UnitedHealth Group Incorporated (UNH) Earnings Call Transcript & Summary

Good morning, and welcome to the UnitedHealth Group Second Quarter 2026 Earnings Conference Call. A question-and-answer session will follow UnitedHealth Group's prepared remarks. As a reminder, this call is being recorded. Here are some important introductory information. This call contains forward-looking statements under U.S. federal securities laws. These statements are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present expectations. A description of some of the risks and uncertainties can be found in the reports we file with the Securities and Exchange Commission, including the cautionary statements included in our current and periodic filings. This call will also reference non-GAAP amounts. A reconciliation of the non-GAAP to GAAP amount is available on the financial and earnings reports section of the company's Investor Relations page at www.unitedhealthgroup.com. Information presented on this call is contained in the earnings release we issued this morning and in our Form 8-K dated July 16, 2026, which may be accessed from the Investor Relations page of the company's website. I will now turn the conference over to the Chairman and Chief Executive Officer of UnitedHealth Group, Stephen Hemsley.

Thank you. Good morning, everyone, and thank you for joining us. Our second quarter results and updated full year 2026 outlook demonstrate continuing progress toward delivering more consistent and dependable performance. They are a sign of stronger broad-based performance disciplines taking hold in each of our businesses and a restless desire to drive mission-aligned change across the enterprise and advance our social impact. UnitedHealthcare has improved performance in its Medicare businesses through thoughtful benefit planning and design, all while remaining respectful of persistently elevated medical costs. Our Medicaid business is in line with expectations as we continue to work with states on ensuring appropriate rates. Our commercial benefits business, consistent with the broader and more diverse commercial market it serves, continues to experience higher-than-expected cost trends due to factors Tim Noel will discuss shortly. At Optum, we're seeing building momentum from Optum Health as the business recenters back to its integrated value-based care delivery model. This resulted in another quarter of improved care management and greater operating discipline. OptumRx continues to perform to plan as transparency initiatives we announced early this year resonate well in the marketplace. Optum Insight also on plan remains on a multiyear path of reinvestment and innovation as we bring modern, intelligent technologies and services the areas of various need in the health system. We believe Optum Insight is exceptionally well positioned to help modernize and simplify the health system as it brings AI-enabled tools and services to market. Across the enterprise, we're focused on serving consumers and care providers in ways that are reliable, affordable and transparent. That requires us to pay close attention to areas where the system isn't working well enough. Areas including care approvals, accuracy of information and speed of response, access and scheduling, digital services, care path navigation and more. We are committed to making the health system work better for all stakeholders by simplifying processes, by being clear more consistent and faster in the experience we offer and by redesigning and modernizing that experience altogether. AI technology is helping us move faster. We're using it to improve service interactions, reduce administrative burden and support better decision-making, always in service of improved experiences and outcomes for both patients and care providers. UnitedHealth Group has a long history of evolving to meet the needs of a constantly changing U.S. health system. That evolution today includes a tech forward view actively and appropriately embracing an AI paradigm for our businesses. A management team with skills and vision to help in building a more advanced health system and an ever-evolving organizational structure and culture aligned to that system. Our operating structure today broadly reflects a set of highly regulated benefit businesses and a complementary set of products and services for patients, care providers and customers. We will continue to look to build and evolve ahead of the health system itself. We're making solid early progress both in how we better approach those we serve and in our results. We have much more work ahead and need to continue to get better by focusing what matters most with solid management and execution disciplines aligned to our mission to better serve people and the health system itself. With that, I'll turn it over to Tim Noel.

