Q1 2021 UnitedHealth Group Inc Earnings Call
Ladies and gentlemen, thank you for standing by and welcome to the United Health Group first quarter 2021 earnings Conference call. At this time all participants are in a listen only mode. After the speaker's presentation. There will be a question and answer session to ask a question. During the session you will need to press star one on your telephone as a reminder, today's program.
Ram is being recorded and now I'd like to introduce your host for today's program Andrew witty. Please go ahead Sir.
Good morning, and thank you for joining us to discuss our first quarter results and positive outlook as we continue to execute on Unitedhealth group's long standing mission and strategies.
The exceptional dedication of the people of Optum and United Health care again defined this period, they've adapted swiftly and creatively to demand in a rapidly changing circumstances implemented new ideas and importantly remain focused on serving people exceptionally well.
As a result adjusted earnings per share were $5 and 31 sentence.
Reflecting strong execution at both United Health care and Optum.
In light of our strong start to the year balanced with continued respect for the potential pandemic related effects. We have previously described.
We are increasing our full year adjusted earnings outlook to a range of $18.10 to $18 60 per share.
I'll touch briefly on two highlights among many in the quarter that illustrate the increased momentum all colleagues at Unitedhealth group of driving.
People served with our employer and individual offerings grew nearly 100000 in the quarter.
Even within the context of a challenged U S employment environment.
And this underscores the growing consumer orientation affordability and breadth of our products.
Optum insight revenues increased 14% and operating income increased 45% compared to the year ago period as more normal activity levels among health care system customers returned.
Leading to expansion in how we help them advance clinical and operational excellence.
Significant innovation in automation in the Optum insight businesses drove strong productivity gains.
We have the right capabilities assets and strategies in place and we remain restless to innovate evolve and further integrate our offerings to serve more people more effectively both directly and with our many external partners throughout the health care environment.
To achieve this we'd be sharpening our focus in three key areas first delivering even greater value to those we serve throughout the health care system by better harnessing the collaborative capabilities of Optum and United Health care.
We believe we can develop new products and services, which support people more effectively by bringing to bear greater application and adoption of the combined offerings of these two distinct and complementary organizations.
Optum Kaz work supporting Medicare advantage patients illustrates this well and I'll speak more to this shortly.
The second area of focus increasing the application of our technology and related resources to improve care for people and the operation of health systems.
There are benefits for everyone and helping to make the health care system more more like an actual system.
Proving the natural flow accessibility and use of information is essential to that goal.
Within our secure and protected framework.
We can help cat, we can health care providers and payers better serve patients by more effectively simplifying key administrative processes and <unk>.
By providing timely access to relevant information.
The third focus is making health care work better for consumers.
We're ambitious to meet the rising expectations of health care consumers.
We will continue to improve our offerings, including in such critical zones has greatly simplified intuitive and satisfying consumer digital experiences.
And advanced health care banking and payment services that enable people to find price and pay for cat digitally.
You'll hear more from US about these approaches in the months ahead, but today I'd like to focus on the first.
Locking greater value for customers at the intersection of Optum, and United Health care, including through our ability to develop new useful service offerings.
One of the most effective ways of doing so is through stronger alignment of the high quality clinical services of Optum care to address the needs of patients we serve for our nearly 90 health plan customers.
A key foundation is increasing the clinical outcome accountability of our Optum care practices.
Of the 4 million patients who opt in cash serves in some form of accountable arrangement today 2 million are being served under fully capitation arrangements.
And this demonstrates the strong growth in progress.
For the Optum cash 20 million patients in total.
Is one reason why we view the potential of Optum care is only beginning to be harnessed.
These accountable arrangements drive measurably better patient outcomes and experiences all at lower cost.
For example, seniors served by Optum care physicians under such arrangements spend on average one third fewer days in the hospital and have 40% fewer days in skilled nursing facilities than seniors in traditional Medicare.
We expect the gross and the number of Optum care patient served under accountable arrangements to accelerate.
A further example of using our combined expertise to advance more beneficial service offerings is the recent opening of our first of its kind optum integrated care facility in Riverside County, California.
While we have long offered and continue to actively develop our senior focused clinics. This new clinic and community Center offers a comprehensive range of primary care led services, including a pharmacy all under a single roof and importantly, it is especially orientated around supporting Medicaid Medicare and commercial.
On individual members of all ages.
This comprehensive health Center provides improved care access with modern onsite services, including annual wellness visits chronic disease management support coordinated care with trusted specialists and laboratory imaging and pharmacy services.
The adjacent community Center includes the full service, Jim and meeting rooms for health education.
We see Optum and our payer partners is uniquely positioned to be able to offer these types of impactful venues and look forward to learning from the community and expanding the services.
To sum up we continue to organize and apply the unique capabilities of this organization in ways that enable us to execute on the goals we established for 2021.
Beyond and to continue to deliver on our 13% to 16% long term earnings growth objective.
