UnitedHealth Group Incorporated (UNH) Earnings Call Transcript & Summary

Good morning, and welcome to the 2021 UnitedHealth Group Investor Conference. Delighted to welcome all of you who've been able to join us here in New York in person, and of course, to everybody who's joining us online. It really is a pleasure to have the chance to see many of you together again, and we really appreciate your effort to join us. During the next few hours, you're going to have the chance to meet with and hear from around 50 of my colleagues from across UnitedHealth Group, both within the room and virtually some video-ing in. I'm also delighted to let you know that our Board of Directors is here today and will be here throughout the morning. As we go through the morning, there'd be an opportunity to hear from the stage. There'll be a Q&A session, we'll have seminars. And there will also be chances to chat with our executives across the lunch tables as we break here in the New York meeting rooms. So I hope very much that you'll have a really great opportunity to get to know us and most importantly, to get to understand what we're focused on as we look at the next eras of growth for UnitedHealth Group. This organization is really all about its people and what those people can do for us. The people you're going to see here represents 340,000 other colleagues across the whole organization. Doctors, nurses, pharmacists, technicians, engineers, finance experts, marketing experts, customer experts, people who answer phones, people who run spreadsheets, people who give injections, people who replace hips. It's an extraordinary panoply of skills of passionate people. People, who every single day wake up in the morning inspired by the mission of UnitedHealth Group. And that mission doesn't just inspire the people who are here today and the people who work inside this organization. It inspires people on the outside. In the last few months, you've heard that label, The Great Resignation. Interestingly enough, in the same period at UnitedHealth Group, we've received 827,000 applications from -- for people to work for us in the United States. Worldwide, it's over 1 million people. Interestingly enough, we have about 400,000 or 500,000 people apply more than once. So they're super inspired by what it is we're trying to do. Within our leadership today that you're going to meet, you'll also meet people who've come from all sorts of different places. You'll me people who've been here just a couple of months, and you'll meet people who have been here for 25 years. You'll meet people who have built their entire career at UnitedHealth Group, and you'll meet people who have recently joined from other advanced careers. You'll meet people who used to work in government, people who used to work for our competitors, people who come from the Blues, people who come from companies like Target. You also might find the occasional refugee from big pharma. So this is a great organization of talented people focused on making sure that this company can truly transform health care. And we do that based on our 2 platform businesses, Optum and UnitedHealthcare. We're focused on trying to make the experience for individuals and families simpler, more affordable, more accessible so that they can live a healthier life so that they can really face their health care challenges with less anxiety and less worry about how to navigate a complex system. And it is a great paradox when you think about U.S. health care; so much money invested in innovation, so many people, so many smart people, medics innovators, Silicon Valley, Boston, every hospital system, trying to figure out better and new ways to do it. And yet, somehow, despite all of that effort, all of that innovation, all of that investment, all of that talent, it remains too expensive. It remains too complex, and it creates too much anxiety for the people who rely on it. One of the reasons for that, I would argue, is that for all of that innovation, the system remains hugely fragmented. It's point solutions. But what we've learned, I think, over the last 10 or 20 years is no matter how clever an individual point solution might be, it's just a point solution. And in some ways, clever point solutions can just add more and more complexity to an already complex system. And so for us at UnitedHealth Group, we're more and more focused on how can we take those areas of innovation, how can we think about it in a more systemic way, how can we integrate rather than fragment? How can we bring smart innovation combined with the right kind of incentives aligned with what individuals need to make sure that we can develop really significant services and product offerings that can truly make a difference, not just add to the weight of health care activity. And that really has been the foundation stone laying process that has been going on over many years at United Health Group in both UnitedHealthcare and of course, in Optum. By the way, you might notice today a slightly updated version of the Optum brand, which you'll begin to see reflected. I'll come back to that later in my comments. As we think about how we might integrate and we look forward, it takes us to a very exciting space around how we think about growth for this company. And one of the things I hope you take away from the next few hours and everything we share with you, is a relentless fixation on the growth opportunities that we have at UnitedHealth Group. And I would argue they've probably never been greater for this company for 2 reasons: one, the need outside in the real world is extraordinary and not getting smaller; and two, the skills and the foundations which have been laid have created a fantastic position for us to now be ambitious around new areas of growth and opportunity to better integrate services to give better service to our clients, customers, patients and their families. So let me pick out just 5 areas, which we're going to be focused on over the next several years. Some of this is going to be relatively familiar, some a little newer. But these are the 5 areas that we would really expect to drive the growth of UnitedHealth Group over the next several years. First and foremost, value-based care. The care delivery area, the whole story that you've seen developing here at UnitedHealth Group as OptumCare works with UnitedHealthcare to ensure that we can develop a highly effective approach value-based care, making sure that the physicians have the time to do the preventative work, have the focus on the patient and deliver, in our view, superior experience, superior economic and clinical outcomes. That's what we've been building. You've heard us talk more and more about that. It's a huge part of the growth of this company. It's a big driver of the growth we expect to see next year as we double again the number of lives that we take under full capitation within OptumHealth and OptumCare. But it's important as we think forward, not just to think about OptumCare or even value-based care as simply a primary care strategy. It's not just a clinic strategy. We see that now much bigger. We see that as a clinic strategy wrapped together with our behavioral care strategy, wrapped together with our ambulatory strategies, our virtual strategies and others. So think much more about how we can wrap those services all the way around the patients and their families. How we can certainly use the physicians at the center of that network really as quarterbacks for all of the other capabilities we have. Think about how it might happen in the clinic, but it might just as easily happen in the patient's home. There should be no division between medical focus and behavioral focus. After all, the brain is joined to the body. And so making sure that we think about all of these things together is going to be central to the future growth of the value-based care strategy. That care delivery agenda is a great first example of how we are relentlessly integrating, working together across our organization, focused on collaborating between the strengths of Optum and UnitedHealthcare to build what we believe can be differentiated contribution to patients' lives. Second area, health benefits. UnitedHealthcare Platform is an extraordinary platform from which to envision everything else that comes from UnitedHealth Group. It would be almost impossible to build the scale of care delivery and value-based strategy that we have without UnitedHealthcare. The vision that comes from that organization, the teams of people who lead that organization in terms of understanding what's needed by our most needy patients across the U.S., whether they be seniors or complex patients, folks who've been excluded from care is an enormous opportunity, has been a fantastic foundation stone of this company. But we see the potential growth there in many areas, you'll hear a lot more about that in the seminar later today and during some of the further sessions. Health technology. How can we leverage the technology that we have inside of this organization to be a much greater contributor to the modernization and streamlining of the health care system. You'll hear a lot about this in the way we're working with hospital systems. We're often painted as not necessarily the friend of the hospital system. As you'll hear later today, we're increasingly becoming the ally of our hospital partners. And that's where we want to be. We know through our technology capabilities, we can truly help our partners in the hospital sector, release enormous value and transform their own businesses. Just one example of how technology is going to be a key driver of this organization. Another place with technology we'll speak to directly is our fourth area of future growth, Health Financial Services. The entire financing network, the complexity of how people get paid, the number of glitches in that system screams out for modernization. It requires a streamlining of the plumbing, and it requires a re-envisioning of how fintech within the health care system can be developed in the 2020s rather than relying on 1990s technologies. That's an area that we believe we're in a great position to influence, and you'll hear again more of that today. I'm delighted that Kurt Adams is here as well today, who leads our service organization, he'll be around for you to talk to us well around exciting programs he's running around cash card and other off-benefit financial service opportunities that we see being developed. So those areas play incredibly exciting role in the future of the business. Fifth and final area, of course, the most commonly transacted part of health care, pharmacy. Pharmacy remains the key touch point across the entire health care system, but pharmacy is changing, and we're going to change with it. The future is not going to be these enormous scale high-volume PDMs. The future is all about how we can really make sure that we are at the cutting edge of frontier medicines, rare disease, specialty sure that we're going where this environment is going. The overwhelming majority of new technology in pharmaceuticals is heading towards the specialty complex space; our business will evolve accordingly. But we see that pharmacy platform as a strong area of growth and of course, an integrated part of everything else I've just talked about. Hard to imagine value-based care without an integrated pharmacy solution. That's why we're continuing to build up our community pharmacy, platform within the behavioral health space, just as one example. So some really important growth areas for the company. All of that comes on top of what you've seen so far. So we continue to believe that we can be a relentless multi-payer organization. We are incredibly proud that a huge fraction of the Optum business is servicing non-UHC clients. We expect that to continue to grow. That's a key driver of this company. We do not judge ourselves by how well we like each other. We judge ourselves by how well we deliver for others, how well we innovate compared to our competition. And we recognize that we're just a relatively small piece in this giant health care ocean, but we do believe that we have a really unusual mix of opportunity. We have that opportunity to combine our innovative juices, stimuli with the capacity to scale and test quickly. You're going to see some really good examples of that today. I'm going to call out Optum Virtual as a really great one. Optum Virtual had almost 0 lives at the beginning of 2021 by the end of next year, 14 million people flowing through that network. So to go from 0 to 14 million in about 12 months just demonstrates the capacity of the company to take an idea, tune and develop it, scale it. That's really something of value to the entire health care system is it can help others see the path forward, and that's good for everybody. We want everybody's experience to improve. Let me just lift up the perspective just a little more and maybe be a little bit more reflective. So if I look back over the history of the company, very simplistically, you might say that we've typically met an individual or a family through the UHC insurance platform of the company. And then as Optum has been built, we gradually introduced those members to various services that UHC has commissioned to provide to the membership from Optum. So essentially, we've met people through the insurance membership, and we've gradually connected them to Optum. And that's been great. And that has been a fantastic evolution for the 45 million members in the U.S., the UHC look after every day. But I think in the future, things are going to evolve dramatically. In the future, we got to recognize some really incredibly important changes. Some of it stimulated by COVID, some of it well established before; consumers, patients, families. They want more direct engagement. They want more direct relationship, and we are in a fantastic position to build that through Optum. And so as I look forward, in addition to that mechanism I just described, where we meet people through insurance and then we connect into service, in the future, it's just as likely, in fact, I think it'll be more likely that we will first meet people through Optum. We may meet them as a patient, one of the 30 million or so who roughly come into our clinics. We may meet them through pharmacy. We may meet them anyway through Optum. The key is then is once we've met them through Optum, making sure they're introduced to all of the other services and opportunities that we can give. Let me give you a very simple, completely made-up example. Imagine somebody comes to us online to Optum's store looking for Advil. Okay. That's great. I'm delighted they've come to us for Advil. But maybe they're coming to us for Advil because they have a sore knee. And while they come to us, they realize that we have a clinical network that can help consult maybe virtually on that knee. So they got to Optum Virtual. And maybe through that, they find their way to a referral to an SCA center for a knee replacement because it turns out they really needed a knee. But on the way to the knee replacement, they also realize they don't have the money to pay for the knee. So maybe there's a short-term financing need for that patient and maybe Curtin Financial Services can help on that. And then while that's all going on, that 28-year-old invincible actually realizes they're not so invisible after all. And after the surgery decide actually, they should have had insurance all along, and then they meet UHC. And that's really the future of the company. It's really a reversal of the model we've used in the past. And it's an opportunity for us to reach out. It's an opportunity for us to lift our growth ambition from 45 million members to 330 million Americans. And that's really the growth perspective as an organization, we are really focused on. Those 5 areas I talked to you about, value-based care, health benefits, health technology, fintech and health care and pharmacy are the next 5 great opportunities for us to build an integrated approach, absolutely deliver that for our insurance membership and absolutely offer it to consumers who might meet us in any one of those venues I just described. To do all of that, we need to really step forward in our technology platform and capability to ensure that we are a go-to consumer platform or venue. Whether they come to us physically or remotely, we want to make sure we are best in class, and we're not today. That's an area where we will absolutely be engaged. So 3 themes really pull through from what I've just talked about, that really are necessary for us to be excellent at to deliver those 5 growth areas. Number one, collaboration between UHC and Optum. Co-innovating, helping, try, fail, scale, succeed, all of that needs to be done together. Fantastic internal collaboration is the key to creating these insights, these integration points, know which piece of innovation to take, know how to stitch it together, know how to launch an integrated model. Second, technology. Huge need for us to continue to appropriately understand the data we're privileged to hold and make sure that we can connect people more effectively. And thirdly, our consumer skills, making sure that we are truly able to be there personally. When an individual needs us in whatever venue they need us, Optum becomes the front door for the company. It becomes a way to democracize (sic) [democratize] access to the technologies and the capabilities we have. We think that can underpin sustainable growth for the future of the company. But sustainability doesn't just extend to the economics of this organization. It extends to our much broader contribution. And today, for the first time, you also have the opportunity to attend an ESG seminar. And I'm delighted Patricia Lewis, our Head of Human Capital, is going to be leading that session. I hope very much you'll take the opportunity to go listen to Patricia and the team there. There's a lot for them to talk about. This is an area we're really doubling down on, both internally and externally. Our acceleration of our diversity and inclusion commitments and our progress there, under Patricia's leadership, has been terrific, but it's really just beginning. There's tons more for us to do there, but we are determined to be a leader in that space within the health care sector. Our commitments across the board on areas like health equity, you'll hear much more about in the seminar. It's an area we think is completely authentic for us to make our contribution to social environment. It's to our core. It's to our mission. It's what we try and do every day. And by focusing on the health equity agenda, it makes us more restless, more interested in trying to help those who might be excluded. You'll see an example of that later on this morning. And then thirdly and finally, of course, the environment. And I'm delighted to tell you that today, for the first time, the company is making a commitment to be net zero by 2035. We made that commitment with a joint commitment to say we will achieve that without reliance or minimal reliance on carbon offsets. We're going to do it authentically and properly. And we are determined to make sure that as part of our efforts to streamline and simplify health care, we're going to do that in a way which contributes to carbon reduction. We're involved with the National Academy of Medicine Decarbonization Strategy nationally. UHC co-chairs that alongside the administration and the National Academy of Medicine. It's a great place for us to help the whole sector move forward in this important agenda. And there's one other little thing we're going to try and do, we're going to try and take our business paperless in the next 2 or 3 years. That might sound really minor. But actually, when you think about the amount of complexity and the amount of paper which is generated in the system, I don't know how many explanation of benefits letters you all receive you can imagine if we can start to make progress there, it's a really tangible way of demonstrating simplification. So our commitments are all about growth, are all about pulling together areas of innovation and opportunity, trying to drive integrated service offerings to open up new areas of opportunity for patients, providers and of course, for ourselves. And we aim to do that in a deeply responsible way, as you would expect from this company. We want to do things that are authentic. We want to do things that last. We want to do things that make a difference. We want to do things that make a difference for individuals and their families. We want them to be healthier. We want them to recover more quickly, and we want them not to be anxious about being able to afford their care. We think if we can do those things, we have a remarkably sustainable growth profile going forward. And I hope during the rest of the day, you'll have the chance to get to know more and more of that detail. We truly welcome your engagement and your questions as we go through the rest of the sessions. With that, I'd love to invite John and Dirk to come up on stage for us to kick off the rest of the session. Just while they're coming up, you're going to start to hear us talk about a series of different activities going deeper into some of the things I was just talking about a little bit earlier on, but there's a few common themes. So rather than repeating it 18 times during the rest of the morning, I thought I might just give you the headlines up front. The kind of thematics that might run through what you're going to hear. The first, you're going to hear a lot about data analytics being a kind of underlying capability, clinical expertise, of course, making sure that we're doing a great job of trying new ideas and then bringing them to scale as fast as possible and how we can drive greater connection across the whole system. All of those 4 things, you're going to keep hearing time and again: data analytics, clinical expertise, getting to scale, quick try, move, innovate, move this business forward. really trying to underpin the mission that I described all the way through. So I hope you recognize that kind of aspect of our work as we go through the session this morning. And who better to start us off than Dirk?

