UnitedHealth Group Incorporated (UNH) Earnings Call Transcript & Summary

[Presentation] Good morning, everybody, and welcome to the 2024 UnitedHealth Group Investor Conference. We're delighted that you're all here, and I'm very personally grateful of your willingness to give up some time today to meet with us and listen to me, my colleagues and everybody who's involved in UnitedHealth Group to update you on how things are going at the company. So thank you for being here, first and foremost. The last 2 years has been a dynamic 2 years, to say the very least. And last year, I stood here and talked about an impending price cut coming in the form of a funding reduction through the V28 adjustments that CMS had announced in February of '23. And as we've gone through '23 and '24, we've seen a sequence of unprecedented changes, really, in the funding environment of the business in which we operate on behalf of the government. Whether that was through V28, whether it was through underfunded growth rate on a year-on-year basis, or through the reform of the Part D model which hasn't fully compensated for the increase in benefits which have been committed to, all of that has added up to a significant amount of dynamic for our sector to deal with. Maybe more than we've seen ever before, and certainly more than we've seen in the last several years. Combine that with the hangover effects of the COVID pandemic and the return to accelerated MEDEX trend that we saw during the last year, those 2 pressure points have unmistakably created a tougher situation for everybody who competes in this marketplace that's so important to people across the country. What I hope you've seen from UnitedHealth Group though is, during that period, we have really dug deep into our resilience and our tenacity. That notwithstanding changes to what we expected to happen or changes to the external environment, we continued to stay focused on our core mission to improve the system for everybody and our ability to deliver for our shareholders. We continue to make sure that we don't buckle under the pressure to say, "Well, why don't we just take an easier path? Why don't we just accept that things are different and change our goals?" We don't do that. We figure out ways to solve problems. We figure out ways to respond differently to different situations that come up in front of us. And we believe that, that serves us well, not just in the short run, but in the longer term as well. And I hope you've seen that during the last couple of years. But I'd be the first to say that the plan that we executed over the last couple of years is not the plan that we exactly planned to execute because of the changes that we had to deal with. We haven't been afraid to start to refocus our organization. We haven't been afraid to embrace technology at a much faster rate. We haven't been afraid to look at ways in which we can address our cost base even more aggressively than we'd originally anticipated. We will continue to do that. We're not afraid to divest ourselves of businesses which are no longer performing as well in our organization as needed, or maybe those which have been obsoleted by changes in the way in which the funding environment has been developed. All of those things are simply reflections of a deeply pragmatic organization which is committed to its mission, it's committed to its product delivery, and it's committed to doing the right thing for people every single day. Running through the whole organization is a culture of restlessness, of performance orientation, but most importantly, a culture of compassion, a culture of compassion which focuses not just on what we do but how we do it. Making sure the quality of what we do is tip-top, making sure that quality is something that we individually, that our families, that your families, that everybody's families, would want to be exposed to. It's why this company is the only and the first company to try to build a national ambulatory quality patient management system, akin a little bit to what you expect to see in hospital systems. How can we be confident of the quality of care that's being delivered across the ambulatory networks? Really, you can't today, because those systems don't exist. But we're building the first version of that. And we're building the first version of that quality system at the very moment where we're all under the most funding pressure we've had for the last decade or more. It's a good example of how we will never make a short-term decision simply for quarter which might put at risk the future. We're committed to making sure that we're always playing chess and never playing checkers. We will never put short term ahead of quality outcome, and we will never put the short term ahead of the strategic value opportunity of this company. Next year is a good example of that proof. You can see our guidance for next year is a little lower than we would normally like to step out with at the beginning of a year. It's a little lower for all of the reasons I just alluded to, those pressures accumulating as we transition through those pressures. In particular next year, the second wave of V28 and in particular the consequential impacts of the Part D reform. But as we cycle through that, we are continuing to commit to our long-term 13% to 16% adjusted earnings per share growth. Our ambition inside UnitedHealth Group is undiminished by the pressures we deal with on the outside of this company. We continue to see many opportunities to return to that growth rate, and that is clearly our goal. But the important thing to do for 2025 was not to fall into the trap of overly cutting and underinvesting in the future to accelerate '25 and undermine the potential of delivery in '26, '27, '28 and beyond. The future opportunity is enormous for this organization. Not least because despite who we are and because despite of what we're able to do, we still occupy a tiny fraction of this enormous environment called the U.S. health care marketplace. Still less than double digits of this marketplace do we occupy. In most of our competitive positions, we're very often not the leader, we're often second or third. We are often the insurgent. We like being the insurgent. We like to be the company that wants to try and change and innovate. And we see our opportunities to grow across all of our various spectrum of the company, whether that be in our value-based care businesses, in Optum, whether that be in our benefits business, whether that be in our pharmacy business, whether that be in our growing financial services businesses, or in our technology-led businesses. Those 5 growth pillars remain the engines of the organization. And they're the engines because that's where the need is and that's where the scope for growth exists. In almost all of those categories, we have enormous opportunity to continue to grow. What we have to do over the next year is adjust to the reality of the new funding environments. And we're ready to do that. We've got through this year. We've got through this year well, although differently. We will get through next year and into a very, very different environment, we believe, for the long-term future of the company. Those external signals that we've absorbed as a sector over the last 2 years really send a couple of unmistakable messages. Number one, people want lower prices. Why would you reduce funding? You want to send a message you want more efficiency, you want more efficiency. You want more simplicity. You listen to the narrative, people complain about complexity. You listen to the policy, they want to spend less money. We need to respond to both of those things. The good news is that's exactly why UnitedHealth Group exists. We exist to try and help improve the health system for everybody. We want to make it work more easily, more smoothly, more intuitively, more transparently. That's exactly what working to do day in and day out. We're living in the era of AI, if you haven't noticed. And if we took the greatest AI machine that could possibly exist, and maybe we're 10 years away from that day where that machine exists, and you asked it to design the American Health system, even AI wouldn't design the health system we have today. In no way you would design something as complicated and as contradictory and as difficult to navigate