UnitedHealthcare (UHC) recently commissioned Milliman to compare the total cost of care (TCC) for its commercial large group preferred-provider-organization (PPO) health plans against a national medical experience benchmark. For this analysis, we define TCC as the total medical allowed charges per member per month (PMPM), adjusted for health status, demographics, geographic mix, and excess large claims. The study uses 2022 historical medical claims and enrollment data from UHC and the MarketScan database of Merative, a third-party medical technology company. Results are also presented separately for employer groups that participated in UHC’s Naviguard program, an out-of-network (OON) program intended to reduce costs and provide enhanced advocacy to support a successful OON resolution. PMPM comparisons between UHC and the benchmark are reported at the Milliman Health Cost Guidelines service category level—specifically inpatient, outpatient, professional, and other medical services.

This report was commissioned by UnitedHealthcare.