Thanks, Andrew. That's a great place to start. When we talk about value and a value-oriented system of care, we have something specific in mind. For some, it's about risk transference or incentive payments. Those are critical access -- those are critical aspects, but we actually take a broader view. Put simply, it's better care at lower cost. For payer, provider, consumer incentives are fully aligned. For care providers, it's about creating greater capacity for patient care, ensuring physicians have the time, tools, insights to care for their patients when they're sick and to keep them well. For payers, it's about making high quality, accessible and affordable, keeping chronic conditions in check and making every health care dollar do more. For consumers, it's about simplicity and outcomes, quality care whenever and wherever they need it. These pursuits are connected. They can't be achieved in isolation. In order to drive growth, we're mobilizing the full capabilities of UnitedHealthcare and Optum to create a better system in 3 specific areas. Okay. This is the tell him what you're going to tell him part of the talk. So everybody pay attention. One, driving value over volume; two, creating comprehensive home and community care at scale; and three, streamlining and simplifying the health care system. That's the focus of what we'll talk about over the next few minutes. So with that, I'll turn it over to John.

Thanks, Dirk. Driving value over volume at scale can deliver durable improvement for the health care system. But evolution of this magnitude is difficult in a system where the fee-for-service routes run deep. It's especially difficult for physicians and health system trying to balance the daily demands of volume-based business models, all while building the financial and operating capacity to move to fully accountable care. Optum and UnitedHealthcare are helping tens of thousands of physicians move along the value continuum. And we are accelerating these efforts because they help patients live healthier and more independent lives. These more accountable models resonate with physicians. They can spend more time with their patients, provide high-quality care and have measurable impact on their patients' health and well-being; ultimately, all the reasons they became doctors in the first place. As we work together, physicians get access to a collaborative network of peers, advanced data for more informed decision-making and technology that aids clinical approaches, care coordination and administrative management. And we are by their side helping navigate every step of the transition. The experience on this journey of Dr. [ Rafael Rodriguez ] illustrates this well. [Presentation]

We get to hear those stories almost every day. And Dr. [ Rodriguez ] is among the 60,000 physicians who care for more than 20 million patients in more than 40 states. OptumHealth today delivers value-based care to 4.5 million patients with more than 2 million in fully accountable arrangements. Our growth continues in many ways, including standing up optimal sites of care, which combines strong outcomes with physician and patient convenience at far lower cost, adding physicians organically, even hiring directly out of residency and providing mentoring and training, and attracting new patients due to our high-quality comprehensive service offerings. We're expanding in new geographies such as the Northeast corridor, where we now serve almost 4.5 million patients, more than twice as many as 4 years ago. And we're deepening our presence in long-established markets like Texas, Florida, California and the Mountain West. We asked some colleagues in Southern California to explain more about their experience. [Presentation]

[ Beth ] and [ Amer ] show that UnitedHealthcare and Optum can have a profound impact, both when collaborating directly with each other and when they direct their considerable capabilities toward a common goal of improving experiences for people. UnitedHealthcare has been a leader in provider-oriented value-based care for many years. In fact, to date, most of our UHC Medicare Advantage members are cared for by a provider with some level of value-based arrangement. However, the scope is quite modest compared to what we believe it can and should be. Looking at the Optum Care practices, those that have been with us the longest consistently deliver top clinical and patient outcomes, including almost 20% fewer hospitalizations, and achieve strong operating performance. In fact, at those longest-standing practices, the number of patients served, number of physicians and total revenues have grown by multiples and largely organically. This evolution doesn't happen in just a year or 2, it is a multiyear process. So as we think about the growth potential, what's striking is that over half of our current practice portfolio is what we would consider still quite early on in their transition. And even among those most advanced practices, we still have considerable opportunity to build out the scope of their service offerings. This is one important reason why we are confident in the long-term double-digit growth outlook for the business. Further, we expect continued growth as we expand our coverage of value-based arrangements to serve more people in the commercial and Medicaid channels as well as adding more people in Medicare Advantage. Andrew?