as the system we all find ourselves in today. Because nobody designed it, it simply evolved. And we're now in a situation where we're all trying to strive to deliver better patient experience, higher-quality outcomes, lower cost outcomes, greater transparency, greater predictability, from within a thicket of a system of regulation and complexity which none of us designed, we all have to figure out how to decode. And that's what we're doing at UnitedHealth Group. Now to do that, in reality, you have to have access to a lot of different capabilities. If you are in the business of trying to improve health care for everybody, not just for a small subset, not just for the people in your town or village, but for everybody, then the need to have access to broad sets of capabilities, where you are able to start to rethink that thicket of complexity, where you're able to rethink alignment of incentives: How you get payers and providers in step through value-based care, how you think about how you might use data to understand how to manage pharmaceutical price negotiation so you can bring down those drug prices for patients across the country. How you can use data and digital technologies to create new apps and new access, so on a phone, any consumer is able to know immediately where the very best place to go get their medicine or their treatment is, whether on or off benefit. Those things, you don't just do on a Friday afternoon in the shed in the garden, those are significant industrial innovation environments that we are able to develop. The future of U.S. health care requires that simplification, that consumerization. It requires us to find ways to take cost out. It can only be done by bringing together many different elements of the system to think differently, to think in a more aligned way, to put the patient at the center of every decision; to make sure we're focused on the outcome, the clinical outcome, the experiential outcome and the financial outcome. That's what we're driving towards in this organization. And it's why we believe those 5 growth pillars: value-based care, benefits business, the pharmacy business, financial services and technology-led businesses, are so critical to all of this. Within all of those businesses are the componentry to reimagine American health care. And people need and they want that. You only have to walk into a room with 5 people to hear 4 stories of frustration. I couldn't find a doctor. I didn't know where to go. It's too difficult to understand. And of course, we hear it from policymakers through the various decisions we've seen over the last couple of years. During today, you're going to hear in the seminars a lot more about those 5 growth pillars. And I really encourage you, those of you who are able to attend those seminars, to take advantage of the Q&A sessions where you'll get the chance to meet about 50 or 60 on of our senior executives and physicians and clinicians from across UnitedHealth Group. Please take advantage of the opportunity to get to know them and to ask them questions about how they see the journey and the mission that we're on. But for the next couple of hours, here on this stage, you're going to hear from a smaller group, maybe 14 or 15 people. And we're going to take you a little deeper into progress we're making and where we are on just 3 of the key areas that I've already referred to, but for me, really sit centrally and probably most differentially within our strategy of going forward in this business. The first is value-based care. The second is our progress in consumer. And the third is how we're leveraging technology and AI to bring to life all of the opportunity that we see in front of us. That's what you're going to see on this stage. And then we'll have a session of Q&A at the end for all of you have asked -- all of your questions as you wish. As we go into this next couple of hours. Value-based care, you know that's a key priority for us. It's been an area of great dynamic over the last 2 years. Many companies who have begun to put their toe in the water of value-based care, particularly provider organizations, have been very significantly burned by the rapid and sudden shift in funding dynamic in the marketplace. What we've done is continue to double down on our strategy. You're seeing today another 650,000 lives will transit to Optum Health in fully capitated manner over the next 12 months. We continue to build out our networks of clinics across the country. We're continuing to refine that model. We continue to refine and modernize our at-home platform. And within those 2 statements, there's a really good insight into how United operates. We introduced models of care or models of work or models of alignment: Value-based care in the clinic; how we might utilize home and community alongside that; how we might meet patients where they really want to be, which is not really in the clinic, but in their home. But we know at the very beginning, we'll get things wrong. And so those models have to be constantly reiterated and reiterated. You saw in the clinics. We've been doing that for over a decade, and you can see that, that model is now beginning to be truly replicable at scale, at speed, which is why we can absorb this 650,000 patients per year into that new model. And we know those patients love it. They want to be in that environment. They like the focus on prevention. And it's an important way in which they believe and they know they are getting more care and attention. You're going to hear more about that today. But as you think about what we do in the home, we're at the beginning of that journey. It's a little bit like the clinics 10 or 12 years ago. We're at the year 1 or 2 of the home journey. We're constantly revising and reforming how we develop that model. It's almost impossible to reimagine how to intervene in U.S. health care in theory on a piece of paper and then just launch it as a finished product. You have to get in, you have to start working with patients and provider networks and you start to figure out what works and what doesn't work. And what you'll see and what you'll hear is the momentum within this organization to relentlessly improve and develop and refine our approach to value-based care. Now despite the occasional critics, if you step back, the super strong alignment of opinion leaders, administration and policymakers across the U.S. for the last 20 years says, "Do more value-based care." Four administrations, every CMS over the last 20 years have said the same thing. They argue about how much they should pay for it, but the direction of travel is completely uncontroversial. When you think about it from a logic point of view, it's uncontroversial. When you think about it from a medical point of view: Put prevention first, make sure you get ahead of things, make sure you're thinking about the whole person not just a slice of that person, it's uncontroversially sensible. That's why we're so focused on it. You're going to hear a lot more of that. You're going to hear from our physicians. You're going to hear patients. You're going to hear from people who really are part of that world. But make no mistake. Again, our ambition in value-based care is undiminished. This is, we believe, the best way to start to address the complexity and the thicket of the environment in which we all find ourselves. It's what gives us that aligning focus. Consumer. You'll see a lot of examples of the progress we've been making in consumer, and I couldn't be happier about that. 4 years ago, we marked out that consumer would be a key area of focus for this organization. And I think a lot of people looked a little bit sideways around whether or not UnitedHealth Group could really become more of a consumer organization. We're on the march in that journey. We're not done by any stretch. And maybe we're only just in the first 15% or 20% of that journey. We probably are. But compared to where we were 4 years ago, our responsiveness, our ability to have, to give access to individuals where they want it, typically mobile, in a format where they're able to understand it, we're seeing that reflected in every possible metric. We're seeing it in our NPS scores. We're seeing it in our retention scores. We're seeing it in a reduction in the number of people who feel the need to call us because