top digital health builder, Deneen Vojta M.D.

Vojta currently heads up R&D at UnitedHealth Group as an EVP, but she joined the company nearly 15 years ago after it acquired her startup, direct-to-consumer child obesity program provider, MYnetico.

During her first six years at UnitedHealth, Vojta led the company’s pioneering efforts in diabetes prevention. Her work with the YMCA and the CDC helped paved the way for future digital diabetes prevention-focused startups like Omada Health. While UnitedHealth’s efforts in diabetes prevention evolved significantly over the past 14 years, the current iteration of the program, called Real Appeal, actually de-emphasizes “pre-diabetes” and focuses simply on weight loss.

Vojta’s work at UHG has led her well beyond prediabetes and childhood obesity, however. Her team has helped develop and pilot in-house programs related to renal disease, prenatal care, musculoskeletal issues, behavioral health, diabetes management, and more. (In the sections below, I’ll dig into many of these in more detail.)

The most recent launch from Vojta’s R&D team is a high-profile diabetes remission-focused program called Level2. Vojta has coined a term to describe Level2 and similar programs her team will likely launch in the coming years — “special purpose care delivery organizations”.

Another thing that jumps out after listening to many of Vojta’s presentations and interviews over the years is her appreciation for how long it takes to bring a successful digital health program to market. She brings this up often along with the promise that UnitedHealth is “willing to do the hard work”.

Here’s an excerpt from a talk she gave at Columbia Business School in early 2018:

Many of the programs that Vojta’s team develops end up incubating at UnitedHealth Group Ventures. In a February 2019 lawsuit filing, UHG helped explain how this intrapreneurial team operates, which makes clear how it’s different from the venture fund, Optum Ventures:

We’ll get into a few of the startups who successfully merged back into the mothership, but first, let’s look at a recent spinout: as mentioned briefly above, Vojta and UnitedHealth Group Ventures’ big digital health launch of 2020 was a diabetes-focused program called Level2.

Level2

UnitedHealth Ventures Group incubated this diabetes remission program with some data science backing from Savvysherpa, an R&D firm that UHG quietly acquired in December 2017. When Level2 launched, a number of UHGV team members switched from the Ventures group to Level2.

UnitedHealth typically keeps programs like this one quiet. It’s unusual for it to send out a press release and solicit media interviews as it did with the launch of Level2. (As it happens, Level2 has been hiding in plain sight on Apple’s AppStore since June 9, 2018.)

At first blush, Level2 is UnitedHealth’s version of Livongo Health or Virta Health:

In its launch release, UnitedHealth mentioned real-time insights and remote intervention — a staple of Livongo’s marketing — and that some of Level2’s early users have gone into remission and no longer need medication for their Type 2 diabetes. That’s Virta Health’s positioning.

Level2 stresses incentives as a key piece of its program. If permitted in the participant’s state, they could earn financial incentives, like cash or gift cards for simple things like interacting with their coach, consistently wearing their CGM, or going for a walk.

At a high-profile presentation during UnitedHealth Group’s investor day in December, Deneen Vojta shared more about Level2’s positioning, the program’s offerings, and what it could lead to next. (This talk was also the first time I heard her use the term “special purpose care delivery organization.”)

This was Vojta’s overview of the program:

How Level2 saves money:

And, perhaps most revealingly, Level2’s likely business model and where it goes next:

Clearly, Vojta’s group has other special purpose care delivery organizations in development at the UnitedHealth R&D group’s Query Lab. (Or, based on the way Vojta phrased that above, Level2 will expand its focus to include other conditions.) One more quote from that talk Vojta gave at Columbia a few years back might help point to the origin story of Level2 as well as its business model and a possible future opportunity:

None of the above really digs into the dieting component of Level2, which, if it is anything like Virta, is crucial. While this never mentions Level2 by name, a recently posted clinical trial sponsored by UnitedHealth looks to be an RCT to test the pilot program. Here’s part of the brief description:

And here’s a more in-depth explanation of the intervention arm’s protocol:

Curiously, UHG initially described Level2 as a “pilot” program. At launch, it was available at no additional cost to “230,000 employer-sponsored, fully insured UnitedHealthcare members in 27 states and Washington, DC.” It planned to open Level2 up to some self-insured employers by the end of 2020, and by December — at the UnitedHealth Group investors’ day — the company positioned Level2 as a new “special purpose care delivery organization” not a pilot. UHG also made clear that Level2 is not a disease management program:

That last line reads like the realization of what Teladoc-Livongo may someday pull off if they are able to successfully merge their operations in the coming year. UnitedHealth Group has that in place right now — today.

