Profits at Minnesota's largest company, UnitedHealth Group in Minnetonka, grew twice as fast as sales last year as the company added hundreds of thousands of Medicare Advantage members and continued rapidly expanding its profitable Optum businesses.

UnitedHealth Group's $242.2 billion in revenue last year translated into $13.8 billion in net profits, growth of 15%. The company accounted for 23% of all the employees in the Star Tribune 50, and more than 40% of the revenue. The more pressing concern for the sprawling managed-care and health-services company is not past performance, but what's coming next.

The COVID-19 pandemic has decimated plans for 2020 sales and earnings growth at many health care companies. But for UnitedHealth's large commercial insurance division, analysts are concerned the business may make too much profit this year, because so much health care is being avoided while members continue paying premiums.

Visits to emergency departments declined 42% in late March and April nationally, compared to ER visits last year, researchers recently reported in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. No one knows what medical-care volumes will be later this year.

Many of UnitedHealth's commercial insurance members are seeing credits of at least 5% applied to their accounts this month, but the company may have to return more money to customers later this year. That's because of the federal cap on insurer profitability called the medical-loss ratio, or MLR, requiring insurers to spend at least 80% or 85% of premium dollars on medical care and quality improvement.

"If UNH has outsized profits from the pandemic, UNH will do all it can to get those funds back to those that need them [consumers, patients, clients, health systems]," Credit Suisse stock analysts wrote April 16, summarizing company management. UNH is UnitedHealth Group's stock ticker symbol.

But UnitedHealth also provides billions of dollars of direct health care and prescription drugs to patients, through its OptumHealth and OptumRx divisions. It's difficult to know how the changes in health care use, coverage and costs will turn out for the diverse company.

"UNH expects significant quarter-to-quarter MLR volatility this year," the Credit Suisse analysts wrote.

As of May 7, analysts there were still projecting adjusted earnings per share of $16.40 for UnitedHealth Group's full year, representing 8.5% growth in profitability. UnitedHealth has not changed its own 2020 EPS adjusted net earnings guidance of $16.25 to $16.55.

The only other health care company in the state with more than $1 billion in profits was medical-device maker Medtronic, where revenue held stable at $31.1 billion and profits climbed 3% to $5.3 billion for the four fiscal quarters that ended Jan. 24.

Joe Carlson • 612-673-4779