Thanks, Steve. The pricing benefit design and market actions we've taken over the past year have been central in supporting our second quarter results and improved full year outlook. As you have seen, UnitedHealthcare's overall performance in the second quarter exceeded expectations, driven by better results in Medicare Advantage, while commercial benefits remain pressured. I'll start with medical costs. Through the first half of the year, we are seeing divergence within our portfolio. Medical cost trends in Medicare are still running well above historical levels, but below our expectations so far in 2026. The primary reason for trending below our expectations in Medicare is our own initiatives, including benefit design, care management models and network curation. Other factors have an influence as well, including prior year development, a more favorable respiratory season and weather patterns. We expect the 2026 Medicare medical cost trend to come in below our initial estimate of around 10%. Commercial costs are stubbornly high, rising above expectations, which we believe is consistent with what is being experienced across the sector. Turning to the overall performance of our individual benefit offerings. Medicare delivered a strong second quarter. Membership retention was better than previously anticipated. We now expect full year Medicare Advantage enrollment to decline by approximately $1.1 million and Medicare margins to finish 2026, above 3%. Looking to our 2027 bids, our benefit planning remains disciplined and grounded in the current trend environment. We will continue to support program and margin stability through actions, including benefit adjustments and selective changes in market participation. In Medicaid, overall performance during the quarter, including cost trend was broadly in line with expectations. We are beginning to see early signs of improvement from initiatives, including those targeting elevated behavioral health cost trends, but we expect Medicaid margins to remain pressured for 2026. Our focus is on closing the gap between lagging reimbursement rates and underlying medical cost trends, while continuing to partner closely with states to support the long-term sustainability of Medicaid benefits and support them in identifying and reducing fraud, waste and abuse. Within our commercial offerings, as I noted, we are not yet seeing evidence of cost trend moderation. In fact, it is the opposite with medical cost trend modestly above 11% level we previously saw. The primary drivers of pressure from the independent resolution process under the No Surprises Act which applies only to commercial plans and more aggressive billing practices among providers, especially higher service and coding intensity and higher cost per encounter that result from the more fee-for-service orientation of commercial plans. At this distance, commercial margin recovery will remain a focus area longer than originally anticipated. Returning to UnitedHealthcare as a whole. We are confident in being able to deliver meaningful earnings growth in 2026 and into 2027. We with the reinvestments we are making in the business to build a stronger, more durable foundation for 2027 and beyond. Of equal, if not more importance, we remain intent on modernizing essential health care experiences to improve how consumers and care providers experience the health system. For example, in the quarter, we committed to eliminating by the end of this year, 30% of prior authorization volume and nearly 2/3 of prior authorization requirements for pediatric care. We continue to take concrete steps to reduce complexity and increase speed by further simplifying prior authorization, increasing consumer responsive digital experiences providing greater support to rural hospitals and care providers, offering more consumer-centered product innovation and much more. AI is both an enabler and accelerant to this effort. We're early in this work, but clearly on the path to improve the health care experience and strengthen relationships with our stakeholders, starting with consumers and care providers. And we're confident these efforts will bolster United Healthcare's long-term performance and market position. And now let me hand it to Patrick Conway.