Sanvello, AbleTo, and a growing number of behavioral health bets

A more established digital health offering that is already officially a subsidiary of UnitedHealth Group Ventures, is the mental health business unit, Sanvello. UnitedHealth has not really hidden the fact that they own Sanvello, it is well-marked on Sanvello’s website. The business unit does have something of a secret, however: UHG never disclosed that Sanvello was created following an acquisition.

Here’s the backstory: A health startup, named Pacifica Labs, announced that it had rebranded as “Sanvello” back in June 2019 without mentioning an acquisition or UnitedHealth. Pacifica tweeted:

“It’s not just a rebrand” was right. What actually happened was UnitedHealth acquired Pacifica and relaunched it as Sanvello. Here’s what this program offers:

• Self-care: Sanvello’s app offers mental health resources, symptom tracking, and more for self-directed care.
• Peer support: Sanvello’s app includes chat groups focused on particular topics including general anxiety disorder, eating disorders, LGBTQ issues, chronic illnesses, and more.
• Coaching: CBT-trained coaches can chat one-on-one or lead a group video session.
• Therapy: Sanvello also offers virtual teletherapy or telepsychiatry right from the app.

Less than one year after Sanvello’s debut, Optum buys AbleTo

Optum has led much of UHG’s work in behavioral health. Since Sanvello’s rebrand, a more recent acquisition, AbleTo, has become a focus for the organization.

News first broke of this deal when CNBC reported in April 2020 that AbleTo was about to be snapped up by UnitedHealth’s Optum for about $470 million. No official announcement materialized until mid-summer when UnitedHealth briefly mentioned the deal in its Q2 earnings report:

More recently, at the UnitedHealth Group Investor Day in December 2020, AbleTo had a starring role. The virtual event marked AbleTo’s public debut as a key part of UHG’s behavioral health offerings moving forward.

During his introductory remarks about AbleTo, Optum’s Chief Digital Officer Phil McKoy touted Optum Behavioral Health’s large network of 235,000 providers and growing. McKoy explained that Optum had “expanded virtual care and app-based solutions for depression and anxiety, as well as telepsychiatry and pharmacy behavioral services.” When he introduced Dr. Rena Pande, the Chief Medical Officer at AbleTo, he said she would share “more on how our platform helps connect people to the support they need.”

As if Pande’s participation in the annual investor day didn’t speak to this already, McKoy’s intro positioned AbleTo as a core component of Optum Behavioral Health now.

Here’s how Pande described AbleTo:

For a hint at what may have sealed the deal for the UHG-AbleTo deal, Pande also shared a few of AbleTo’s topline outcomes. She said AbleTo’s programs have reduced depression “by nearly 50 to 60 percent and anxiety symptoms by approximately 45 percent, while at the same time improving physical health like diabetes self-management measures and even medication adherence and altogether resulting in 45 percent fewer hospital stays.”

It’s telling that Pande’s hypothetical example is a scenario where AbleTo is made available to someone on a UnitedHealth insurance plan. As far as I can tell, while they are mentioned in various places, neither Sanvello nor AbleTo has been widely deployed through the beneficiary business yet. (Given the $470 million price tag for AbleTo and the relative quiet surrounding Sanvello, it seems like UHG might have picked a winner already.)

Ginger, Talkspace, and more already work with UHG

Like most things at UnitedHealth Group, the organization’s behavioral health ambitions are actually much more complicated. I was surprised to find out that UHG has relationships with many other mental health-focused digital health companies — big and small.

Back in 2017, Ginger noted that it had partnered with “some of the nation’s largest health insurers, including United and Optum, to offer Ginger.io as an in-network service.” While you might assume this ended the day UHG bought AbleTo, Ginger confirmed to E&O that this agreement is still in place today.

On May 29, 2019, which was just days before Sanvello announced itself to the world as a new UnitedHealth-owned, virtual mental health provider, Talkspace announced that it had inked a deal with Optum to be a “contracted virtual visit provider group”.

UHG also offers a digital health program called Recovery Record, which is focused on eating disorders, to many of its beneficiaries.

