This is translating into significant NPS improvements in many of our businesses. And we removed friction from the system through expanded access to 24/7 virtual visits and UnitedHealthcare’s efforts to eliminate nearly 20% of prior authorizations. Throughout ‘24, you should expect to see an even greater investment in our digital capabilities, as we continue to identify opportunities to, leverage technology to reduce administrative costs, improve productivity, and further enhance the consumer experience at both Optum and UnitedHealthcare. And now, I’ll turn it over to John Rex, UnitedHealth Group’s, Chief Financial Officer. John?
John Rex: Thank you, Dirk. Our colleagues’ ongoing focus on further expanding and strengthening the foundations, which underpinned our growth pillars is paving the way for consistent growth in 2024 and beyond. Revenue in ‘23 of $372 billion grew by over 14% with double-digit growth at both Optum and UnitedHealthcare. Fourth quarter adjusted earnings per share of $6.16, grew 15% and brought full-year adjusted earnings per share to $25.12, a growth of 13%. As Andrew noted earlier, at the end of December, we entered into an agreement to sell our Brazil operations and expect to close in the first-half of this year. Upon closing, we expect to record a charge of approximately $7 billion, the majority of which is non-cash and largely due to foreign currency translation losses accumulated over several years.
The impact of this one-time charge will be excluded from our ‘24 adjusted earnings per share measure. For your modeling purposes, the full-year ‘24 outlook incorporated about $6 billion of revenue for Brazil or about 1.5% of consolidated revenue. Before reviewing our business results, I’ll offer some brief comments on care activity. Care patterns remain consistent with those we shared with you in the first-half of ‘23. Activity levels continue to be led by outpatient care for seniors with orthopedic and cardiac procedure categories among the more prominent. As we’ve noted, our benefit design approach assumed these activity levels persist throughout ‘24. And the care patterns we observed exiting ‘23 reconfirmed that decision. On the margin, we saw some modest late-year seasonal activity, such as strong and welcome response from seniors to scheduled physicians at this to receive RSV vaccinations.
In some cases, these were accompanied by additional necessary care being obtained, especially for people that had not seeing a physician in some time. A positive outcome for people’s health. In some though, as we reflect on full-year ‘23 results, overall care activity was broadly in-line with the views we’ve shared earlier. And as we enter ’24, we’re confident in the response of pricing and benefit design actions we undertook. With care patterns, continuing to be supportive of our care ratio outlook of 84% plus or minus 50 basis points. Turning to the performance of our businesses in ‘23. Optum Health revenues grew by 34% to over $95 billion as we increased the number of patients served under value-based care arrangements by about 900,000 to more than 4.1 million, expanded services in the home, and broadened and deepened the levels and types of care we offer.
Optum Insight’s revenues grew 30% to $18.9 billion. We concluded the year with a revenue backlog of $32.1 billion, an increase of $2.1 billion over last year. This growth was driven by our diverse and expanding product portfolio, which connects many of the key stakeholders across healthcare, whether it’s launching new decision support solutions for providers, claims editing software for payers, or simplifying the payment process for all, our continued investments are fostering the next phase of Optum Insight growth. Optum Rx revenues grew 16% to over $116 billion, driven by the continued addition of new clients, expansion with an existing relationship, and organic growth of our pharmacy services businesses. In 2023, both customer retention and new wins were among the best Optum Rx has delivered.
At UnitedHealthcare full-year revenues of over $281 billion grew nearly 13%. Adding to Andrew’s earlier comments, within Medicare Advantage, we expect a majority of our full-year growth outlook to be realized outside the annual enrollment period with the growth patterns consistent with those we have experienced over the more recent years. Our Medicaid enrollment outlook for 2024 balances two key elements. First is that, state redetermination activities will be largely completed by mid-year. And second, that growth within existing states such as North Carolina and other new opportunities will partially offset these impacts. Within our domestic commercial offerings, we expect to serve about 1.5 million additional people in ‘24, a strong result.
And we are encouraged by the continued positive customer response we are experiencing as we look ahead. Our ample capital capacities continue to underpin our long-term growth objectives. Cash flow from operations in ‘23 was $29 billion or 1.3 times net income. We returned nearly $15 billion to shareholders through share repurchase and dividends and deployed over $10 billion in growth capital to build for the future. To summarize our ‘23 performance and start to the New Year further solidifies and reinforces our confidence in both the ‘24 and long-term growth objectives we shared with you at the end of November. Now, I’ll turn it back to Andrew.
Andrew Witty: Thanks, John, and thank you, Dirk. Heading into 2024, I hope you all sense our confidence. We have talented people who are committed to our efforts, to help build a simpler and more consumer-friendly health system for the people we serve. And we are well-positioned to continue to deliver on the well-established commitments we’ve made. Operator, let’s open it up for questions.
Operator: Thank you. The floor is now open for questions. [Operator Instructions] We’ll go first to Justin Lake with Wolfe Research.