Thanks, Tim. As Steve noted, we are seeing positive momentum across Optum, with all 3 business segments performing in line or ahead of plan through the first half of the year. OptumHealth is intently focused on improving its clinical care and operational experience to better serve the 20 million people we care for through primary and specialist care, ambulatory surgery and home health. Over the last year, we have made significant changes in how we operate this business locally and nationally and are seeing the initial benefits of this approach. We are steadfast in our intent to optimize an integrated value-based care system that benefits patients, care providers and taxpayers. On the clinical side, we are advancing approaches that better support care providers and drive measurable improvements to patient care at lower costs. I'll offer a few examples. First, enhanced support for patients during key transitions of care has resulted in approximately 10% reduction in hospitalization since implementation late last year in the Western and Southern regions of OptumHealth. Second, home health initiatives to better support patients as they return home where they can be managed more comfortably and effectively have reduced readmissions. In pilots, the effort has driven a more than 20% improvement in timely care delivery alongside reductions in acute care utilization and shorter skilled nursing facility stays. And third, in rural health we've expanded access to care by integrating house calls and home-based care capabilities, coupled with treat in-place offerings for patients with complex chronic and behavioral health conditions. Today, OptumHealth reaches nearly 90% of U.S. counties and conducts approximately 2.5 million rural patient home visits annually. We will expand these programs across our OptumHealth footprint by the end of 2026. On the operational side of Optum Health, we have established a clear regional and national management focus. This gives us greater and more timely visibility into performance, driving consistent, best-in-class standards across the portfolio and deploying technologies to support clinicians and the important work they do. There is real progress on the rollout of AI-based ambient listening capabilities available to 70% of our employed providers today and on track to exceed 90% by year-end. Collectively, these actions are yielding tangible results. Patient experience in our care delivery sites is up approximately 5% year-over-year, and patient access has expanded by nearly 200,000 and more patient-facing hours. We are in the early stages of these efforts. Optum Health will build upon this foundation with additional investments in clinical workflow improvements and network performance. more deeply embedding AI and automation to further improve operational performance and clinician experience. Additionally, we entered the 2027 benefit planning season very differently than years past starting with much earlier proactive collaboration with all our payer partners. This will translate to greater care coordination for patients while more appropriate aligning rates and risk. As our plans and initiatives begin to mature and scale with disciplined execution, we expect margins to continue to steadily improve. Turning to Optum Rx. For a few years now, we have been leading an industry-wide shift towards transparency and fee-based services, where we are delivering affordability and better outcomes regardless of pricing structure. That's why we continue to win new customers and retain existing ones with retention rates in the high 90s. In May, we announced a new pharmacy care approach based on a monthly per member fees with full PBM and GPO fee transparency and enhanced consumer tools. Client feedback has been positive and focused on how greater transparency and clinical alignment can address trend challenges shifting the conversation to affordable health outcomes versus economic guarantees. This all builds on our industry-leading commitment last year to pass through 100% of manufacturer rebates to customers by the end of 2027. We are well on our way as we expect to end 2026 with more than 95% of clients on 100% pass-through. Moving to Optum Insight. AI-enabled approaches continue to gain traction as more payer and provider customers seek differentiated capabilities to drive better performance. The emerging suite of products include solutions such as AI-enabled coating, real-time payer and provider interfaces and clinical quality and safety support. These products are driving real impact for customers, making health care simpler, faster, better and more affordable. For example, Value Connect is an AI-driven insights platform, integrated into provider workflows and electronic health records to improve value-based care performance. Early client results include a 17% reduction in pharmacy costs. Bringing this all together, halfway through the year, we have made steady progress in each of our Optum businesses and we'll continue to find ways to better serve patients, providers and customers. I'll now turn it over to Wayne DeVeydt.