Thanks, John. As I said before, the opportunities in home care will be massive over the next decade as growing capabilities enable it to become a practical and preferred setting for primary urgent and post-acute care. We already know how much cost can be taken out of the system by simply shifting care settings moving half of routine joint replacements to ambulatory centers, diagnostic imaging into low-cost centers and treating people at urgent care instead of emergency departures, could save the system almost $400 billion over the next 10 years. But there's way more that could be gone after. The real opportunity lies in migrating more care out of facilities and into the home. There are many facets to our comprehensive home and community model. And today, we'll highlight 4: home, virtual behavioral and community care. Let's start in home. High-quality home care is only possible with a value-orientated payment model. We just won't work in the fragmented fee-for-service world, given the time pressure physicians face with high patient volume. Instead of getting paid based on how many patients they see, a value-based model compensates providers on the quality of patient outcomes, which is why home care and the more personalized approach that comes with it are so important. Here's how Dr. Kylander and her team are supporting a couple in Boston. [Presentation]

I'd just like to say thank you to the [ Parker ] family for letting show that, and I hope you will join me in wishing them all the best as they face their health challenges. I'd like also maybe to ask Dr. Wyatt Decker, the Head of OptumHealth to comment a little bit from your perspective on what we just saw.

Yes. Thank you, Andrew. What you just saw that comprehensive care focused in the home for the [ Parkers ] is an area of significant investment for us at OptumHealth, particularly for seniors. In fact, in 2022, we'll nearly double the number of fully capitated lives we're caring for in our home and community platform. And the other comment that I'd share with you is the deep satisfaction that our clinical teams have working in these kinds of environments. Dr. Kylander is triple-certified in family medicine, geriatric and palliative care. She now does 5 or 6 in-home visits a day, instead of 15, 20 or 30 visits in a clinic setting in a fee-for-service practice. She tells me she loves her job, and she really hope she never goes back to the grind in a fee-for-service practice in the clinic setting. In the home, we often see things and gain insights around social determinants, food and security or even fall risks that we would never do in the clinic. So Andrew, this is a very powerful platform for us that will continue to add value as we grow.

That's great, Wyatt. Thanks. And I think as you and I have talked before, you can imagine in the future, primary care being much less office orientated, and over time becoming much more home orientated. And as you just heard from Wyatt, that seems to work well for a lot of the physicians, and it clearly works for the families. It's a lot easier to see the challenges and the problems when you're in the home just as you saw with the [ Parkers ] there. Of course, that's just one way where we're meeting people in the home. Another is through house calls, a true collaboration between Optum and UnitedHealthcare, where our clinicians help seniors in Medicare Advantage programs manage their chronic disease, close gaps in care and stay healthy and out of the hospital. Our teams not only look after our members' medical needs, they help with any number of life challenges like keeping healthy food in the fridge or find an assistance with a utility bill. Our house call clinicians will make about 2 million home clinical visits in 2021, leading to hundreds of thousands of referrals for much needed care. Nearly 80% of that results in an in-person visit with a physician within 90 days. Now you can imagine the last 18 months, how important this has been for seniors who just didn't want to leave their homes during the COVID pandemic. Imagine how isolated they would have felt if it wasn't for those visits from our house call teams and how many gaps in care would not have been spotted and how much disease would have spiraled further out of control. Helping people safely return home from the hospital is also critically important. And this year, we'll managed nearly 500,000 post-acute care transitions earning member satisfaction scores of more than 90% and reducing cost by nearly 25%. Another critical element of our strategy is virtual care. I mentioned a little bit about this earlier. Virtual visits, yes, offer transactional convenience, but we believe there's more value to patients and physicians when the full range of care services, primary, urgent and behavioral care are all integrated and available at a moment of need. That's why we built the Optum Virtual Care platform. It lets patients connect with their own care provider, not just any care provider, and is now available 24/7 to more than 7 million UnitedHealthcare members. And as I said earlier, in '22, we'll be able to provide access to double that number, 14 million across all 50 states. This is an example of how we can quickly bring good ideas to scale through enterprise collaboration, meeting a critical market need while going from 0 to national scale in just months. Optum Virtual also provides the backbone for UnitedHealthcare's brand-new virtual first health product, NavigateNOW. It connects members to a personalized care team, simplifies the experience for patients and helps reduce premium cost by about 15%. It is currently available to employees in 9 cities, and we plan to add 25 more cities by the end of next year. And then we intend to offer it to our self-funded customers starting in 2023. Here's how it works. [Presentation]

Ask almost any employer or payer, and they'll talk to you about the challenges of meeting the fast-growing demand for behavioral care, not just with point solutions, but with fully integrated and connected care. We're really leaning into this need, as I suggested earlier. So far this year already, we've added 35,000 providers to Optum's behavioral health network, which now totals more than 300,000. Behavioral care should be an intensely person-to-person experience. So it's important to have the capacity to be at the patient's side whenever and wherever they need it and increasingly, that's done virtually as well. In fact, today, we deliver about half of all of our behavioral services in a virtual setting. We know demand for quality behavioral care is going to keep growing. So we'll continue to build on our broad capabilities to help people get the compassionate care that they need, from those coping with mild levels of anxiety or depression to those with severe complex needs. In the past few years, we've shared with you the work underway in our community pharmacies to address these needs. Over time, we've worked to more tightly integrate our medical behavioral pharmacy care services across all modalities, digital, telephonic and in person. And today, we'd like to share more about how we're finding people who really need help and connecting them to the full range of resources they need to stay out of the hospital and lead more independent lives. [Presentation]

So again, we'd like very much to thank [ Jordan ] for letting us share his story. Actually, he made a phrase in the middle of that conversation, which encapsulates everything, "My life changed when everybody else got their act together around me." That really brings to life this notion of integrating our activities. That's what he was describing. He was struggling to get traction in all of this system with all of the challenges he faces. When everybody else started to work together and integrate, then his life changed, an extraordinary impact. Now as many of you know, our community pharmacies, which have grown very significantly over the last 3 or 4 years, are very often co-located with family health centers, community health centers. And often you'll go and you'll see lines of folks in similar situations to [ Jordan ], lining up outside, waiting to access these sorts of services. The demand is quite extraordinary, and we're incredibly proud of the services that we deliver to these folks. Heather Cianfrocco is with us, who's the President of OptumRx. And Heather, you oversee all of this, so maybe I'd love to get your reflection.

Yes. I'd be glad to hear. Thanks, Andrew. And you also just witnessed a very heartfelt first in-person visit between [ Jordan ] and [ Allison ] after over a year of working together virtually. So [ Jordan ] was first identified by Optum Behavioral Health for the comprehensive Medication Management Program, which you could see here that [ Jordan ] needed and [ Allison ] helped him with so much more than just medications. That community pharmacy program that Andrew talked about really works to bridge the gaps between behavioral and medical care, medical and pharmacy services by identifying services that a patient is receiving and then identifying those unmet needs. In this case, [ Allison ] really helped [ Jordan ] with even stable housing. So we'll spend a little bit more time this morning in our OptumRx seminar talking about the community pharmacy program as well as the continued collaboration between Optum's Behavioral Health and our pharmacy businesses. But in the meantime, I just have to give a huge thank you to [ Allison ] and [ Lindsay ] of the community pharmacy program as well as [ Yolanda ], our housing partner, for the work that they're doing every day to make what's sometimes a fragmented system more connected for everyone we serve. Thanks, Andrew.

Great. Thanks so much, Heather. And I'd encourage all of you to spend some time with Heather and her team in the pharmacy breakout session or seminar. In addition to what you've just heard to Heather, there are a whole series of really exciting updates in terms of the specialty programs that our pharmacy teams are beginning to build and accelerate into the marketplace. Heather, thanks again. So people like [ Jordan ] who struggle with behavioral challenges often have other medical and social needs. They need whole person care. But they're not always easy to find. Some are without fixed addresses, many without phone numbers. So to reach these people, we need to find better ways to engage and connect others holding the threads of the social safety net, from housing to social services to behavioral health. People who are trusted in their communities and have the credibility with their neighbors, especially those in need. So we began working on a new model that we call Catalyst, created to help advance health equity, one community at a time. The program combines UnitedHealthcare's data with the perspectives of key local partners, local health centers, public housing authorities and social service providers to create long-term sustainable interventions to address each community's unique health and social needs, challenges like homelessness, opioid addiction, maternal health. Each local collaborative establishes its own measurable goals and each partner is accountable for specific results. Let's take a look at how we're bringing this model to life in Ohio. [Presentation]

Increasingly, action plans for addressing social determinants of health are becoming standard in government RFPs and contracts. Our Catalyst work in our Medicaid proposals has helped us already win contracts in Ohio, Tennessee and Minnesota. And we believe it will continue to distinguish our efforts as we see more opportunities in other markets. In the home, in the community, you can see how we're bringing these pieces together and mobilizing comprehensive solutions, connecting people to the care they need where and when they need it. Now Dirk will share how we're working to help streamline and simplify the health care system. Dirk?