they need to speak to us to understand something. All of that is reflective of significant effective progress in our consumer journey. And we will continue to drive very hard on that. That, again, is a forcing influence on simplifying our environment. Even something as trite and as simple as saying we should reduce or eliminate paper in the system forces you to simplify. When you all get your 6-page explanation of benefits document, how many times do you read it? How many of you really understand it? How many of the people out in the real world really take the time to read and understand it? How useful is it versus how complicated is it? It's time for us to start to challenge all of that in the world in which we now live, where people expect information to be much more readily available when they want it, where they want it, exactly what we're aiming to do. Much of what we're trying to do in value-based care and consumer and, of course, elsewhere in our core benefits business and in our financial service business and in our pharmacy business, is being facilitated by the era in which we happen to live. So we happen to live in a time where we inherit a complex health system. We happen to live in a moment in time where governments want to reduce funding levels. On the other hand, we happen to live in a moment of extraordinary technological innovation, a moment in time where our ability to do things has never been greater than it is today. Our ability to actually understand what we have in our hands has never been higher than it is today through technology and, of course, through AI. And we were a very early adopter of AI. We've been working in this space for a long time, and we've been ramping it up very aggressively over the last couple of years. It's an area where we are relentlessly investing, and we will continue to do so as we go through the next several years. Already, 16,000 engineers at UnitedHealth Group are equipped with generative AI capabilities. 16,000 engineers. In the last 30 days, we've accepted 8.4 million lines of code generated by AI. 24 million lines so far this year, 8.4 million in the last 30 days, it's completely exponential. That is transforming everything we do inside this company. I would say almost every use case -- and we are now well in excess of 500 deployed use cases, every use case is delivering at least double-digit rate, percentage rates of efficiency in terms of our activity. We're seeing core volumes drop. We're seeing numbers of people needed to undertake basic menial tasks drop. We're seeing our ability to deliver response faster go up. I'll give you one example, pharmacy prior -- PA, automated PAs for pharmacy. Typical turnaround time 7.5 days. So this is a pharmacy claim comes in, requires a PA, it starts to ping back and forward between the various participants, provider, pharmacy, payer, to get that done. On average, 7.5 days to get that approved. We're now deploying, with health systems, automated PA to do exactly the same thing. 7.5 days, 29 seconds. That is transformational. That kind of shift we're seeing in business field after business field across our organization. Technology is -- you're going to hear a lot more about this from Sandeep and the team today. Technology is allowing us to streamline administrative efficiency. It's allowing us to bring to consumers information in a format which they can understand and digest, which you could only have dreamed about 2 years ago. It's allowing us to take speed as a real advantage into this marketplace. And it's allowing us for the very, very first time to start to be able to understand the enormous amount of information we have as a company. What does that mean, for the very first time? Well, let me unpack that a little bit. So think about data, and I'll give you a few very simple examples. Think about data. The vast majority of all the data that we deal with is unstructured data. It's free text. It's contracts. It's endless pages of information. It's not just tables of numbers. Tables of numbers are easier, they've been easy for years. The free text is where all the value really sits. It's almost impossible, up until now, to be able to really systematize your access to that information. What that means is you don't really know what's in there, or you have to hire a lot of people with very high levels of training to interrogate dense information to try and get the truth out. What that leads to is mistakes, because you pull information out of dense text, it's not quite right, it's maybe transcribed wrong, it creates an appeal. Boom, off we go down the little journey of appeals and all of the cost that, that associates. AI allows us to access all of that information. Even as simple as, what are your contractual rights to the information that you are looking at? What can you or can't you do with that information? That's all buried in thousands of pages of contracts which were written years ago when those data sets were brought into the company. AI can access that information instantly. What does that do? It unlocks your capacity to make your data labeled, to be able to move it to be able to access it and to work it. So AI has utility far beyond the administrative efficiency, it unlocks data across the organization, and it does 2 other things. It allows us to fundamentally start to think about how we can help every clinician have the best possible advice and information every time they make a decision or a choice. Not for them, simply to advise them. And then secondarily, AI allows us to make sure that across the organization, we are able to see information and be able to connect dots faster than we could possibly have imagined in the past. All of that allows us to move at speed and pace across the business. So what you'll see over the next couple of hours is that value-based care agenda, that consumer agenda and the way in which technology and AI is being used to bring that forward. We think that the combination of all of that, alongside our other elements of the growth pillars, are truly differentiating in this marketplace. And one of the great attributes of UnitedHealth Group for the last 40 years has been, when it figures out a way to do something well, it is unparalleled in its ability to bring it to the marketplace. It's unparalleled in its ability to scale a good idea. Just look at the UCard from 2 or 3 years ago. Look at Surest right now in terms of the pace of adoption of that new benefits product. Think about how we can implement things like that automated PA idea that I just talked to you about. Think about what we can do as we get access to information in a more productive way than we've ever done before. That scaling dynamic allows us to truly contribute to improving the system across the whole environment. Culture of this organization is really at the heart of everything. It's restless. It's compassionate. It's performance-driven. And over the last couple of years, we've proven that we're tenacious and we're resilient. And we demonstrate that our ambition is undimmed. A lot of people say about companies like United Health Group: "they can't innovate." People have written papers saying that the established health care companies will never be able to be a consumer company in the way that maybe start-up consumer companies can be. People write that successful companies will never self-change their business models, it will always be up to somebody else to change it for them. People see things like that about this company. But when you talk to the 400,000 people who work in this company, they say words like can't and won't are not in the dictionary. Words like will and can are in the dictionary. And what you're going to see today is an organization that, even in environments where funding levels change, policy can be a little unpredictable. We have a clear North Star around what we're trying to do. We are going to improve health care for every individual who wants it, and we're going to improve the health system. And we're going to do it through the deployment of the capabilities we are fortunate enough to be custodians of, with the skills of the most brilliant people in health care, some of whom you're going to see today. And we're going to demonstrate once again that when the going gets tough, the tough get going. Thank you very much. [Presentation]