Thank you, Patrick, and good morning, everyone. I will briefly review second quarter results then discuss expectations for the remainder of the year as we refresh our 2026 guidance. Overall, the quarter and full year outlook reflect improved performance across our businesses with notable improvements in UnitedHealthcare and Optum Health. UnitedHealth Group reported adjusted earnings per share of $6.38 compared to $4.08 in the prior year. Total revenues were $112 billion largely consistent with the prior year, while operating earnings of $8 billion grew 55% year-over-year. This improvement reflects product and portfolio actions taken over the past 12 months along with more focused and consistent management disciplines. Turning to medical costs. Our reported medical care ratio of 86.7% includes $860 million of net favorable prior period medical development, the majority of which is in year development. This compares to 89.4% in 2Q 2025. Days claims payable was 47 days, up approximately 2.5 days from a year ago. The operating cost ratio was 12.7% for the quarter compared to 12.3% a year ago, as we continue to focus on operating discipline, while making targeted investments across technology, AI, care delivery enhancements, customer experience and advance in healthier communities through the United Health Foundation. Moving to cash flows on our balance sheet. Operating cash flows in the quarter were approximately $11 billion or 1.9x net income, reflecting timing of substantial government payments and strong earnings. This provides capital to strengthen the balance sheet, invest in growth and return value to shareholders. Through mid-July, we have deployed $4 billion for repurchases of 11.4 million shares. We now expect to complete total share repurchases of at least $5 billion in 2026 compared to initial guidance of $2.5 billion. During the quarter, we returned $2.1 billion to shareholders through our dividend which our Board increased to $9.28 per share on an annualized basis. And lastly, on July 2, we successfully closed the previously announced combination with Alegeus. Our debt-to-capital ratio was 41.2% at the end of the quarter compared to 44.1% 1 year ago and 170 basis point sequential improvement from the first quarter of this year. We remain on track to reduce our debt-to-capital ratio to approximately 40% by the end of 2026. As you saw earlier this morning, we have updated our full year 2026 guidance to reflect performance through the first half of the year and a more mature understanding of expected membership mix and utilization patterns for the remaining 6 months. We continue to be respectful of medical trend and we believe this refreshed outlook appropriately balances risk and investments with durable run rate earnings. A few areas of this outlook to highlight. We're providing new adjusted earnings per share guidance range of $19.50 to $20 with slightly more earnings in 3Q relative to 4Q. We are increasing the full year operating earnings outlook for UnitedHealthcare to at least $12 billion and for Optum Health to at least $2.2 billion. These changes reflect operational improvement underway across the enterprise. We now expect a full year medical care ratio of 88.1%, plus or minus 25 basis points. We expect the operating cost ratio to come in at the higher end of our previously discussed range as a result of investments in our people, communities and AI. The overall earnings cadence for the year remains consistent with prior expectations. UnitedHealthcare earnings continue to be weighted approximately 75% to the first half of the year. Similarly, we expect nearly all of Optum Health earnings to be recognized in the first half with modest profit in 3Q and offset by modest losses in the fourth quarter due to the seasonality of the risk-based businesses. In contrast, Optum Insight and Optum Rx remain more heavily weighted towards the second half of the year. with each expected to generate approximately 55% of their full year earnings during the back half as client implementations, growth investments and normal business seasonality progressed through the year. So overall, we're seeing a 2/3, 1/3 first half to back half next. Steve, back to you.

Thanks, Wayne. Over the last few quarters, this enterprise has undertaken a broad-based effort to improve how consumers and care providers experience the health system, while addressing the chronic cost trend issues driving the everyday challenges of access, affordability and complexity. Our press release this morning has a sampling of these initiatives. Our efforts focus on essential themes: affordability, transparency, modernization, simplicity and convenience. As the U.S. health system continues to evolve, we will evolve our approaches and our businesses as a scaled and diverse enterprise driving integrated value-based care anchored in the first principles of the right care at the right time and in the right setting. A system where incentives are aligned to those first principles and the better health and the better cost trends that drive. Value-based care approaches are a key component of the effort to make health care more affordable by bending the cost trend by better aligning incentives for both consumers and care providers. Artificial intelligence technologies applied in practical ways that help people can be an accelerator to achieving that goal as we use them to literally reimagine our enterprise. You should expect us to continue along that path and pick up momentum as we better fulfill our mission with accountability to you and all stakeholders in health system. Now we'll go to questions. Thank you, operator.

[Operator Instructions] And we'll take our first question from Justin Lake with Research.

Just wanted to touch on a couple of numbers. First, on Medicaid, you had talked to minus 1.1% to minus 1.7% margin. previously curious. It sounds like you're seeing some improvement there. Maybe you could give us some color on what you expect the year to end up. And then on commercial, can you talk about the magnitude of the cost trend pressure you're seeing here versus that 11% expectations and maybe update us on how we should think about commercial margins this year and the trajectory versus the previous assumption? I think you assume you're going to get back to target in 2027.

Sure. Thanks, Justin. Mike, do you want to take the first one? Medicaid?

