As a result of the progress at both Optum and UnitedHealthcare, we have increased our 2021 adjusted earnings outlook to a range of $18.65 to $18.90 per share.
You will likely have seen the CMS Medicare Advantage Star quality rating showing 95% of our UnitedHealthcare members will be in four star-rated plans or better for 2023, up from 78% for 2022 and a new high for our company.
Within Optum Care, on behalf of the many payers we serve, 99% of Medicare Advantage patients will be in four-star plans or better for 2023.
We were encouraged by the ongoing strength in our employer and individual business, which has now grown by over 330,000 people this year with revenue up 7% year over year.
Entering the open enrollment period for Medicare Advantage, we have more than 2.2 million people served under physician-led, fully accountable arrangements and expect '22 to be another year of record expansion in this key part of our portfolio.
Seniors served by our home and community offering experienced a 14% lower rate of hospital admissions and about a 4% higher rate of physician encounters.
Last week, we reached a new multiyear partnership with a leading and innovative health system, SSM Health, whose 40,000 employees, 33 hospitals and post-acute facilities and 300 physician clinics serve the people of Missouri, Oklahoma, Wisconsin and Illinois.
OptumRx continues to deliver to health system partners, such as its new multiyear agreement with Point32Health, which serves more than 2 million people in New England through its founding organizations, Harbor Pilgrim Health Care and Tufts Health Plan.
OptumRx is having a substantial impact through its community behavioral health pharmacies, which now serve nearly 700,000 people with mental health, addiction and other conditions through more than 600 dispensaries across 47 states.
The pharmacies deliver a high-touch approach to care that contributes to a more than 90% medication adherence rate and lowers emergency room visits and hospitalizations by 18% and 40%, respectively, driving better outcomes and a lower total cost of care.
Within our UnitedHealthcare government businesses, we have increased processing efficiency by 25% over the last year by using Optum technology to improve auto adjudication rates and intelligent work distribution to appropriately skilled channels.
In the third quarter, the Optum platform comprised 54% of enterprise operating earnings and continues to show strong growth momentum.
Our updated full-year '21 outlook includes unfavorable COVID impacts, consistent with the expectations we have discussed throughout the year.
This quarter, there were approximately 60,000 COVID hospitalizations meaningfully above the second quarter, with the month of August peaking at nearly 30,000 and then declining in September.
OptumHealth's third-quarter revenue and earnings increased 32% and 37%, respectively, year over year.
Revenue per consumer grew by 30%.
OptumInsight's revenue grew 13% in the quarter, and earnings grew 15% as the revenue backlog increased by 12% to $22.3 billion.
OptumRx revenue and scripts grew 6% year over year and earnings, 5%.
Medicare Advantage membership has grown 745,000 this year, inclusive of plans which serve dual special needs members.
We expect to add a total of over 900,000 Medicare Advantage members.
The number of people served through managed Medicaid grew by more than 1 million members over last year as we began to serve people in new regions such as North Carolina, Kentucky and Indiana, and as state-based redetermination activities remained paused.
Our liquidity and capital positions remain strong with third-quarter cash flows from operations at $7.6 billion, or 1.8 times net income, and we ended the quarter with a debt-to-capital ratio of 39%.
Still, as the dramatic variation over the last 20 months has demonstrated to all, prudent management suggests we should offer an outlook respectful of the fact that the current situation is without precedent.
These and so many other elements lead us to believe our performance expectations for the years ahead remain fully supportive of our long-term 13% to 16% earnings-per-share growth outlook.

Summary:
As a result of the progress at both Optum and UnitedHealthcare, we have increased our 2021 adjusted earnings outlook to a range of $18.65 to $18.90 per share.
Our updated full-year '21 outlook includes unfavorable COVID impacts, consistent with the expectations we have discussed throughout the year.
Our liquidity and capital positions remain strong with third-quarter cash flows from operations at $7.6 billion, or 1.8 times net income, and we ended the quarter with a debt-to-capital ratio of 39%.