Thanks, Andrew. The drive to make health care work better for people's needs happens -- these happen on 2 levels. First, the elements that directly touch the consumer and influence how they think and feel about their experiences; and second, the elements that take place at the system level would have a downstream effect on how care is delivered. There are many areas today where our teams provide outstanding service at that individual consumer level. Take our Medicare Advantage programs, which are direct consumer-to-consumer businesses where customer satisfaction is paramount. Today, 95% of UnitedHealthcare MA members and 99% of UnitedHealthcare's MA members served by OptumCare will be in 4-star plans or better next year. But the reality is, to many health care experiences, including some of our own, still don't measure up. We're going to make that better by focusing on the full end-to-end journey and working to simplify every touch point. Health payments and integrated banking are a perfect place to start. As a financial service company, that's in the transactional flow of health care Optum Financial supports more than 8 million consumers with their health bank accounts and has deep relationships with over 2 million care providers. It was because of our unique capabilities that the Department of Health and Human Services asked us to deliver more than $100 billion in CARES Act lending, ensuring providers had essential funds to keep their doors open during the spring and summer of 2020. And that was on top of the provider payments we processed during the normal course of business that year. Looking to the future, Optum will continue to build out capabilities to help streamline and simplify payments and eliminate pain points from providers, payers and consumers alike. For providers, we'll process nearly $260 billion in electronic payments this year, up from $178 billion last year, taking out paper and saving money. We're driving hard to improve their cash flows, applying technology and adaptive multi-payer payment capability to unlock working capital in real time while reducing the stress and administrative burdens also. For consumers, we're helping to make health payments more convenient and affordable giving them the confidence as they seek care with trusted payment options. One example is Care Cash, a prefunded debit card for members to use to pay out-of-pocket health care expenses with primary care providers and doctors who meet the right standards for providing high-quality and cost-efficient care. Another example of it is a first-of-its-kind health banking card with differentiated rewards. We're using our proprietary technology and network of more than 30,000 retailers from big box to local pharmacies to ensure consumers get the most value from their benefits and adopt healthy behaviors. In January, we will introduce our members to the UCard. UnitedHealthcare's Steve Warner, is here to tell us a little bit more about it. So Steve, how is the weather in Minneapolis today?

Yes. Good morning, Dirk. It's another beautiful but chilly morning. The lakes have started to freeze over, but no snow yet this year. So the people who love the snow are getting a little restless.

Yes. They just can't wait to use their snowblowers. I know how they are. It's the typical Minnesota profile there. So it's like, hey, tell us a little bit about the UCard and what we're trying to achieve and what the objectives are.

Yes, sure. So every year, insurers send to millions of Medicare Advantage consumers multiple cards to engage in their plan benefits. These include a member ID card to use of the doctor's office and the pharmacy and OTC card for the purchase of approved over-the-counter items, a fitness card to access in-network gyms. Many D-SNP plans today now offer a food benefit as well. So you get a food card to support that benefit. And on top of all of that, you get rewards cards for completing health-related activities. And while each of these cards serves a valuable purpose, the experience of so many cards can often be overwhelming, and it can be confusing. So we challenged our teams to do more with less, and we created the UCard to really do 3 things: first, to combine all of those plan elements onto a single card that's easy to use and that reinforces the UHC brand throughout the plan year. Our members get 1 card that can be used across settings for everything from benefit verification to plan engagement to payments. The second thing we wanted to accomplish with UCard was to enhance our rewards programs and make them more accessible to consumers. When our members do things like get a flu shot, get a mammogram or even walk a certain number of steps in the day, financial rewards can be automatically loaded onto the UCard. No extra steps required, no additional cards to mail. It all just happens. And then finally, we wanted to give our members more options. The payment technology that's embedded in the UCard allows our members to shop for things like OTC items, food items or to spend reward dollars at over 30,000 retail locations around the country.

Good. That's great. Great explanation. So Steve, how big do you think this can be?

Well, yes, as you mentioned, we're going to launch in '22. By 2023, we expect to be rolled out nationally to our individual Medicare Advantage population, and we're aggressively working to add even more capabilities to the card as well. Ultimately, though, we think the potential for this technology is much bigger, and we can actually see a future where this capability replaces member ID cards for tens of millions of consumers across product lines, making health insurance a little bit simpler and more satisfying.

That's great. Thanks for the great work, Steve. I appreciate all you and your team are doing. So let's next shift to pharmacy, the most frequent consumer touch point in health care. We've seen several people today who are taking multiple medications. This is an area where we've been innovating to help make it more simple. Dr. Anne Docimo, United Healthcare's Chief Medical Officer, is coming to us today from the City of Brotherly Love to share more about our multi-dose packaging program and who it's designed to serve. Hi, Anne.

Hi, Dirk. Good morning.

How's it going there. Is it Philly today?

Well, it's great here in Philadelphia, so -- where it's always sunny. It's a great day.

Yes. So tell us a little bit about the capability. Go right ahead, Anne.

Well, we do have a multi-dose packaging system for drugs, but it also includes a comprehensive medication review. And the first step is really the pharmacist reviews the entire medication list to look for opportunities to optimize the plan. These opportunities can include things like generic substitution, dose adjustments, which could be for patients with kidney disease or other conditions and also de-prescribing, actually discontinuing medications. This may happen if a patient is on 1 -- 2 or more medicines in the same class, like statins to treat high cholesterol. And this happens because patients with multiple conditions often see multiple providers. Once this list is finalized, the pharmacists contact the prescribing physician, they review any recommendations and make any necessary adjustments. So in this way, from this comprehensive review, the medications for that member are definitely going to be safe and effective. Once the list is finalized, the medications are put into date and timed packets and they're easy to use and easy to open. It's a very simple system. And members get everything they need delivered to their home every month.

No, I think that's great, Anne. And I know the perfect use case. I can remember when my mom was taking care of my dad, there was -- she had a big yellow pad and on the top row of medications and on the side were the dates and the A.M., P.M. and the like, and she would go through and she checked off when she gave the medication. So this capability, clearly, eliminates that sort of problem that she had.

Right. And your father's -- that story is not unusual. Members with multiple chronic conditions, can be having 10, 15, even more different medicines every day. So managing that can be really challenging, especially if you're trying to do it on yourself -- by yourself. So this simple system has worked really well. Members can be compliant with their care plan. And in some cases, it actually helps them to remain independent living at home.

So thanks, Anne. Great work. I appreciate everything you and your team are doing. See you, Anne. Okay. So this approach, the technical process and innovation is really cool. But here's what counts, people are taking their medicine. Adherence rates are in the 90s, very similar to our community pharmacies at much higher rates than people using traditional models. These are just a couple of ways we're working to improve the consumer experience, care that's more accessible, more convenient and more effective. We'll continue to build out our suite of direct-to-consumer offerings and connect cross-channel experiences. As Andrew said earlier, this is how we'll reach people in the future with Optum as the front door. As we work to make experiences better for people, we're also focused on system-level change. Health systems play critical roles across the country but face growing financial and operational challenges. With our broad capabilities, scale and experience, we are uniquely able to help tackle the most pressing issues. When Optum works with a health system, we start with revenue cycle management. But ultimately, we draw on the full strength and breadth of Optum: operations, analytics, technology and care coordination. Drawing on combinations of these building blocks, each partnership is structured to meet the health system's unique circumstances and needs. Our success is tied to theirs, as agreements are structured with totally aligned incentives. Our goal is to provide local systems with the capacity they need focus on their patients and ensure long-term financial stability. Over the last couple of years, we've established partnerships with a growing number of health systems from coast to coast, each structured to meet the system's unique circumstances and needs. These include most recently, John Muir Health in San Francisco Bay Area, where we're focused on improving the consumer experience across the systems, clinical and administrative touch points. Boulder Community Health in Colorado, where we're working to create a management model that connects its ambulatory and acute settings. New York State's Bassett Health Network, where we're trying to solve patient access challenges given the system's large rural geography. And our newest relationship SSM Health, a broad-reaching partnership aimed at accelerating value-based care and digital engagement across their Midwestern markets. Two of our valued partners can give you a better sense. [Presentation]

As you listen to Robert and Laura speak, one of the things that I think about is that our teams in where they actually partner with health systems. The additive is we kind of show up and help. The local health system has the things that they're good at. We have some things that we can help with. And ultimately, it's one of these things where the parts are actually greater than the whole, and it's a really good thing to have these partnerships. So anyway, what we're beginning our work with Laura and the SSM team, our partners at Boulder and John Muir are achieving strong results, from revenue management to care efficiencies. At Boulder, there have been measurable improvements in patient experience with better outreach for transitions from ambulatory to ambulatory care management. We continue to see a robust pipeline of opportunities as we deepen our existing partnerships and engage with more local health systems. Our local health system partnerships are one of many ways we're bringing together technologies and both operational and clinical expertise together to make health care run more efficiently. We believe our combination with Change Healthcare will actually accelerate this work, helping clinicians by simplifying their access to evidence-based guidance tools in real time as they interact with patients, cutting down on friction in the transactions between clinicians and payers by removing waste and barriers and to make the health care process simpler and more transparent; improving patient health outcomes and lowering costs by closing gaps in care more quickly; making it easier for the consumer to manage their health finances and payments; and helping providers get paid more quickly and accurately. We're energized by the value in this combination and what it will actually bring to the health system and everyone we serve. And we look forward to completing this transaction in the first part of 2022. Now, this is the tell them what you told them part of the talk. We hope you see in all of this a determination to create a higher-performing truly value-oriented system. One, that delivers value over volume; two, that creates comprehensive home and community care at scale; and three, streamlines and simplifies the health system. Why? To ensure better experiences, better outcomes and lower costs for everyone. With that, I'll turn it over to John, who can take you through the financials today.