We believe everyone deserves a health care experience like Mirna, and that's why UnitedHealth Group is committed to making value-based care a reality for every patient and provider in this country. We believe in value-based care because it works. We surround patients with a personalized primary care team that helps them stay on top of their screenings, ensures they're taking their medication and coordinates and consults with high-quality specialists to better manage chronic disease. Our teams detect symptoms early, intervene before problems arise, engage through the care transitions and help people stay out of the hospital and live healthier lives. You'll hear many examples today from the team of how this approach leads to better experiences and outcomes for patients with more accessible coordinated primary care, a more rewarding experience for providers with better tools and information to treat their patients and ultimately a higher-performing health system. The benefits of value-based care are real, and this is why it remains the centerpiece of America's long-time health policy. The seeds were planted more than 20 years ago. At the time, access to primary care was limited. Rates of chronic disease were on the rise. The first wave of Baby Boomers were about to begin aging into Medicare. Health care costs were outpacing inflation. And the prevailing fee-for-service system left providers with little choice but to do more tests, schedule more visits and administer more care just to stay afloat. It was clear to everyone that health care was headed in the wrong direction. Health care policy experts agreed that value, not volume; and quality, not quantity, was the answer. And they set in motion a decades-long bipartisan effort to realign incentives to encourage and reward physicians for delivering higher-quality care at lower cost. And at the same time, CMS began creating programs and incentives to spur innovation. And this has been reinforced multiple times over multiple administrations. Policymakers have tested dozens of value-based models, all in service of their ambitious goal to have every person served by Medicare and the vast majority of Medicaid patients participating in accountable care models by 2030. That's more than 150 million people, yet we think the opportunity is so much greater. Because of the success of Medicare Advantage, value-based care continues to gain substantial traction among seniors and people with complex care needs, delivering far superior patient outcomes at a significantly lower cost than what it costs taxpayers to provide fee-for-service Medicare. When I talk to employers, pick a sector, any size, they all want the same thing: Increased access to high-quality primary, behavioral, and pharmacy care for their employees, but at a lower cost to both the employer and the employee. That's why the number of people we serve in commercial value-based plans has grown nearly 50% over the past 2 years. Value-based care's promise appeals to what all people want from health care: Patients who are seeking more information, coordination and high-quality care teams; providers who are striving for a rewarding culture and team-based approach to practicing medicine; and payers, including taxpayers, who are demanding improved outcomes and value. And we will feel the difference as more and more of our health system transitions to value-based care. As you've seen from this stage before, our premier care delivery organizations are delivering value-based care at scale in the commercial market. We've expanded our commercial value-based offerings in Texas, Southern California, Nevada and markets in the Northeast, too. Over the next decade, you will see our value-based care efforts accelerate and help this enterprise grow. Today, Optum works with more than 100 health plans. We serve more than 100 million consumers, offering integrated care and increasingly care delivered in the home. While seniors in Medicare constitute the largest proportion of people in our most comprehensive models, Optum also serves hundreds of thousands of people across our commercial, Medicaid, exchange and special needs plans. And these numbers will continue to rise as our capabilities and resulting impact grows and as we continue to share our expertise with partners across the system. Value-based care is an enterprise priority. It's a UnitedHealth Group ambition grounded in our ability to create connections across care delivery, technology, pharmacy, benefits and financial services, wrapping it all around the patient and the provider. Having these capabilities under one roof with the ability to tackle the complexities of the health system at scale is essential to improving health care in this country. This morning, we're going to update you on our journey and demonstrate why we are confident in our ability to deliver on the growth commitments that we have made to you. And we will begin with our care providers: Primary care physicians, specialists, surgeons, who practice value-based care everyday in cities across the U.S., from Boston and L.A. to Seattle and Houston. [Presentation]