Finally, Optum Ventures has relationships with digital health companies with a mental health focus, including OxfordVR, Mindstrong, Holmusk, and Springtide.

Given the multitude of digital health companies focused on behavioral health, this round-up is unlikely to be a comprehensive one of companies with ties to Optum or UHG. It’s clear, however, that the organization has placed many bets in mental health and forged partnerships with competing companies offering overlapping services.

And those were just in the past three years!

Quick review: UHG’s DPP to weight loss journey

UnitedHealth Group Ventures, which, again, is the company’s incubator for homegrown digital health startups, has stood up a handful in various therapeutic areas, but this part of UHG has had a key focus on cardiometabolic conditions.

As I mentioned above, after acquiring Dr. Deneen Vojta’s startup MYnetico, Vojta helped lead United’s pioneering work with the YMCA on the beginnings of the diabetes prevention program concept. United built on its in-person diabetes prevention programs with the YMCA by building its own online DPP program, named Not Me, in partnership with a digital health startup named Jiff (since acquired by Castlight).

Not Me was short for “Tell Diabetes Not Me” and it got started around 2013. Before that, Not Me was actually a TV documentary about diabetes prevention, and so the online version had similar elements to Omada’s initial DPP program but the heart of Not Me was watching the 16 episodes of the TV show, which was a documentary about six people working their way through a diabetes prevention program. GE was the first employer to offer Not Me to its employees.

By mid-2014, UnitedHealth rebranded Not Me to LoseUWin, with the tagline: “When you lose, you win.”

Within two years, LoseUWin was replaced by Real Appeal, a more generically marketed weight loss program powered by a newer UnitedHealth acquisition, Audax Health. Audax was rebranded as Rally Health, which is still a part of UnitedHealth’s portfolio today. (More on Rally in a dedicated section below.)

Real Appeal’s homepage claims the program has had more than 700,000 participants over the years, and it — quite purposefully — makes no mention of diabetes or diabetes prevention. As Vojta explained on a podcast a few years ago:

Dueling strategies: Cardiometabolic vs Behavioral health

UnitedHealth has a reputation among digital health insiders as preferring to build in-house. However, it has clearly built much of its business, including its digital health capabilities, via acquisitions. The section above, focused on its growing collection of assets, investments, and partners in behavioral health, shows how promiscuous the company can be when it wants to be.

So, maybe this reputation is undeserved?

It makes sense when you consider that for many years UnitedHealth was going it (mostly) alone with its homegrown cardiometabolic programs. Its DPP-turned-weight-loss program Real Appeal and its new diabetes remission program Level2 are all clear examples of this tack. So, early digital health companies, which largely focused on cardiometabolic conditions, did not find a willing partner in UnitedHealth.

Also, remember: Optum Ventures was late. It only launched in 2017. It largely missed the early funding rounds of today’s leading cardiometabolic-focused digital health companies. It makes sense from a timing period that Optum Ventures’ focus would end up centering more on behavioral health, which has raked in massive amounts of venture capital in the past three years.

So, UnitedHealth has operated quite differently in behavioral health. In addition to the timing of the market, the key problem digital health hopes to solve in these two therapeutic areas is different too. If virtual mental health services are first and foremost solving an access to care problem, why wouldn’t UHG want to make it easier for its covered lives and its customers covered lives to access as many virtual providers as possible?

As UnitedHealth Group Ventures launches new special purpose care delivery organizations like Level2, I’m curious to see whether Optum and Optum Ventures partner with and invest in those new programs’ competition. Was it just timing with cardiometabolic digital health startups or did UHGV manage to get Optum to stay out of its lane?

Remember, Vojta said her team is looking to rollout Level2-like programs for chronic kidney disease and heart disease next. More data here would be helpful, so I’ll be watching closely to see how this plays out.

Other UHG digital health programs

In these next few sections, let’s take a look at the various digital health programs dreamed up by UnitedHealth Group Ventures or acquired by Optum over the past few years. These include some shuttered ones, some soon-to-launch ones, and others of unknown status.

Wellhop for Mom and Baby

Like Level2, Wellhop is a pilot program incubated at UHGV. Unlike Level2, the launch of the Wellhop pilot at the end of 2020 was met with zero fanfare — not even a press release. As far as I can tell, it’s never been mentioned in a news article before, and it appears to be a fairly new addition to the AppStore.