Thank you, Dirk. First of all, thank you again for joining us here today, here in person and online. I just feel I have to take a moment here and just stare out and gaze at the room because it's so incredible to have people gather back together again, and we appreciate you taking the time to join us here for the day. And the same familiar room, right? And I say familiar, I know that after all these years of coming to this same venue, I still get lost on my way to that maze of rooms in the seminar level of this hotel every time. And I've always wondered how can it possibly still be so confusing after I've been coming here that long. In fact, as we were preparing for this conference, I realized it was exactly 10 years and 1 day ago that I attended my last conference as an audience member, November 29, 2011. And I was sitting right over there. I think about where you are today, Lisa. And it was freezing in here back then, too. Recalling that conference got me curious to look back and see what the UnitedHealth Group of 2011 had to say about its ambitions. Two things stand out at this distance. First, that the growth projected by UnitedHealth Group of 2011 was based on a number of initiatives whose roots went back many years. And second, that many of the efforts that were in their earliest stages in 2011 are now some of our most substantive and growing businesses. I raise these points and we'll spend a couple of minutes on them because they reveal a vital characteristic of UnitedHealth Group. Think big, start small, learn fast and scale successes. The consistent approach of the enterprise has been to see an adjacent need or gap and to try out many new things, as we seek to develop high-performing capabilities to drive better health and experiences for the people we serve and durable growth for the enterprise. This is important to understanding our future. So I'm going to give you a couple of quick examples. That conference was the very first which Optum was discussed. It wasn't positioned as a new company. Instead, the 2011 narrative very deliberately invoked a 15-year history, nurturing the foundational businesses. This new yet established business was expected to post $28 billion in revenue and $1.25 billion in operating earnings, about 15% of the enterprise total. I recall thinking 15%. That's nice, but you still get a health insurance multiple. Let's talk when you break 30%. A few days prior to that 2011 conference, UnitedHealth announced the acquisition of a company called XLHealth. I remember using my Yahoo! Search engine to figure out what it was and did. The company gave only a glancing reference to XL over the course of that 8-hour conference. Today, that building block has expanded to become a vital clinical service, serving over 2 million seniors in their homes, improving near- and longer-term health outcomes for people with medical, behavioral and social needs. About 3 months prior. The new OptumHealth made its largest affiliation to that point. Care delivery barely got a mention at that conference. And as you know now, it was just a start. That year 2011 was also viewed as one of great uncertainty in U.S. health care, with the implementation of the Affordable Care Act still very fresh. As an analyst, I was assessing what challenges that might pose for insurers. UnitedHealth Group, on the other hand, was assessing how much opportunity there would be amid change for UnitedHealthcare and its new old Optum business. But every year has its share of uncertainties, and this enterprise was built to thrive in ever-changing landscape as it remains today. Take commercial benefits, which back in 2011, comprise nearly half of UnitedHealthcare revenue. Since then, even as the commercial business will have grown over 40%. It now comprises about 25% of revenue as other markets such as Medicare Advantage and Medicaid have grown more rapidly with more growth to come. And that 15% Optum earnings contribution, now it's over 50% and looks to continue in that trend. I'm reminded of all of this, that health care for the most part, changes gradually and continually. Arguably, as it should, since it's about people's lives, and each part is affected in large and subtle ways by changes in others. While a look back can be instructive, we know it's a forward view that's critical to you. It helps to realize that the seeds of the next generation of health care are being planted every day at this enterprise and that many may not fully emerge for 3, 5 or even 10 years. The question, of course, is which new capabilities and investments being planned today might grow and develop as we look at the decade ahead. Given our breadth, many come to mind. Let me touch on a few of these forward themes, all of which align within the strategic growth framework Andrew described. Virtual Services could be one area. Already, our comprehensive services have become the foundation for a multimodal care system, one which integrates medical, behavioral and social needs with an emphasis on care team continuity, and coordination across virtual, in-person and purely digital channels. Yet the reach, consumer usefulness and technological sophistication have room to evolve greatly. And if meta channels ever evolve, we will be there as well. Another, serving people with complex conditions. That 10% of the population that requires 65% of the nation's health care resources. At this stage, after years of building out capabilities, we're serving a portion of that population, surrounding them with coordinated services, they so urgently need and increasingly in their homes. This is difficult, complicated work each day, but an area we think still has untapped potential for improving quality of life and scaling meaningful services. Another, as a result of our long-standing focus on building out primary care delivery, which is perhaps the most intimate relationship one can ever have with a consumer. We are building a deeper understanding of what it means to be consumer first. And of the road and cultural shift, it will take to get there. We see that future as one with the modern tech channels and experiences that are largely missing from today's health landscape, broadening how and where we can serve consumers and driving new levels of loyalty and retention. And one last forward-leading idea might be health financial services. We have steadily built a strong platform for consumer health banking and payment connectivity. What it could be, though, includes advanced and modernized financial clinical intersections, supporting billions of dollars of health-related payments across the system, greatly informing and simplifying the experience among physicians, patients and payers, helping providers better manage their working capital needs and connecting important health-related financial factors for people such as food, housing and transportation. The evolution of this enterprise has been about more than a shift in member or business mix, or how strategic collaboration contributes to our long-term 13% to 16% earnings growth rate. It has been about continuous evolution in the way we see markets and reach and serve people to have even greater impact on their health and to provide strong returns for you, our shareholders. It's why we maintain a bifurcated view at our company. A sharp focus on executing the here and now deliberately linked to a longer-term view at where health care is and could be going. And it's why our confidence in how we will serve, evolve and perform in the future, has its roots and actions in investments and commitments made in years past, in '21 and those we expect to make in '22 and beyond. Over the course of this gathering, from the small dinner to this morning's presentations to the Q&A forums to the management lunch to the business seminars, we hope you've sensed from the many leaders gathered here our restless ambition, to continue expanding the ways we can serve people in the decade to come. It is a mindset that enables us to deliver the results you have come to expect from us, and you can continue to expect in the future. So now let's turn to those numbers. Our 2021 net earnings per share outlook for $18.75 to $18.90 compares to the original $17.75 to $18.25 outlook we offered a year ago. Enterprise growth in '21 has been led by Optum, with operating earnings growth approaching 20%. Within Optum, the OptumHealth and OptumInsight businesses stood out as strong drivers of performance. Moving to '22, our initial outlook for adjusted earnings per share of $21.10 to $21.60. And within this, we anticipate continued COVID-19 pressure, although at this point, lower compared to '21. Revenues will approach $320 billion, growth of over $30 billion driven by double-digit growth at both Optum and UnitedHealthcare. Taking a closer look at '22, I'll start with Optum. Optum will comprise over half of consolidated operating earnings. Optum's operating earnings are expected to grow 16% to 19% in '22 to about $14 billion, once again led by OptumHealth. This growth is being driven by the many ways in which Optum engages across the health care system, serving benefit plans, physicians, employers, large health systems and increasingly consumers. OptumCare is centrally positioned to help the millions of people it serves across more than 100 benefit plans move into more comprehensive value-based arrangements. You heard earlier that Optum has fully accountable or capitated relationships with more than 2 million patients. But what does that really mean? First and foremost, these relationships serve people better. There are many ways to measure this. Patients spent 25% more time on average with their physicians, 20% less time in post-acute facilities and have more than 1/4 fewer hospital readmissions. These patients have higher-quality health care experiences and better outcomes. And their NPS scores bear that out. In '22, we expect to add 500,000 new patients for whom our physicians are fully accountable, double this year's increase. This will drive revenue per consumer growth of over 25%. This metric is an essential measure inside our company because it helps demonstrate that we are serving people more deeply and more comprehensively. We expect this measure will grow at strong double-digit levels for years to come. OptumInsight is today providing diverse and integrated solutions for health plans, governments, biopharma, med tech as well as for the health systems you've heard us speak about. These broad health system partnerships make a positive impact on care delivery and the communities they serve. You can expect them to continue to increase in number and scope. This momentum is reflected in the breadth and growth of the OptumInsight revenue backlog, expected to grow in '22 by $3 billion to more than $25 billion. Deploying advanced, more modern capabilities enables us to increase our long-term operating margin outlook for OptumInsight to a range of 18% to 22%. While the broad field of the health care data analytics and technology have been around for some time, when we consider their potential, we see them as still at very early stage. And you should continue to expect strong advancement of who, how and where OptumInsight serves in the years to come. OptumRx' capabilities provide a strong foundation for creating broader and deeper benefits for people and the health system. Our pharmacy services orientation is based more on integrated clinical-level care than procurement and distribution. You heard us discuss the Optum community pharmacies, which provide access guidance and care for underserved populations and drive meaningfully differentiated health outcomes. OptumRx specialty and community-based services have the potential to expand the number and ways in which we can serve people to have more positive impact on their health. Home infusion as services, so vital during the pandemic, have become a best practice and the future of how we will serve people more effectively. These advancing pharmacy services, including community, home delivery and specialty now comprise about half of revenue, and OptumRx will continue to evolve. Turning to UnitedHealthcare. We expect net medical member growth of upwards of 1 million people in '22, led by our Medicare Advantage offerings even as we expect modest net attrition in Medicaid due to the resumption of redeterminations by the states. Revenues at UnitedHealthcare will approach $248 billion, growth of about 11% over '21. We expect another strong year of Medicare Advantage member growth, continuing the momentum of the last several years. Activity throughout this year's annual enrollment period has tracked well with our expectations, underscoring the consistency and attractiveness of our offerings. And thanks to the steady strides made in quality performance, we are excited that we can enroll people in our 5-star plans throughout the entirety of '22. Making it easy for seniors to engage with us how, when and where they want, is an important element in member satisfaction and retention, and we do continue to advance these efforts. For example, about 1 million of our senior customers now engage with us digitally each month, interactions which further strengthen our connection to them. In Medicaid, our new state awards and renewals demonstrate the growth momentum, which has been building over the last several years. In '21, we were honored to begin serving the people of North Carolina, Kentucky and Indiana with other recent awards in Nevada, Hawaii, Tennessee and Ohio. And in '22, we will begin serving in Minnesota, and we are eager to add new regions as we look ahead. In the employer and individual market, we continue to grow in '22 and beyond. The strong response to our newer innovative products is a key reason why. Products such as NavigateNOW featuring consumer convenience, and premiums 15% below standard plans, which use the Optum virtual network as a first option; Bind, which allows greater benefit choice, certainty and flexibility; and Harmony, which aligns with OptumCare to create better experience and value for consumers. These and other newer market responsive offerings will serve nearly 1.2 million consumers and are the base for further innovation. Our growth and diversification continues to provide a strong balance sheet with ample financial capacities. Our capital deployment practices remain consistent. And in '22, we expect to generate cash flow from operations approaching $24 billion, 1.2x net income. Returning capital to our shareholders remains a priority. The total dividend payout at that 2011 conference of about $650 million is today $5.5 billion, having advanced at a strong double-digit rate each year since. And we expect to repurchase between $5 billion and $6 billion of stock next year. With significant available growth capital, we will continue to expand and evolve our health care platforms to serve even more people more comprehensively. So like some of those seeds planted a decade ago, many of the elements underway at today's UnitedHealth Group are creating an enterprise that will not be known in full until that investor conference in that year 2031. Nonetheless, I expect that session will feature some familiar themes. A story of strong, consistent and diversified growth; of a company continually building upon its socially relevant capabilities, creating value across the health care landscape, driven by a strategically collaborative and highly focused group of people connected by a shared mission, to help people live healthier lives and to help the health care system work better for everyone. Thanks very much. We will now set up for the Q&A session and be joined by a number of our colleagues, both on stage and in the audience today. So feel free to stand up and stretch your legs, but please do not go far because we're going to resume in just a few minutes. Thank you. [Break]

Please take your seats. We are ready to resume. Thank you.