Those are just a few of my colleagues who, together, are serving 4.7 million people in value-based models, more than twice as many as we did 3 years ago, yet this is just a fraction of the nearly 340 million Americans today. We're intent on serving more people in our integrated care models by consistently delivering differentiated clinical quality through evidence-based medicine, proactive patient engagement and deeply coordinated care, and unifying our operating infrastructure and systems to serve more patients across more geographies and plan partners. As a physician, I've seen firsthand how value-based care leads to better patient outcomes through a team-based approach, led by primary care doctors and supported by multidisciplinary care teams. Together, they keep patients healthy and deliver high clinical quality as reflected through benchmarks like Star ratings. Our model starts with early engagement to deliver the right preventive care, quickly detect conditions and delay disease progression. In fact, nearly 3/4 of our in-home visits result in a primary care visit within 90 days. Additionally, nearly 3/4 of Medicare Advantage patients in our value-based models were screened for breast cancer and colorectal cancer. And more than 90% of our Medicare Advantage patients with hypertension adhere to medication recommendations. Our care programs are tailored to unique patient needs and result in better chronic disease management. For patients with diabetes, uncontrolled hemoglobin A1C levels can lead to severe complications. But with a dedicated care team to help manage diet, lifestyle and medications, 70% of diabetic patients under our control -- under our care have control of their A1C levels, an 11-point increase year-over-year. Our longitudinal data empowers care teams to deliver timely, targeted care, improving patient outcomes and experiences and reducing costly and unnecessary treatments that arise when those conditions are not addressed. As a result, Medicare Advantage patients in Optum Health are 10% less likely to be hospitalized for stroke or heart attack. Over the past 2 years alone, our early engagement, timely clinical interventions and affordability programs have reduced unnecessary medical cost by more than $1 billion, and we see significantly more opportunity ahead. Now to deliver exceptional care and further enhance clinician collaboration, like you saw in the video, we're advancing our infrastructure, systems and data supporting care delivery. For example, our unified care data systems will include 100% of our value-based care patients by the end of the year. This is up from just 18% in 2023. This gives us a comprehensive view of every patient, unifying data from multiple sources that allow for earlier signaling and actionable insights at the point of care. And our practice management systems are delivering a more cohesive, consistent experience for our care teams and patients. Just one example of this effort is with our electronic medical records. By the end of the year, more than 80% of our employed providers will be using 1 of 3 preferred EMRs, down from 18 less than 3 years ago. We're also taking this integrated approach across claims, provider and patient services and referral management, enhancing the scalability and flexibility to support a broad range of value-based relationships across Medicare, Medicaid and commercial plans. In just 2 years, this work has already generated efficiencies, resulting in nearly $1 billion. And importantly, it uniquely positions Optum to serve more value-based care patients well into the future. And this is just the beginning. These focus areas, our relentless pursuit of clinical quality and a more unified infrastructure, are foundational to our future growth, strongly position us to expand value-based care to more people and gives us confidence to deliver on our long-term margin target of 8% to 10%. Our physicians and care teams are doing this work every day, providing care to millions of people in local communities across America. And more than ever, that care is occurring in the home.

