'Healthcare is distinctly local:' Why the CEO of UnitedHealthcare Global turns to local healthcare systems to grow its global business

• UnitedHealth Group, the US-based healthcare giant, is growing its footprint outside the US.
• Its first big move was in 2012 into Brazil, with the acquisition of a company called Amil.
• The experience has been beneficial to both UnitedHealth's business in the US and in the countries it's expanded into, UnitedHealthcare Global CEO Molly Joseph told Business Insider.
• "I think that's been a rich experience for UnitedHealth Group locally within our international markets as well as what we've taken from those markets that have perhaps added to our flexibility and innovation throughout the broader enterprise," Joseph said.

Minnesota-based healthcare giant UnitedHealth Group has a lot on its plate.

The company has a $256 billion market cap, employs more than 285,000 people, and makes $201.2 billion in revenue.

And in recent years, the company has set its sights beyond the US healthcare system. UnitedHealthcare Global CEO Molly Joseph has been with the organization for 15 years, 10 of which have been focused on exploring healthcare markets outside of the US.

In 2012, UnitedHealth made its first big move outside the US when it bought Amil, the largest healthcare company in Brazil.

In many ways, Brazil's health system looks a lot different from the US's. In 1988, Brazil wrote universal healthcare into its constitution, saying public healthcare had to be free to all 200 million citizens.

For most Brazilians, the public system covers everything from checkups to hospital stays. About 26% of the population is covered by private health insurance, usually provided by employers, similar to the system in the US. On both the public and private sides, there can be issues: long waits associated with the public system, and rising costs for private health insurance.

Read more: US investors are pouring millions into a healthcare company that doesn't take insurance and lists its prices like a 'McDonald's menu'

As part of its business, Amil operated hospitals. When UnitedHealth came on board, Joseph said, they decided to go beyond hospitals so that they weren't the only place members could go for their healthcare.

"One of the things to focus on in Brazil was rounding out the care continuum so that the hospital door wasn't the only door in the health system," Joseph told Business Insider. "Being able to provide the right care at the right place for people, which gives to better outcomes, which gives to better cost."

So they set up an Optum - the data and analytics business within UnitedHealth - in Brazil to focus on aspects like population health, and other services that could be done without getting admitted into the hospital.

When UnitedHealthcare Global first got to Brazil, primary care was the least used specialty within the Amil member base.

To change that, Joseph said, the company set up health clubs and centers where members could go get check-ups and appointments for routine health concerns or vaccines. Today, it's the most-used specialty among UnitedHealthcare Global's members in Brazil.

At the same time UnitedHealth was applying some of its own US-based programs to the Brazilian market, Joseph said she learned a lot from what was happening on the ground in the country.

"Health systems are unique, healthcare is distinctly local," Joseph said.

For example, UnitedHealth wanted to bring chronic disease management programs it had developed in the US down to Brazil. It learned, however, that its members in Brazil didn't respond to the way UnitedHealth approached them as an insurer. But if the members were approached in a different way, say, by a doctor, they were much more willing to take part in the program.

Ultimately, the company brought that better approach back to the US.

UnitedHealthcare Global is now a growing business for UnitedHealth - in the first half of 2018, the business made $4.9 billion in revenue, compared to the $3.8 billion it made in the first half of 2017.

Now UnitedHealthcare Global is in Chile, Colombia, Peru, and Portugal in addition to offering health plans to people living working outside their home country.

Joseph said the approach the company's been taking globally has been to combine the expertise that exists at a local level with the enterprise backbone UnitedHealth can provide.

"We have focused on creating value in each one of those markets through the combination of our local capabilities, local experience, local teams, and our enterprise core competency," Joseph said.

See also:

• How a 29-year-old went from dropping out of an Ivy League college to leading digital strategy for America's largest health insurer
• One of America's largest healthcare companies wants to use AI to 'solve some of the most wicked problems in healthcare'

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