Great. Thanks, everybody, for coming back so quickly. We really appreciate it. And for those of you watching online, thanks for your patience. I guess you might have gone out to make a cup of coffee as well. What we're going to do now is open up the floor to Q&A. I'm delighted to be joined by a number of our leaders from across the company. You'll see all of their names. We thought if we went through all it would burn up too much time. So you'll see their names there. Also to let you know, we have other colleagues in the audience. We may ping questions to, if necessary. All I'd ask you to do, if you can raise your hand, then Brett, Zach, Moses have got -- will come to you with a mic. If you could wait for that because then people who are listening remotely will be able to hear the question and then we'll call you up. So let's go.

Okay. We're guys -- Zach, are you going to pick Zach, go ahead.

Sure.

Zach, go ahead.

I've got Josh Raskin from Nephron.

I guess not surprising, my question's on OptumCare. And I was curious as you think about the importance of the primary care, I'm hearing a lot more than just primary care from you. So I'd be curious how you think about that primary care is that relationship that you talked about, what other pieces you think you need? And then more importantly, what's the process? How are you moving your 60,000 physicians now to risk-bearing and sort of help us think about that process.

Yes. Great question, Josh. Thanks so much. And before I ask Wyatt to go deeper on it. One thing that I think is often not everybody sees actually is within our 60,000-plus physicians, probably nearly half are kind of specialties -- specialists, right? So even within our base population of kind of office-based physicians, we've got a very diverse group even within that. And then as I was talking earlier today and to your point, we see this whole arena being complemented by a whole -- whether it's behavioral care, whether it's at-home care, virtual care. But Wyatt, why don't you go...

Agreed, Josh, thanks for the question. When you think about our 60,000 physicians, they are a blend, as Andrew mentioned, of specialty care and primary care. And I'd also like to emphasize there's an additional 20,000 advanced practice clinicians, nurse practitioners and others that are a critical member of the care delivery team. And so increasingly, we're thinking about our workforce, not so much as the 60,000 affiliated employed physicians, but the 80,000 APCs and physicians. And then the specialists are a critical part of our model because, as you know, specialists drive an enormous amount of downstream utilization in hospitals or alternatively as an example, in ambulatory surgical centers. And so for us, having a network of affiliated and employed specialists who practice evidence-based medicine and are focused on delivering just the right amount of care, not too much and not too little, is quite critical to our value proposition.

And just to Josh's second question. Just reflect a little bit on what you do the year before we transfer risk in closing. Just maybe kind of a minute on that second, that's quite an important piece of it.

Yes. So the question and the point is we know that it's critical to move from fee-for-service to value, and it's, of course, a major theme of our conversations today. We do that by bringing doctors on board and educating them in the process of providing value-based care what's necessary. And we also surround them with a team that helps them deliver that care in a differentiated way. And we take the deep expertise of markets like Texas, and you heard Dr. Amar Desai speak about Southern California and now we're bringing that expertise to new markets like the Pacific Northwest or the Northeast corridor.

Great. Thanks so much, Wyatt. Brett?

Thanks, Andrew. Justin Lake. If you'd like to ask your question, could you stand up for us, please, Justin? Just want to show how tall you are relative...

That's not a huge bar, Brett. The -- so my question is OptumCare as well. So why you're probably popular today. You keep putting up 30% revenue growth. I keep mismodeling it. You keep beating the number. So wanted to try to understand better how to forecast this business. For instance, you gave us a couple of numbers. Your patients served in OptumHealth, I think, is up 1%, but your capitated membership's up 25%. So maybe you can help us think about the pent-up demand there. Maybe you can give us some numbers along the lines of, for instance, how many Medicare Advantage members do you see that aren't in capitated agreements that could be moved over, over time. Is there some way to give us some ability to think about the TAM there.

Very good. Yes, I appreciate the question. So our growth engine is multimodal. So think of it as growing in our established markets and states going into new markets and states. And think of it as our deep partnership with our colleagues at UHC who continue to grow their books and then transfer, particularly Medicare Advantage to us when it's appropriate and makes sense. But we also have 99 other payers that we have deep relationships with. And so that's another growth engine is other payers, particularly in the MA and dual special needs groups. And you'll see us increasingly growing in commercial and even Medicaid. So often, we talk about the 20 million patients we serve today, that is a growth engine and some of those are commercial and they'll age in, some are fee-for-service Medicare, and they'll transition over to Medicare Advantage. But as you can sense, we actually have about 5 ways that we're growing. And that's really how we're hitting that kind of 30% growth for our value-based care.

It might be good as well in the state to ask Brian to comment a little bit from his perspective at UHC because at the end of the day, there's a tremendous relationship that drives all of this going forward. But I just want to emphasize this point. When you think about it, you've got more physicians every year. You've got more physicians taking more risk lives every year. You've got more other services being supported into that environment really to Josh's question as we wrap around. So all of that just starts to level up, which is why this kind of revenue per consumer served is really a relevant metric to look at because that's where you start to capture all of these different layers that feed in parallel. But Brian, it would be good to get your perspective on where you think this goes from your angle?

Yes, it's multidimensional as Wyatt said. It starts with community MA. Think traditional Medicare Advantage, our transfer in 2022 will be the biggest we've ever had. Two years ago, we had no dual special needs plans in capitation. Next year, we will have moved several markets in that regard as well. And beyond just what happens around that traditional PCP environment, we're also now moving home risk, and you've heard a little bit about the community and home model as well. We're doing that in Georgia and the Northeast. And as Andrew pointed out, we've now really started to find some receptivity in the commercial market, primarily on the West Coast for the Harmony product. So it's really a layer cake, if you will, of opportunity, and I look at 2022 as much more meaningful than 2021, and still in its infancy as I look at its opportunity.

Thanks, Brian. Thanks so much for the question. Moses?

Our next question is from Kevin Fischbeck with Bank of America.

Kevin.

I know you guys are trying to avoid talking about COVID, but Dirk would be mad at me if I didn't try to get John to quantify this. So the dollar -- I guess when you think about the 12% to 15% growth you're looking for this year, that's a little bit below the 13% to 16%, even though there's a COVID tailwind to it. So just love to try and have you reach us back to that long-term growth rate this year. But then also, you mentioned that COVID is still a headwind. Can you just talk about which businesses do you think are impacted still in 2022 and kind of underearning because of COVID?

John?

Yes. Sure. So on the first point, yes, COVID impact is lower than it was in 2021. Our expectation, at least, at this point as we sit here today in this session for 2022. I put it in the zone of about half the impact with some ranging around that in terms of what we experienced in '21. I would say it's even more heavily biased to UnitedHealthcare in terms of where the impact is being felt for '22 versus what we described last year.

Yes. Thanks, John. Zach?

I have Ricky Goldwasser from Morgan Stanley.

So Andrew, a bit of a strategic question for you. UnitedHealth is the largest insurer in the country. Is United also Optum's largest customer? And if not, how do you incentivize employees in the organization internally to think of United as such? And a follow-up to that, if we think about that vision of Optum being the front door to health care into growing revenue per member ultimately over the next decade, how do you balance that sort of the payer-agnostic sort of approach with that alternate goal of having wrapping around a UnitedHealth member with all these Optum services.

Right. So 2 great questions. So just to start with the second. The Optum front door, I think, works provided that the services which then are behind the front door are market-leading, great value-added services. I think, honestly, the only way Brian Thompson buys anything from Optum is if that box is checked. Because in reality, he can't compete and he can't survive in his world unless he's been serviced at the top of the marketplace. Now once we -- so the embedded opportunity to your first question is by being able to work together across the platforms to innovate and iterate the way in which we think we can develop our services. That's really the kind of unique strength of being in the same family. And as I tried to lay out, I think it's becoming increasingly clear that being able to pull together multiple strands of what happens around families and patients and systems, actually, is beginning to look like the key to really try to -- really the key to driving outcome. So the way we incent people in the organization, broadly speaking, if you look at our leadership cohorts, they're incented at UHG level. So actually, when you look at the way in which we incentivize the organization, we basically stand them full together. And I think that's a very powerful driver of the way we look to drive greater collaboration in the business. If you look within our growth organizations, they are massively encouraged to go and ensure that we are intensely pluralistic in terms of who we engage with. So whether that's from a payer perspective, who we sell services to who we work with in the clinic. You just heard 99 payers working with OptumCare. That's very evident in that part of the organization. But as you move up through the organization, the people are making the big capital decisions, the people are making the big investment decisions up and down the company, where we basically view that as a UHG cohort, and they stand and fall together. And I think that works great. You get a real sense of energy across the company. And one of the things we've tried to do is really emphasize the value to the patient and the outside world through our internal collaboration. The more we can get that wheel spinning around innovation, the better. And Optum front door, I think that is a -- that's an opportunity for us to really change the way in which this company engages with the environment, right? So that changes fundamentally the scope of how we can engage the numbers of people we can connect with and how we can then introduce them to the services we have, assuming that they are super competitive services, which is what they've got to be. They have got to be top-of-game services.