Today, there are nearly 13 million people who are dually eligible for Medicare and Medicaid. As an internist and Chief Medical Officer for UnitedHealthcare's Government Programs, I can tell you this is a group struggling with some extraordinary challenges. Nearly half of this population are not in good health by any clinical standard, about half needs support with mental health and about 1 in 4 have been diagnosed with at least 5 or more chronic diseases. Exacerbating these challenges are widespread disparities in access: Access to traditional primary care, access to mental health, access to pharmacy care; and those other critical but less obvious elements for a healthy life, nutritious foods, stable housing, reliable transportation. Given the depth of the needs and historically high rates of hospitalization, the average cost of caring for people in these vulnerable populations is more than twice what is spent to care for people on average. Nationally, participation in special needs plans has more than doubled during the last 5 years, and we expect it will only continue to grow. Less than half of those eligible for a special need plan are currently enrolled in one. And these are just a few of the many reasons where our partners in government, at CMS and across state Medicaid agencies, are hungry for innovation. And home is becoming an optimal setting for delivering value-based care, engaging people who are most in need and otherwise have limited access to care in the comfort and safety of their homes. Optum's home care models are designed to do just that, keeping patients healthy and out of the hospital, and surrounded by a team of physicians, nurse practitioners, social workers, pharmacists and others who are all working to ensure no one slips through the cracks. Let's take a look at how our colleagues are bringing this model to life for those in special needs plans in Georgia. [Presentation]