Here’s what the pilot program promises:

The virtual meetings are every other week for a total of 11 prenatal meetings and 8 postpartum meetings. So, the whole program lasts for about 9 months. Between meetings group members can chat with each other via a discussion board.

The pilot program is available to fully-insured UnitedHealth members, its own employees, as well as employees at CenturyLink, Charles Schwab, Oak Ridge National Laboratory, Sephora, Target, and the United States Postal Service.

(Interestingly, in February 2019, UnitedHealth Group posted a few job ads for certified diabetes educator-trained coaches and a pharmacist for a pilot called Wellhop Diabetes Care. The job description made it sound like Level2 was originally branded Wellhop Diabetes Care. At first, I wondered if this pregnancy program named Wellhop included a diabetes-focused virtual care offering for pregnant women with gestational diabetes. However, it seems like the former is the case.)

In some ways, Wellhop looks like a mulligan from a similar program that UnitedHealth Group developed back in 2016. It ultimately gifted the assets to that prenatal program to The March of Dimes.

Joy Builder

The most unexpected offering from UnitedHealth’s Savvysherpa group is the health coaching program that has the largest possible user base:

If you search for Savvysherpa on Apple’s AppStore, three apps show up with the company as their developer: Level2, Wellhop, and Joy Builder. Joy Builder hit the AppStore on March 26, 2019, but Savvysherpa hasn’t updated it since June of that year. While it’s still on the AppStore, it appears to be shuttered — or at least on the back burner. While Savvysherpa seems to have worked with UnitedHealth’s R&D team for years, it only officially became a part of UnitedHealth at the end of 2019.

Moment Health

There’s at least one more UHG mental health-related program I didn’t mention in the section above: Back in 2014, UnitedHealth Ventures Group stood up an altogether different mental health program, called Moment Health. This offering was more focused on selling scalable and accessible mindfulness and resiliency solutions direct-to-consumer and to employers. Moment’s goal was to improve health, performance and increase happiness. Moment was primarily an in-person, on-site mindfulness training program, but it had online offerings too. It looks like it shut down back in 2018, but its website is still up and running here.

Orthology

Another big initiative that is nestled under the UnitedHealth Ventures Group is a musculoskeletal and physical therapy focused business unit called Orthology. Orthology is primarily a brick-and-mortar provider of physical therapy rehabilitation services, but like most providers right now it also offers virtual care. I mostly bring it up to set-up an intro to the next section. Read more about Orthology’s care regimen here, but the final piece of their process points to its digital therapeutics ambitions:

Virtual Therapeutics Corporation

Through its Orthology subsidiary, UHG owns a majority stake (67 percent) in AR/VR-powered digital therapeutics company named, aptly, Virtual Therapeutics Corporation (VT). It started up about five years ago. Here’s how Kirkland, Washington-based VT describes its work:

Virtual Therapeutics’ product pipeline is not posted on its site, but this might be a hint: The company categorizes various research studies (conducted by other companies and academics) that indicate where VT sees promise for VR/AR digital therapeutics:

• treating stress, anxiety, and PTSD
• pain management
• treating fears, disorders, phobias
• healthcare, wellness, and rehabilitation
• improved learning retention

In May 2019, Virtual Therapeutics kicked off a study of its own with 50 participants at a healthcare provider in Las Vegas, Nevada. The study includes VT’s virtual reality digital therapeutic “module” for pain management. VT refers to its platform as “RIBS”.

I saw some indication that the company was also working on aging in place applications for its platform as well as workplace wellness. The VR headset may not be the only hardware that Virtual Therapeutics ends up using in its digital therapeutics programs — it will likely include other health-tracking wearables, too.

While Linkedin still shows more than a dozen employees at Virtual Therapeutics Corp., curiously, the company hasn’t shown any other signs of life in 2020. One other footnote here: Optum Ventures has made an investment in a competing startup, Oxford VR.

Naviguard

Here’s another consumer health tool incubated at UnitedHealth Group Ventures that is just finding its ways into employee benefits packages for 2021: Naviguard. Naviguard describes itself as “your fierce defender from out-of-network bills,” but, in its current iteration, anyway, it seems to be more focused on simply educating UnitedHealth members. Naviguard looks pretty thin right now: It offers tools like checklists and whitepapers to help people better understand their benefits, how to avoid OON surprises, and how to negotiate OON bills if you get one.