I would also tell you is that UnitedHealthcare is by far and away, the most demanding customer of Optum. There's no question, right? So I mean if you think what happened I was getting you some profit. I mean, you heard me talk about 9% of the MA members are in OptumCare and 4-star plans. Well, guess what, Brian Thompson is happy with that, right? But I would also say it goes deeper. It's like, hey, to the extent to which Optum does a really great job in Payment Integrity. Well, you know what, those great jobs they do for UnitedHealthcare goes to other payers as well. So there's a real flywheel effect in terms of UnitedHealthcare being demanding on the part of Optum and Optum frankly, delivering free United Healthcare.

Thanks so much for the question, Ricky. Brett?

Yes. Thanks, Andrew. Next question is from Ralph Giacobbe.

So I guess back to OptumCare. So 60,000 physicians. It sounds like half is primary care. Can you give us a little sense of the 30,000, call it, in primary care? How many of those are risks? Are all of them sort of taking risk? That's sort of 1, 2 is those that are taking risk. Can you give us a sense of how many patients they're treating on average? I think in one of your videos, the doctor said he went from 250 MA patients up to like 950 over the course of a few year period. So I guess I'm trying to get at the visibility that you guys have because a lot of this is just basically sort of handing off those patients. So the 30% growth is sort of UHC largely to Optum, right? So I'm just trying to understand the capacity or how much more room there is with that. And then the last piece, sorry. is the profitability ramp, right? So you understand how you lock in the profits on the UHC side that come over to OptumCare, what's the ramp to profitability there on, obviously, a lower, overall premium dollar?

Yes. Thank you. And kind of breaking down your questions. starting with the value-based care proposition. We actually have considerable operations, particularly in the Northeast Massachusetts, New York, New Jersey, Connecticut as well as Washington state and a bit now in Oregon that are primarily fee-for-service. And you'll see us in '22, as we talk about the 500,000 risk lives that we'll be assuming care for increasing the number of risk lies in those markets. So today, we actually have a fair blend and even in our well-established markets, we have fee-for-service in Texas and Southern California and Florida as examples. But what we find is that both for the patient experience and the stickiness and the opportunity to really provide the comprehensive set of solutions that we've already been talking about on the stage today, that's really where value-based care is remarkable. And the second point is as we create that value and create that savings in total cost of care, we're able to deliver a portion of that to you, our investors. So we'll continue to move. Now the second question you asked is, what's that investment period like? And how long does it take? And to be frank, as we move lives, there is investment upfront. So we'll invest the year before we do those risk lives substantially and bringing on the teams, the technology and the training to make sure that we really manage a comprehensive solution for those individuals. So you'll see us move those risk lives in. And in year 1, it's an investment year. In year 2 and 3, we start to see the investments begin to pay off. And when you look at us because we've been in value-based care for over 10 years, we have also mature value-based markets that are generating the kinds of returns that we'd expect. And then the last piece of your question, if I captured it all is the question around as you move from a payer like UHC to OptumHealth and OptumCare, how do we create that value? And I think that the slide that you saw earlier says it all, which is 99% of our OptumCare UHC members, 99% are in 4-star or greater. That means not just 4-star, 4.5 and even 5-star plans. 5-star plans can roll year round, as you're probably aware. So that's just one example. So the other is we're able to, as providers actually initiate protocols, evidence-based care that's embedded in the physician's workflow that we know decreases low-value care or overutilization of services. And so for us, that's where this transformation begins to happen, not only for the patient experience for the outcomes and for the total cost of care.

Thanks, Wyatt. I think that was a super clear explanation. I think really understanding that kind of roughly 3-year cycle in terms of kind of investment and getting the practices to move into the new ways of work is really important to recognize. And obviously, as you can see, the sort of huge scale of what we're moving through, that degree of investment, which runs through year minus 1, year 0, year plus 1 and then starts to move forward. is really material. Now what I find super encouraging is when you look at the vintages, as we measure, of clinics, which have moved from fee-for-service to value year by year by year, what you would hope to see and we do see is improved speed and performance, we're getting better and better at this. Now that leads to 2 things. One, we get more and more confidence to deliver -- to transfer more and more people. Second, obviously, the economics start to get into shape much more quickly than they might have done in the past. So I think you've heard a great description of what goes on within that part of the business. And it's important, and where you end up is an economically sustainable model, which for a lot of these doctors, fee-for-service really isn't economically sustainable. You end up with a situation where the patients have a much better experience. The payers have a much better experience, and you get there over that period of 2 to 3 years of investment. Next question, Moses?

Gary Taylor with Cowen.

First one to compliment Andrew on his shoes, I haven't been able to take my eyes off those since you walked out earlier. So really like those. As I'm booking my hotel for the 2031 Investor Day, I want to think about a decade out. And there's so much discussion about value-based care, not just here, but other companies around the ecosystem. And so much of that is oriented around in MA, which makes a lot of sense because it's a risk coated population, it's target-rich, you can make these incremental investments and be rewarded for it. What do you think it takes to get the commercial population in Medicaid? And a decade from now, are we still living off the value-based care growth in Medicare? Or is there really going to be an opportunity to move these more transitory populations such as commercial and Medicaid into value-based care?

No. Thanks for the question. I'm going to ask in a second, Brian. I'm going to ask Brian and Dan actually to make a couple of comments on those in specific response to what you asked for. But I think you've got to step back and say, what we're really trying to learn and every day, we make a mistake, we fix it, we get it better. So constantly trying to learn on this. We're trying to learn a way of managing risk, which, of course, initially is in the Medicare Advantage arena, but those skill sets can be applied much more broadly. And more and more, I would expect in 2031 to be talking about how our risk management skills have found their way across the whole space. I don't really see any logic. So if I sit back and think about all the conversations I have with people who lead, for example, big employers who are struggling with cost of health care, if they could see a model which could deliver for them more reliable cost out turns, better responses all the rest of it, why wouldn't they go there? Now it may not be the same structure. It may not have the same components as the current MA approach, but underpinning it I think there's a driving logic which takes you in that direction. Maybe ask Brian to pick up on that and then the Dirk -- and then Dan.

Yes. I definitely see a lot of receptivity in the market. Let me start with it's not a lack of a desire between us and OptumCare. It's really finding that market niche with a customer and a consumer in particular. We've seen it in the West Coast for some time where they're willing to work with a provider-payer relationship in a different way. Normally, it includes bringing a couple of options to the table for that employer group. And as we see that take shape outside of just California. I think you're going to see a natural tendency for more commercial groups to take on a value-based arrangement like who we have with OptumCare. And I think it gets started with things like digital convenience, what other tools and capabilities can drive a differentiated product, not just looking at perhaps what might feel like a more narrow network. So as those networks stay broad as those capabilities get enhanced with digital, I think you're going to see a greater customer response to value-based alignment like what we have with OptumCare in the commercial marketplace.

Dan?

Sure. I'd just offer that importantly, to Andrew's point around foundations, I think there's important foundations. When you look at the variation in the cost of care in commercial site of service has a fondly different impact than it does in Medicare and in Medicaid, as an example. So building out the foundations around our ambulatory footprint, but also the virtual and digital foundations that really helped with the engagement and the steerage and the redirection and the referral patterns that can really be successful in the commercial marketplace. And the other thing I'd offer is, as Andrew talked about, kind of reversing the polarity and how would we pull historically insurance through to services and then services back through insurance. That's another area that we see opportunity to look at our OptumCare assets, how they connect through to our home-based assets and how do we go directly to employers and introduce ourselves in that way as well. So a lot of different dimensions and ways to approach it, but obviously, Medicare Advantage, the concentration of complex needs. The 2x cost profile in Medicare, it's a reasonable place to start building foundations towards commercial for sure.

Absolutely. Thanks, guys. Zach?

I've got A.J. Rice from Credit Suisse.

When I think about your priorities for inorganic growth, capital deployment, we always think about the care delivery side of OptumHealth and we think about OptumInsight, which you're obviously in the midst of a deal. You've thrown some new -- you've emphasized, let's put it that way, some new areas today, like Optum Financial and other things. When you guys think about capital deployment and where you might go for inorganic growth, is the priorities changed in any way? And then maybe just on a follow-up on that, if John could spend a second on the 13% to 16% growth target for the next few years, how much of that is organic in your mind? And how much is capital deployment, either share repurchases or inorganic growth?

Thanks, A.J. Great question. John, why don't you take both?

Sure. Take the last one first. So about 3 to 5 points of that growth would be what we'd call inorganic growth. It was consistent with the model we've had over the last number of years. An important part in that, A.J., to consider is we don't expect that to be year 1 impact. What we're benefiting from are vintages, to use the term Andrew used, that were investments we've made over the past number of years and of those has come into producing assets. So we're often laying down that capital a few years in advance of where we expect that to contribute to that growth. The same profile that we've had for a number of years in terms of the company and the inorganic growth opportunities. In terms of specific areas, yes. So all these areas would be areas of interest to us. I would tell you, they've been areas already of interest to us. You can expect we probably already made some investments in some of these areas. I would still expect OptumHealth broadly to be a significant focus and Care delivery to be a significant focus in terms of capital in terms of capital allocation. But these other areas will -- are certainly also in that zone. I wouldn't -- some of them are small, some of them are large in terms of that configuration. I don't know that it would look so startlingly different from the outside, though in terms of what you deserve from us thus far.

Thanks, John. Next question. Yes, over in the back Yes, an online question, I think.

That's right. We have a question online from Michael Wiederhorn with Oppenheimer. Can you discuss the top line growth of community and state despite the headwinds from redeterminations?