Now I'll turn it over to President and Chief operating Officer, Dirk Mcmahon to give more color on initiatives to drive greater performance across the organization.
Thanks, Andrew as Andrew noted, we continue to drive growth by supporting more affordable simpler quality care across Optum and Unitedhealth care.
These are themes you've heard us cover before and we continue to see the benefits of this approach for people for the people we serve.
Let me turn those themes into some specific examples across optum and Unitedhealth care that illustrates how our approach is working.
First is how we've been simplifying the consumer experience over the past year.
We've driven greater engagement with seniors by increasing adoption of digital tools.
Active users of our digital offerings have risen double digits with similar increases in online transactions.
This has led to greater adoption of our digital therapeutics.
In the first quarter high risk chronic disease patients and our home monitoring program logged.
Over one $5 million biometric measurements, such as glucose level.
99% medication compliance and an NPS of 84.
We've also made it easier for people to get and maintain behavioral health support by expanding traditional and virtual provider network and combine them with modern digital therapeutic services.
Behavioral health needs have increased significantly during the pandemic and as a result, we have seen substantial adoption and our digital behavioral platform that provides on demand and emotional support logging a rise of over 100% utilization.
Always accompanying our work to simplify health care is optum and Unitedhealthcare is sharp focus on delivering high quality care.
We've talked to you before about the advances we are making to integrate patient specific health data and plan information directly into the physician's workflow.
Clinicians can see gaps in care and active close them during the patient visits.
During the patients' visits in addition to other steps that facilitate more efficient care and better outcomes.
We now support over 8 million of these insights enabled digital interactions each month with rapidly expanding physician adoption.
Delivering high quality care has been central in our response to the Covid pandemic. Our most recent effort to help members access vaccines is a Prime example, we launched a vaccine locator tool, helping people find and sign up for a vaccination and we've made millions of outbound contacts to engage members and help them get the information they need.
Lastly, making care more affordable remains potential for the people, we serve and the health system overall and is essential for increasing access.
For instance, through our medication sourcing program high cost providers now source drugs at a network specialty pharmacy, including off Tomorrow Rex for charge market rates only for the drug.
Early work on this has generated substantial savings for our customers.
Our work to make health care simpler higher quality and more affordable to drive strong growth for our business.
At the end of January for example, United Health Care was awarded an Oklahoma sooner care Medicaid contract to serve nearly 200000 people.
Oklahoma previously operated under a fee for service program.
Ward affirms the value, we bring to state partners and consumers and reflects our commitment to expand access to care for all Americans.
We look forward to working with our new partners in Oklahoma and sharing with you on future calls new examples as our work on simplicity quality and affordability continues to create improvements and new growth opportunities with that now I'll turn it over to Chief Financial Officer, John Rex.
Before I review the performance of our businesses as in recent quarters I'd like to provide an update on the care patterns, we're seeing as the pandemic continues to evolve.
Over the course for the first quarter total care activity, including COVID-19 related GAAP rent marginally below seasonal baseline.
Pacing of elective care activity through the quarter generally track and in opposite directions with the rise in declining of Covid incidence rate, which were much higher in the early part of the quarter than in the latter part.
To put this in perspective February and March showed COVID-19 related care at about half the level experienced in January.
Since the quarters end, we have again began to see a rise in COVID-19 related care, while at this time non approaching the January level.
Outpatient care activity was moderately below seasonal baseline for the full quarter running in counterpoint to that COVID-19 incidence patterns over the three months and reflecting a well below average influenza and respiratory illness season.
And total inpatient activity was modestly above seasonal baseline with over 55000, COVID-19 related emissions during the quarter compared to 65000 in the fourth quarter 2020.
Moving to business unit performance opt.
Optum health first quarter revenue and earnings increased 35% year over year.
Revenue per consumer served grew 31% over the year ago quarter.
The growth in this metric continues to reflect the expanding number of people served under value based care arrangements.
And the increasing acuity of the care services, we offer.
Optum insights revenue grew 14% in the quarter and earnings of 45% due to growth in our services and technology offerings and improve productivity.
The revenue backlog at $20 8 billion grew one $6 billion over the first quarter 2020.
As more normalized business activity started to return among our provider and payer customers.
<unk> revenue and earnings were relatively consistent year over year and in line with our expectations.
Adjusted scripts declined modestly from the year ago quarter.
A period during which we provided advanced medications to the people we serve as the pandemic began.
Pharmacy care and specialty services continued to grow strongly in particular home infusion and our community behavioral health pharmacies.
Turning to United Health care first quarter operating results reflected strong execution and continued membership growth.
In addition to the growth in commercial and Medicare advantage offerings noted earlier people served in managed Medicaid programs grew by nearly $1 $1 million over the year ago quarter.
Of the 900000, new seniors, we expect to serve within Medicare advantage. This year about 775000 are in individual and group and 125000 dual special needs offering.
Other importance to the senior customers reserve our house calls clinicians have been considerably more April compared to this time last year to provide their vital services.