Renai

This company, also incubated at UnitedHealth Group Ventures, aimed to optimize care services for people with chronic kidney disease (CKD). Considering that Vojta pointed to CKD as a likely potential target for a future Level2-like program, it’s possible that Renai could be resurrected.

Renai received its budget in September 2017, launched in January 2018, and was absorbed back into the mothership by November 2018. That timeline makes sense given that UnitedHealth announced its intent to buy a multi-billion-dollar company in the kidney care space, Davita, in December 2017. Have to imagine that changed Renai’s prospects. Its website is still live here and this short video about the original Renai patient explains the startup’s mission well. (Update: A reader pointed out a nuance that I missed. United only purchased Davita’s physician assets, Davita Medical Group, and not its CKD business. So maybe Renai’s prospects for a comeback are better than I previously thought?)

Trio Motion

Nestled under Savvysherpa LLC, which operates as a part of UnitedHealth’s R&D team, is another newer acquisition called Trio Motion. UnitedHealth acquired Trio Motion from private equity firm Francisco Partners, which, in turn, had acquired it from Qualcomm.

Qualcomm Life, a former subsidiary of the chipmaker, created the Motion program with UnitedHealth as a wellness offering for UnitedHealthcare members.

Another company affiliated with Trio Motion is Fortify Technologies, which UnitedHealth also now owns. Interestingly, Fortify has a manufacturing facility in the Philippines where it makes the inexpensive wearable activity trackers that the Motion program used.

Still, it’s not clear how UnitedHealth benefits from Fortify. Over the past few years, the Motion program added support for devices from Fitbit, Samsung, and Apple. And UHG’s new Level2 program uses Fitbit Versa devices not inexpensive ones from Trio.

Rally Health

In February 2014 Optum acquired a majority stake in Audax Health, an early health tech company founded by a college dropout in 2010. Audax worked with health insurance companies to reward consumers who made healthy choices with lower premiums. (It wasn’t too far off from what most employer-facing wellness platforms ended up looking like.) Optum rebranded Audax as Rally Health in 2015.

Today, Rally is available to almost 60 million people thanks to Optum’s partnerships with health plans, providers, and some 200,000 employers. Rally’s core focus, however, remains relatively unchanged:

The Real Appeal weight loss program is offered via the Rally platform as is Optum’s smoking cessation program, Quit for Life. Both of these are powered in part by Rally’s coaching function, called simply Rally Coach.

In recent years, however, Rally has had an increasing focus on wayfinding, which when combined with its roots, has made Rally into Optum’s digital front door business unit:

Like AbleTo and Sanvello above, Rally might chafe at some of the duplicate moves other parts of the organization are making. For example, Optum Ventures backs another high-profile startup in the digital front door sphere: Buoy Health.

Vivify Health

In October 2019, UHG acquired remote patient monitoring company, Vivify Health. The company has described Vivify as “a recently acquired Optum asset that uses advanced remote monitoring technology to track patients’ health in their homes.”

Vivify offers a suite of health monitoring devices that can be shipped directly to a patient’s home. The company largely works with healthcare providers but also counts health plans and employers as its customers too. While Vivify has provided RPM technologies to providers operating under risk-based contracts for years, it has also embraced the increasing number of RPM-related fee-for-service codes that are now available.

Surprisingly, Vivify also targets employers with an offering that must overlap with Rally Health:

The offering includes a wide range of services, including virtual visits and chronic care programs:

Vivify is also helping to power a big digital health launch for UnitedHealth Group in 2021 that UHG calls Digital Health @Home. The initiative is for its 6.5 million Medicare Advantage members:

Others that never launched

While most of the internal incubation at UHG can be traced back to UHG Ventures, a number of startup concepts have been dreamed up across the organization and then folded prior to launching. Here’s a quick run-through of a handful of these:

ADHDirect: An innovation studio called Optum Garage at one point developed and validated a concept for an ADHD-focused coaching service for kids and their parents.

Wellvize: Another idea that came together thanks to the Optum Garage was this personalized, affordable fitness training program, Wellvize. The app would create a training program for the user based on their goals, which might include being able to run a marathon.

