John Rex
Executive Vice President and Chief Financial Officer at UnitedHealth Group
Thank you, Dirk, and Happy New Year, everyone. I'll start by expanding a bit upon Dirk's comments on the COVID impacts we're seeing. In the most recent weeks, in-patient hospitalization levels for our members are similar to the January 2021 levels, even with national COVID case rates about four times higher. For those people needing in-patient care, severity is seemingly lower as we are seeing shorter lengths of stay compared to that earlier period. At the same time, we are observing familiar correlations of care activity patterns to other periods of elevated infection rates experienced over the past two years. For example, in these early weeks of January, we are seeing slowing in primary care, elective visit and procedural volumes. Activity over the past several weeks shows primary care visits having declined about 10%, and an even higher rate of decline in specialist visits. As always, our prime focus is on helping people get the care they need when they need it.
Moving now to our specific business performance. OptumHealth's revenue per consumer grew by over 30% in '21, driven by the increasing number of our patients served under value-based arrangements. Consistent with the expectations we shared in late November, we had a strong start to the year and continue to expect to add 500,000 new patients in accountable value-based relationships, benefiting from the groundwork laid over the past many years.
OptumInsight's earnings grew 25% in '21 with operating margins approaching 28% for the year. We ended the year with a revenue backlog of $22.4 billion, an increase of $2.2 billion over the prior year. Our expanding relationship serving health systems has been a key factor driving this growth. And we expect these partnerships to continue to grow in '22 and beyond.
OptumRx earnings grew 6% for the year, driven by the continued expansion of our pharmacy services businesses, supply chain initiatives and strong cost management activities and benefiting from strong customer retention. In addition, we continue to see the impact of OptumRx's movement to a higher value pharmacy care and specialty services orientation.
Turning to UnitedHealthcare. Full year revenues of $223 billion grew 11%. As noted, our 2022 Medicare Advantage member growth outlook is very positive and consistent with the objectives we established at our November Investor Conference. Within the up to 800,000 new members we will serve in '22, about three quarters will be in individual and group Medicare Advantage and the remainder in dual special needs plans. And given the steady strides we've made in quality performance, we have the opportunity to enroll people in our newly rated 5 Star plans throughout the entirety of this year.
Our Medicaid membership outlook for '22 continues to incorporate an expectation that states resume eligibility redeterminations, resulting in modest net attrition. In January, we began serving the citizens of Minnesota and continue to support the Missouri expansion this year as well as renewed relationships with Ohio, Tennessee and Nevada. Over the course of the year, we will look to continue to expand upon the nearly 8 million individuals we serve across 31 states.
We concluded '21 with commercial membership about 200,000 people ahead of the original outlook provided. Creating this momentum is the strong response we're seeing to the new innovative products you have heard us discussed, products such as NavigateNOW, which use the Optum virtual network as a first option. Our capital capacities remain strong. Full year '21 cash flow from operations was $22.3 billion or 1.3 times net income, about $2 billion above the initial outlook we shared a year ago.
We continue to expect our 2022 cash flow to approach $24 billion, about 1.2 times net income. And we ended '21 with a debt to total capital ratio of 38%. These ample capital capacities allow us to continue to accelerate our investments, while remaining committed to an advancing shareholder dividend and supporting our expected repurchase of between $5 billion and $6 billion of stock in '22.
Our 2022 adjusted earnings per share outlook of $21.10 to $21.60 is consistent with the view we offered seven weeks ago. From this distance, in contrast to the past two years, we expect the seasonal pattern to be more consistent with our historical experience with just under 50% of full year earnings in the first half and the first two quarters comparably even.
Now I'll turn it back to Andrew.