This year, clinicians like Stacy and Daphne will visit millions of people like Antonio. As a result of our team-based care model, our most challenged patients, people contending with multiple chronic conditions and in need of comprehensive support, are 18% less likely to be admitted to the hospital and 14% less likely to make an avoidable visit to the ER. Increasingly, we're helping people manage their urgent care needs from home. Clinicians and our always-on call center filled nearly 7,500 of these calls each month. And in the cases that can't be resolved over the phone, a clinician will go to the patient's home to address acute issues and administer medications. Nearly 80% of these cases avoid hospitalization. And we expect to expand this capability to a broader mix of patients in the years ahead. For patients who need hospital care, our care transitions program has referred approximately 124,000 patients in 2024 to home and community programs for further post-discharge support. This ability to smoothly and effectively coordinate care across different settings while minimizing disruption for patients and providers, truly does set us apart. But what is unique and essential to this value-based care model is that no interaction occurs in isolation. Primary care physicians and their care teams are situated in the center of it all. They have visibility to what's going on in their patients' lives, which enables them to develop care plans for a person's comprehensive needs, physical, mental and social, regardless of the care setting. Without question, there is still so much work to be done. Home care remains deeply fragmented, disconnected and too difficult to navigate. It accounts for about $150 billion of the health sector today, and we expect this figure to climb substantially by the end of the decade. By then, 20% of the U.S. population will be 65 or older. More than 9 million will be over the age of 85. People are living longer. They have a lot of needs, yet they all want the same thing: To stay in their homes with their loved ones and enjoy their lives. And that's why we're determined to get this right, connecting the services, experiences and support people need and staying right there at their side every step of the way.

Whether it's care delivered in the home or in a clinic, providers are looking for a partner to help them adopt their own value-based care models. Increasingly, they're turning to UnitedHealth Group's provider solutions, including our advanced clinical decision support tools. These tools help providers follow the most up-to-date standard of care and quickly identify at-risk patients, offering data-driven insights and personalized treatment plans. Our suite of technology and clinical solutions is helping improve quality at the point of care. It's managing risk and population health and more easily tracking outcomes. And all in, our clinical decision support tools will help close approximately 25 million gaps in care just this year. While much of this work is in early stages, our tools are positively impacting people right at the point of care. Dr. McKinley Glover is a physician on our innovation team, and he's here with us to show how our clinical support tools are helping providers prioritize patient engagement and improve outcomes. So Dr. Glover, welcome.

Thanks, Heather.

Okay. So I want to start with some background. Trained radiologist, tell us a little bit about your path to Optum.

Thanks. So radiologists, we love using cool and innovative technology like MRIs and CAT scans to make diagnoses, to help our physician colleagues make the best treatment decisions for their patients. Throughout my career, I've had the privilege of working with physicians across specialties, geographies and practice types. And one unifying theme is that we all need better tools to do what we are ultimately called to do in medicine, which is take better care of our patients.