Thanks, Justin. Yes, our Q2 Medicaid performance was in line with expectations. The first half of the year has benefited from execution on affordability actions, including network curations, payment integrity actions, fraud waste and abuse and identification of operating cost disciplines. Trend remains elevated versus prepandemic levels, but stable with continued pressure in specialty pharmacy, home and community-based services and behavioral health care services. We're also seeing a bit of an increase in trend in inpatient SNF costs as well for our complex populations. An aggregate year-to-date rate actions through 71 accounting for approximately 80% of our annual revenue we're within our expected forecast. We continue to work with our state partners on-cycle and all cycle rate actions and are in active conversations for our [ 901 and 101 ] rates. We continue to believe annualized 2026 rate impact will be in the zone of around 6% to 7% and still lagging elevated medical trend. Overall, our '26 margins will be within our previously communicated range, as you've indicated, negative 1% to negative 1.7%, and we expect to hit that expectation for the year. Thank you for the question.

Thanks, Mike. Dan Kueter, do you want to comment on commercial?

Yes. Thanks, Steve. Justin, thanks for the question. Let me unpack a little bit for you what's going on in the commercial business is obviously a trend and margin are tied together. I think it's pretty straightforward. First on trend, modestly above 11% that we were expecting, as Tim shared. There are multiple drivers. First, the ineffective IDR process that's associated with the No Surprises Act is being exploited by select providers in select geographies. It's contributing 50 basis points or so of incremental trend in 2026. And now totaling at least 100 basis points of total cost. Additionally, provider coding intensity with office visits, emergency departments and selective other care sites, being the primary drivers is also contributing incremental trend to last year and to our expectations. Some consistent drivers continue to be pharmacy costs, I'd highlight specialty drugs, reflecting both higher net costs and growth of newly covered indications. Anti-inflammatory and GLP-1s are part of that mix, as you would expect. And lastly, we're on the utilization and care patterns, we're not seeing any other areas of meaningful offset or pull back in those categories. So now the impact of that trend environment on our margins. We came into '26 planning for margin expansion as you highlighted. And simply put, we're not yielding the full margin expansion for which we planned in 2026. I see '26 as a delay to that margin recovery trajectory, not a setback. So the sticky nature of the persistent and elevated trend is extending the time frame for full margin recovery past 2027, as we've previously discussed and you highlighted. We remain on a multiyear journey. We remain confident that, that journey will result in a return to our historic margin performance of 7% or greater for the commercial group business. That performance is pacing and that recovery is built on a few things: improved administrative cost efficiency AI-enhanced fraud waste and abuse efforts and diligent focus, as always, on medical cost affordability. So thanks for the question.

Thanks, Dan. It's an area we're clearly focusing on going forward.

Our next question comes from A.J. Rice with UBS.

Obviously, the turnaround from a year ago when you came back, Steve, and restructured the team has progressed very nicely. As you sort of assess here a year into all of this, maybe just broadly, where is the turnaround pretty much done, where they're still in your mind opportunities and -- because I have to ask you a numbers question, how about the thought of getting back to the 13% to 16% earnings growth trajectory. I know the goal had been to do that by 28%. Do you feel like you're going to do, obviously, better than that this year. Do you think you're on a sustainable track now to have that 13% to 16% growth going forward?

Yes. I would say basically 2 things in that. I would say we'll probably never -- we'll remain restless. We are never going to not be an improvement and urgency mode. So I don't see this kind of approach really changing. And I think everybody is aligned with that. And so we have a great deal of work to do in front of us. This is not just about returning to a growth rate. This is also about making this company perform in levels and in areas and spaces consistent with its mission and to really provide a positive impact to all those we serve and across the health system. So that broader mission is a restless one. It's a journey, and that's not going to stop. The second is in terms of the growth rate, I don't ever believe I ever didn't believe in the 13% to 16% long-term growth rate. We will have moments along the way when we don't perform to our potential. But if you take a look, I think, at this business approach and the challenges in the health care system, I think that we can grow in that growth rate, particularly recognize that it includes productivity gains and use of capital. And if anything, those things have -- particularly on the technology side, the opportunities there are even greater than they have been in the past. So we continue to be in that mindset of that 13% to 16%. I definitely believe we can perform in that range. really never believed otherwise. We did obviously have challenges in the last couple of years, but we are addressing those challenges and returning to a form, and that's kind of the way we think of it. Is that enough for response?