SenSight: In a trademark filing from March 2017, UnitedHealth Group described this as a “kit consisting of wearable health monitoring trackers and health sensors to measure, track, and monitor biometric data, blood properties, heart rate, body movement, calories burned, and weight for medical purposes” and “to make positive lifestyle changes.” It also described the mark as related to “lifestyle wellness programs featuring one on one weekly health counseling” and “blood pressure.” SenSight appeared to be what UnitedHealth planned to call a digital health program it piloted with Vida Health using iHealth devices and an Apple Watch, but it never launched.

Simplifi and Beyond Seizures: Simplifi was an app-based stress management pilot also powered by Vida Health. Instead of iHealth, this program used an advanced physiological wearable from Empatica, which is perhaps best known for its work in epilepsy. A somewhat similar concept was trademarked by UHG’s R&D partner, Savvysherpa (which UHG acquired in late 2019). Savvysherpa trademarked a digital health program called Beyond Seizures in mid-2014 by abandoned it in 2015. (Notably, Savvysherpa used the same IP attorney for this trademark that UHG uses for most of its patent and trademark work.)

Rx Navigait: This was another trademark that Savvysherpa filed in mid-2016 but, in this case, never abandoned. Rx Navigait is a brand for “conducting health and wellness programs in a clinical setting to promote physical activity in a patient population.” (The “gait” pun might be a hint as to what this program might focus on?)

Takeaways and what to watch for next

UnitedHealth Group is too large for a comprehensive report on its various digital health initiatives. The 7,000 words in this report focused mostly on newer initiatives, recent acquisitions, and subsidiaries that have managed to keep their affiliation with UHG quiet. Here are a few takeaways from this research along with things that I plan to watch closely in 2021:

• UHG is both not as big as it looks and so big it gets in its own way: This $277 billion-a-year juggernaut is a figment of the CFO’s imagination. As Renfro put it above, at best, Optum operates like 500 speedboats. So far, UHG has not demonstrated an ability to leverage its massive resources behind a concerted digital health effort. Its many digital health-focused subsidiaries have overlapping purviews and appear to be run more as separate fiefdoms. (Or maybe it’s 500 boats with 500 captains?) If UHG gets its speedboats in a row and stops duplicating its own efforts, that’s a signal that digital health companies should start to get worried.
• Patience is one of UHG’s biggest assets: Dr. Deneen Vojta’s comments that successful digital health programs require eight or nine years and that investors and entrepreneurs are always claiming things will change dramatically in just one or two years should remind you that UHG can afford to be incredibly patient. Then when they are ready, they can “pilot” Level2 in a population of hundreds of thousands. Or they can swoop in and snap up AbleTo for $470 million without having to mention the price tag to Wall Street.
• UHG has “build” therapeutic areas and “buy” therapeutic areas: After wading through the history of UnitedHealth’s digital health-powered cardiometabolic programs and comparing it to its much shorter and more acquisitive track record in behavioral health, it’s clear that UHG will get set on building in some TAs and acquiring its way into others. Expect that to continue as different conditions start to trend once the funding bonanza around mental health starts to wane.
• “Special purpose care delivery organizations” are a key part of UHG’s digital health strategy: There are so many jargon terms in healthcare that I can’t keep them all straight. It’s possible that “SPCDO” wasn’t coined by Vojta, but it is clear that Level2 and its progeny will be pillars of UHG’s digital strategy moving forward. Optum Ventures’ ex-partner AG Breitensen, who left to start an LGBTQ-focused virtual primary care clinic called Folx Health, predicted this category’s importance two years ago:

• What about Teladongo? UnitedHealth Group has had a longstanding partnership with Teladoc to power its virtual visits. With the Livongo acquisition and the Level2 launch, the two companies are now competing with each other in diabetes. Both have expressed an interest in launching digital health care services for people with CKD too. UHG is comfortable with its own business units having overlapping territories, so maybe this won’t cause any ripples, but the Teladoc-Livongo merger may be a reason for UHG to buy or build its own in-house virtual visits capabilities.
• Digital Health @Home and Virtual Primary Care Plan: Two relatively new initiatives to keep an eye on are UnitedHealth’s Digital Health @Home for Medicare Advantage members, which was clearly created out of necessity because of the pandemic, and its move to offer a Virtual Primary Care Plan. I mentioned the @Home program in the Vivify section above. The Virtual Primary Care Plan got a big shout-out at UHG’s investor day in December:

What were your takeaways from The UnitedHealth Group report? Which of the findings surprised you most? I’ll keep the discussion going in the E&O newsletters.