So speaking of cool tools, talk a little bit about Optum's clinical decision support tools and how they can help support physician practices.

So first, what is clinical decision support? It's tools that provide the right information and knowledge at the right time via the right channel, that enable our care teams to make the best evidence-based and personalized decisions for their patients. So regardless of where practices are on their VBC journey, there are a couple of challenges that are facing all of us. So the first is patients are increasingly clinically complex with multiple comorbid conditions. Next, the amount of clinical information and knowledge is increasing at an exponential pace. And third is the number of therapeutic options has expanded significantly. For example, the FDA has approved over 500 new drugs in the last 10 years and the total drugs available now is over 20,000. So our tools allow providers to stay on top of it all while reducing the time spent in the electronic health record by up to 20%, allowing meaningful time for conversations with patients.

So bring that to life for us in a practice.

Yes. So I've had the privilege of actually working with one of our practices recently and seeing them use our tools in real time, and it was extremely gratifying. As soon as I walked in, the provider said, "Thank you so much for building these tools. They've made my job so much easier." And at the start of a busy clinic day watching her use our tools to identify opportunities for enhancing care delivery and supported by the evidence that providers know and trust, and then most importantly, in the exam room with the patient. The patient and provider having a meaningful conversation about optimizing the therapy and using our tools to personalize those recommendations based on what's important to the patient, including side effects as well as out-of-pocket drug costs.

Absolutely. So let's spend a minute on chronic disease. Dr. Desai talked about the challenge in managing heart failure. How do our clinical decision support tools help physicians and patients manage chronic disease?

Yes. So heart failure is a great example. So nearly 1 in 4 Americans will be diagnosed with heart failure at some point in their life. And research has shown that over 90% of patients are not on the optimal therapy for heart failure currently. And so there's significant morbidity and mortality associated with this. Fortunately, our tools are enabling, at scale, identifying and supporting providers on making the best treatment decisions. And we believe, over the next 5 years, we're able to reduce the total cost of care by up to $4 billion.

So there is incredible need here, but great momentum. So I know you're just getting started, but you're making great progress. Dr. Glover, thank you for the work and also for being here today.

Thanks, Heather.

Thank you. So the next 10 years hold incredible opportunity to further build out our capabilities, connect more of the health system and serve even more people. When you look at the country today, less than 5% of all patients are cared for in the most comprehensive value-based care relationships. But that is changing. Industry studies believe that patients in these types of arrangements will grow by double digits annually for the next several years. Today, we're successfully managing Medicare Advantage, commercial Medicaid and exchange patients, and we do expect to continue to expand our offerings. And we will continue to realize the full potential of our diverse care modalities, the home, behavioral and surgical care, by deploying and connecting them across value-based infrastructure to drive growth in new ways. With a flexible risk platform serving patients across value-based models, by integrating our systems to fully support accountable care at scale and partnering with providers across health care, we are well positioned to grow. As we prove out the value of value-based care, we will deliver even more consistent performance with more comprehensive services. Clinical quality and outcomes will continue to improve. We're already seeing the benefits of integrated services in the home, increasing access to primary care and reducing hospitalizations. Cost savings will accelerate. In our care delivery business alone, our early clinical interventions, operating efficiencies and affordability initiatives are meaningfully reducing costs. And the entire health care experience will feel different. As more providers seek out value-based care, as more consumers are engaged in benefits from the value-based care system, and has more come to expect a more integrated experience, years from now, as we look back, serving 4.7 million patients will feel very small. An important enabler of value-based care is the continued advancement of technology. So now we'd like to update you on our efforts to drive intelligence and productivity across health care.

Thanks, Heather. I'm afraid that we -- as some of you may know, we're dealing with a very serious medical situation with one of our team members. And as a result, I'm afraid we're going to have to bring to a close the event today, which I apologize for. I'm sure you'll understand. We were going to go offline now from the broadcast. And we'll share with you an alternate mechanism to update you all with the information we were going to share with you with the rest of the day. I apologize for bringing things to close, but I hope you'll understand. And I appreciate again you joining us today. Thank you.