That's great.

And we'll go next to Stephen Baxter with Wells Fargo.

I wanted to ask about cost trend in the Medicare Advantage business. You bid for 2026 cost trends to be 100 basis points above 2025 level. So I heard you in the prepared remarks saying that trend is coming in kind of below where you bid to, but trying to understand where you see trends sitting versus 2025, at least in the first half of the year. And then just as we think about what you assumed in the bids that you finalized a month or so ago, was that closer to the first half experience for trend or something closer to what you saw in 2025 or expected to see, I guess, going into 2026.

Sure. Tim Noel, can you comment on that?

Steve, thanks for the question. So I'm going to just start off with just a high-level view kind of across UHC and then turn it over to Bobby for a little bit more supplemental detail on Medicare. So to start, trend remains very high across the board within UHC all product lines when you compare to historical levels. As you know, in our benefit planning, pricing and forecasting, we broadly planned for a continuation of what we saw last year. And as noted in my opening remarks, how this is playing out across the businesses is a little different when you think about commercial, Medicare and Medicaid. Dan highlighted some of the drivers leading us modestly above the 11% we're seeing there. Medicaid, again, largely in line with expectations. And for Medicare trend is coming in lower than our planning assumptions. However, it's really important to note this does not represent an inflection point in trend, we're continuing at those high levels, but it's coming in lower than our benefit planning assumptions. One of the key point before turning over to Bobby that I wanted to raise, is on our exchange business, our exchange business is coming in better than our planning expectations as well. However, it has no financial impact inside of the quarter or the full year because we've made the pledge to return our profits to consumers for 2026. But that is separate from the commercial trends that we've been talking about of the greater than the 11% that we historically had been guiding to. So with that, I'll just turn it over to Bobby for some detail and color on Medicare.

Yes. All right. Thanks, Stephen. So maybe to go one click deeper on the Medicare piece. So important to remember how we built up the 2026 medical trend, Steve and I'll maybe frame it in 3 ways for you First, we saw elevated levels of core utilization in '25. We talked a lot about that, and we assume that, that would continue into 2026. That was kind of the foundation. Second, we adjusted for no year-over-year increases in things like the fee schedule changes and calendar impacts. And then third, we accommodated for some level of potential unknown risk elements. So we've mentioned tariffs and other things of that nature. Now there are a few things I'd point to in terms of why trends to date are a bit lower than our original expectation. First, we've had some positive claims experience as well as any year benefit from things like the lighter food and respiratory season and winter storm impacts that Tim mentioned in the prepared remarks. And we've also not seen the full emergence of material unknown elements at this stage. However, it's also really important and highlight that while medical trends remain high versus the historical levels the improvement we're seeing is also the result of targeted actions that we've taken. And we've done that through benefit design, product positioning that's resulted in a more favorable membership mix. We've had network curation activities focused on high-quality, low-cost opportunities with providers for our membership. We've had broad affordability initiatives, and then we continue to invest in aligned provider models like value-based care. So overall, I feel good about our assumptions for '26, where we currently sit versus our expectations and yet remain intensely focused on affordability given the still elevated levels of medical trend versus the historical baseline. And then to your question on '27, still probably a little bit too early to talk a lot of specifics there. But at the highest level, we did plan reflective of our current experience with appropriate adjustments then for things like fee schedule updates and other natural year-over-year changes, but foundationally not expecting a meaningful deviation from the still elevated underlying core trends.