Yes, sure. Brian, do you want to pick up on...

Sure. A couple of things inside that. Keep in mind, we talked about our growth in Medicare Advantage. The vast majority of our dual special needs is actually in our community and state business. So a big part of that tailwind in our revenue inside 2022 is related to that strength of the recovery that we've seen from physician encounters inside 2021, very similar to the dynamic that we see in our Medicare Advantage book. But what I don't want to lose sight of is just a tremendous growth that we've had organically. You heard about the 7 states, 4 that we renewed and expanded in, 3 of which were new. So it's a combination of 2 factors: the stronger physician engagement in 2021 on our almost 1 million lives in our dual special needs plans combined with the organic growth and strength.

Great. Thanks so much. Brett?

So next question from Matt Borsch.

Just was hoping to maybe understand a little bit more depth to how the global cap arrangements work if we say take a seasoned capitated OptumHealth group of physicians with an MA member. Are you meaning -- sorry, meaning UHC giving up any profit as you do the global capitation? And can we think about what a total profit margin might be on that MA member if you were to take over the profit UHC is earning and what you might be getting at the OptumCare level? I know that's maybe not the fair way to look at it, but it's one perspective that you end up with in terms of how much profit is that member in total generating.

John?

Sure. So the important things, considerations in that. First, the impact that Andrew and others have described how that membership moves in, in terms of the vintages of performance. Important metric we provide, we talked about 8% to 10% OptumHealth operating margins, long-term operating margins. You heard a couple of comments on the stage today. Year 1, it's just straight up investment. 500,000 lives moving in for '22, takes significant investment in '21 for that to occur. And then they mature over the next few years. Just going to pull a few threads also for some commentary that was part of some of the comments that I made earlier on the stage. When we look at those vintages also -- so more than half, well more than half of our practices, if you will, are what we would call early stage at this point in terms of performance. Then there's a minority that are performing more where we expect them to be. You would expect a margin profile on those practices that's above the 8% to 10% level we described and OptumHealth, definitely runs in that zone. And then you get into what else is happening though within those practices. So take maybe a couple of our markets where you're the most built out in terms of movement and performance in that kind of block of business that you're talking about right now. There are other elements that are coming into that -- into that picture, though. We are probably not built out in terms of the scopes of services that OptumHealth offers in that marketplace. I can think of a few of why it's markets where very built out in terms of capabilities of risk assumption and what they're doing for their senior populations. But we're not even close to where we should be in terms of the other offerings that OptumHealth has, ambulatory surgery centers, the home capabilities. The other elements you'd be wrapping around that. So it gets a little more complicated, frankly, Matt, in terms of thinking about it because there are other elements that come into that picture in terms of the types of services we're trying to build around that. But that's kind of the general perspective in terms of the vintage story.

Yes. I think that's very clear. And I mean the other thing I would say is, obviously, the only way there's any economic interest created at all here is that better care is delivered and waste and inefficiency has taken out. I mean that's essentially -- unless that happens, there is no economic opportunity. And then if you think about it, a lot of that benefit preferentially goes back to members, right? So in terms of benefits or reduced premium or whatever else that might flow that way or to doctors because we're trying to create a sustainable economic model for physicians to allocate the time to go from 15 or 20 patients a day to 5 or 6 or 7. So all of that has to happen as well. So in terms of the way I think to think about it is you've got to really feel confident that you've got an approach and a model, which first and foremost, delivering great care and taking waste inefficiency out. That opens the door then for members to have a beneficial experience payers, physicians and, of course, ours ultimately. I think we have time maybe for 1 last question or 2, maybe 2 more. Moses?

Whit Mayo with Leerink.

Actually I have 2, maybe 3 really quick questions. [indiscernible] I should know this, but of the 60,000 physicians today that are affiliated or employed, how many are simply affiliated? And how is that bucket of affiliated physicians, have they been -- is that -- is it a focus of you to try to transition them into an employment status? I'm just kind of curious how important that is for you. And then if you look at your most mature vintage groups that have been taking risk, can you share what the MLR is on those groups today?

Wyatt?

Maybe I'll start with the first question, and I'm going to hark into the video you saw Dr. Rodriguez, who I've backed down in our WellMed Texas practice a couple of years ago. And when I heard his story, I thought he actually captures it pretty well. He was an affiliated physician who we then moved to contracted, which is kind of still independent, but we wrap more services and incentives around a contracted physician from affiliated. And then ultimately employed still with a number of value-based care incentives. And so I think key to the 60,000 physicians is many are on a journey of getting to know us, particularly in newer, less mature markets. And as we do that, we move them into deeper and deeper relationships. Now some want to stay independent, their whole careers and we support that. But others say, no, I want to -- I'm all in, I'd like to be employed. And so we have tuck-in acquisitions that we do in all of our established markets on a regular basis that when we reach that point or we move somebody into an established clinic. We don't really -- I would say, because it's an evolution we don't tend to want to break it down into specific buckets and quantify each bucket because we think of them holistically. We know that the performance of outcomes and cost of care is excellent and employed. It's also can be very excellent in our independent doctors that have a large percentage of our value-based care patients. In fact, in those environments, it can be equivalent. And then the MLRs are -- we're very proud of them, let me put it that way, in our established markets. But again, we don't really tend to want to down into different buckets of our various markets.

Absolutely. But what it helps us as we look at our whole portfolio gives us a confidence around where kind of best practices as of today, and then that gives us a goal really in terms of what we might expect from different clinics over time to progress. And obviously, then there's work to completely improve. We go to last question, Zach, I think.

With Lisa Gill from JPMorgan.

I'm going to break from OptumCare and move to OptumRx. So Andrew, you started your comments and you talked about changes in pharmacy. You talked about technology and specialty, which all makes sense because that's now 50% of the market. But as I think about pharmacy going forward, how do you really envision those payment models? So today, right, it's really all volume-based, every part of this discussion today was around value-based. How do you see that progressing and changing on the pharmacy side?

Yes. Well, obviously, in a second, I'm going to hand this to Heather, who's spending a ton of time working all this through. I think we're going to see -- I think it's inevitable that we're going to go to more risk sharing within the pharmacy space as well up and down the value chain. So I think pharma companies are going to get drawn into this over time. Some are more forward leaning on this, honestly, than others, but I think it's an inevitable consequences as they move to an environment where they have higher and higher prices for drugs which are -- or treatments, which are used by fewer and fewer people. Hopefully, they're going to have -- their goal is to drive very distinct outcomes. Obviously, the Holy Grail is a cure. The good thing about these distinct outcomes is really measurable whether you achieved it or not. And I think that we're going to see a lot more assertive negotiation, advice sophistication actually around how pharmaceutical pricing gets done. Now I'm not saying that's going to happen overnight. But I do think it's coming. I think it's an inevitability. I think we can be very central within that, and it's certainly one of the areas where, for example, it's not the only one, and Heather can extend.

That's great. No, it's definitely a big focus for us. I'd say a few things. I think, first of all, we're really already in value-based care in many respects. And as Andrew said, it's starting in some of those higher costs, but those most those fundamental cell and gene and biologic therapies that can be, in many cases, incredibly life-changing, but are incredibly expensive. We've already seen incredible interest and engagement from pharmaceutical manufacturer partners in value-based arrangements. So we have several of those today. The important -- the critical piece of that is the analytics exchange, the insights and the information from our clinicians our prescribers that help them get to better outcomes and get that right value-based arrangement. And I think the other thing I would say is that the investments we're making today, John talked about our investments. In every part of the business, whether that is in the pharmacy benefit business, helping our clients understand what really are the drivers of those value to do their part too, disease management, chronic disease management and preventive care to actually help the product be effective, wrap around them with social services. And then on the pharmacy side, our own specialty distribution, our infusion services and then tapping into the power of OptumHealth's clinicians to advise us. We're building the tools today. We're making the investments. We are always focused on the client and the patient's needs, and we're working closely and more intentionally with our pharmaceutical partners to really drive for value-based care. So I think when you do talk to us again in 2031, we're going to be that pharmacy component. It might look different. It might be very bifurcated between those maintenance medications and then there's very high cost, but life-changing medications are going to be an essential part of value-based care for UnitedHealth Group and our industry, I think.

Great. Thanks, Heather. And I'm afraid we're out of time for the Q&A session. The seminars are calling, so we need to make sure we wind up and give you all a chance to gather. Let me just finish off by -- first of all, thanking my colleagues for joining me up here today. Great to have you here. Obviously, our team are around and please take advantage of connecting over lunch and other times during the day, and obviously, during the seminars. I want to thank you for taking the time to listen to us to have an interest in what we're working toward. And I hope you take away just a few things. First and foremost, I hope you take away an organization which is relentlessly focused on high-quality growth. This is a growth organization. It's an organization where we feel that 13% to 16% long-term earnings growth rate that you've heard and you're familiar with is absolutely the right and appropriate level of ambition for the company going forward. And I hope you've taken away from the various conversations today, the areas, some of which are newer, some of which are more emphasized, some of which are more established, that we're going to be focusing on in terms of how we dedicate our talent, our investment and our capital to try and deliver those growth areas. We think that piece by piece, those elements that we're going to focus on can help to improve the quality of the health care system that can help to improve the experience of individuals and families. And through that, we can earn the right economic return. We only earn an economic return if we deliver great distinctive value, and that's what we aim to do. I'll finish off where I started with people. I think it's fair to say, and I don't think I'm putting words in the mouths of people here or in the audience or back in any one of our facilities or anybody who's working from home right now for UnitedHealth Group. People came to this company because they believe that in a small way that each individually, they could help solve a problem that they know exists that U.S. health care can be better. They know that. That's why they came. I think we feel more confident about being able to help in that mission now than we ever have done. And I hope you take away that same confidence as you leave the session this morning. So thank you all very much.