And we'll move to our next question from Kevin Fischbeck with Bank of America.

Great. Maybe just kind of following back up on an earlier question about the growth rates. As we think about 13% to 16% is kind of being, I guess, like a North Star growth rate for you guys. I mean, the outperformance this year was -- is pretty dramatic. And just want to make sure that it's not something that we should be adjusting out of this baseline. Is this a good baseline to be thinking about for 2027 if you kind of assume normal growth from here? Or is there anything we should be thinking about either whether it was prior period development or outperformance that in MA that gets rebid to next year? How should we be thinking about that?

I think the quality of earnings is exceptional. Wayne, maybe you want to comment?

Yes. Kevin, let me start by saying I do think, as Steve highlighted, the earnings are quite durable. And we do think the $19.50 to $20 is the right stepping off point, albeit it reflects prior period development. We would say as well that as Steve commented on the 13% to 16% growth algorithm we personally have never deviated from. And we believe that is the right starting point as you think about our stepping off point.

And we'll go next to Lisa Gill with JPMorgan.

Kind of following up on that question. Throughout your prepared comments, you've talked about investment spending, the SG&A of -- in the quarter. How much of that is potentially onetime and where you could see a benefit to that going into 2027? How should I think about the investments that you're making and the benefits that you could see? And again, to your point, Wayne, is there anything that's onetime in nature?

Lisa, similar to the PPD while that benefited us in 1 direction, we continue to invest in our foundation, which you could argue is 1 time. We don't believe that's onetime though. I think one of the things that we are targeting as a team is continuing to build that foundation out over time. We are now up to $1 billion in the foundation, which is a very important part of our commitment to our communities. That being said, Lisa, we have a number of positive momentum items, but the durability of the underlying run rate is strong, and you can see that in our cash flow. So I don't think there's anything you should be carving out in either direction. I think the $19.50 to $20 is the right baseline. And I think you should be thinking about the growth algorithm from that point forward. And I think as you heard, recovery on commercial is going to be a little bit longer than we had anticipated, but that should be a tailwind that we are reflecting in the future as well. along with many of our other businesses that are still not at the optimal margins.

And we'll take our next question from Andrew Mok with Barclays.

Wanted to follow up on the commercial market comments. The IDR process has been in place for a number of years now. So can you help us understand why costs are accelerating now? Is that a function of win rates, dispute volume or resolution timing? And is IDR something that you have confidence that you can price for? Or are there idiosyncratic considerations that make it harder to incorporate in pricing?

Dan.

Andrew, Dan Keter again. Thanks for the question. As I said earlier, the IDR process as part of the NSA is ineffective, and we think there's multiple reasons behind it. It has existed for some time, but it continues to accelerate in the volume of disputes and that has highlighted the deficiencies of the IDR process. Just a couple of things to point to upwards of 40% of all claims that enter the IDR process are ineligible for one reason or another. So as volume has increased, obviously, this creates cost and delay for all involved. Roughly 60% of all arbitration cases are brought by 1 of just 5 entities. That, again, is a recent concentration of disputes in a narrow number of of entities that is different than it has been in the years past. And then I guess further evidence of the weaknesses of the IDR process, and some of the things that continue to evolve, making it dynamic and why it's changed from what it's been in the past. The average payout from arbiters when they side with out-of-network providers is now 11x what Medicare would pay with some of those decisions ranging up to 30x what Medicare would pay. So these numbers continue to evolve. They have accelerated. There are, of course, geographic variations to that as in certain states, their process supersedes the federal process for insured business. So it's variable across the country, but these trends in the aggregate apply to the federal IDR process associated with the NSA. So Hopefully, that's clear evidence. It is certainly to employers of all sizes that the IDR process is not working. Certainly not as Congress intended it, and it needs to be reformed. So those are some of the inside numbers and their accelerations into this year and where we think it needs to go.