We conducted nearly 600000 home visits in the quarter as more seniors and caregivers were vaccinated and comfortable having in person visits.
That's up by a third compared to first quarter 2020 and for.
Four times higher than what was achieved in the second quarter 2020.
Yeah.
Our liquidity and capital positions remain strong with first quarter cash flows from operations at $6 billion or one two times net income.
As we look forward toward the combination with change healthcare, we intend to maintain our long standing capital policy. These.
These include our approach to returning capital to shareholders via share repurchase and in advancing dividend with ample capacity to continue building upon our strategic growth platform.
We now expect adjusted earnings per share in the range of $18 10 to eight.
$18 60 day.
An increase of 35 cents from the outlook, we offered at our Investor Conference.
This outlook continues to include an estimated $1 80 per share of unfavorable COVID-19 related effects.
The substantial majority of which we still expect to occur in the latter part of the year largely as carriers more freely able to be delivered to people.
Now ill turn it back to Andrew.
Thanks, John The story you heard about this quarter is the story <unk> heard for many years and will continue to do so about you know the United Health Group, our focus on better serving people and organizations and health care using the combined capabilities of Optum, and United Health care to improve cash cost and experience and <unk>.
For an attention to execution excellence in all that we do.
Operator, let's open it up for questions one per caller. Please.
Certainly our first question comes from the line of Matt Force from BMO capital markets. Your question. Please.
Hi, yes, good morning, congratulations on the quarter.
I have a question for for you on the.
Prior year Reserve development, which is obviously very large number can you just talk to you.
Where that.
Emanated from in terms of components, whether by program or by quarter in 2020, and how that may be influencing your posture on forward reserving.
Great. Thanks for the credit I'm glad you asked that I know a lot of people probably have that in mind. John you you should answer that I think.
Sure Matt Good morning, It's John <unk>, Let me give a little color on that so yes prior year development of $1 billion favorable versus $850 million into <unk>.
As Im sure you expect that emanates to heavily from the second half.
2020.
A lot from the fourth quarter it was favorable really across the businesses.
The elements there that would be driving that would be largely long.
Kerr deferral activity that.
That would have occurred in the quarter.
When you think about kind of impact to.
To the company and P&L impact certainly there are significant mitigating factors that I know, you're well aware MLR MLR rebates risk corridor arrangement reserve re establishment that occurs.
When I look at it and take it all together with those mitigating factors.
P&L impact would have been in a similar zone to last year's force first quarter with those element coming in thank you.
Thanks, John Thanks, Matt next question please.
Certainly our next question comes from the line of Kevin Fischbeck from.
Bank of America your question.
Okay.
I'm sorry, our next question comes from the line of Robert Jones from Goldman Sachs.
Great. Good morning, Thanks for the question and congrats to Andrew and Brian on the new roles I actually just wanted to ask one on Optum Health I think you said 35 per cent of the growth. There was driven by global cap. You also shared 2 million risk patients and Optum care are now in global cap. Just curious if you could give a little bit more on kind of where you think this number could get to.
The number of patients in global cap arrangements.
Within Optum care. This year and then maybe over time and then it would be helpful to understand a little bit just how many of the 20 million patients you highlighted are actually in MA today. Thanks, so much.
Great listen Robert Thanks, So much for the question before I ask Wyatt Decker too to add.
You put your finger on a really key part of the gross strategy going forward.
Clearly.
Youre going to see over this year and next year and accelerate and move towards more appetite to patients within.
The Optum care universe as I mentioned in my prepared comments.
Tremendous.
Opportunity as we look at those 20 million and growing number of patients who we look after migrating towards what we believe to be a better mechanism to help them manage both of care I'll come on and also the cost implications. So you'll see that continue to accelerate as as we expand our opt in CAD.
Net works.
We are rapidly transitioning all capabilities clinic by clinic to be able to do this.
And.
It's one of the areas I think we feel extremely optimistic about future momentum, but to give you a little bit more detail Doctor Deca, who leads Optum health. Please.
Yes. Thank you Robert for the question, Andrew I think you set it up nicely Optum care has become the nation's pre eminent ambulatory delivery of value based care. It is physician led and increasingly you'll see us, bringing comprehensive services to bear to meet the needs of all of our patients.
Particular focus on value base in particular focus on.
Fully capitate individual.
We will continue to grow over 250000 lives. This year and you can expect that to accelerate in the years to come as we continue to attract individuals through organic growth as well as through our partnership with UHC and as Andrew mentioned nearly 90 other providers.
Thank you.
Thanks, <unk> and thanks, Robert for the question next question. Please.
Certainly as a reminder, ladies and gentlemen, if you have a question at this time. Please press Star then one.
Our next question comes from the line of Lisa Gill from J P. Morgan.
Hi, Lisa go ahead.
Good morning, and thank you for taking the question.
I'm just curious how we think about digital and telehealth impacting medical cash and what you've seen thus far and what's the future of all post the pandemic only think about.
Helping to control costs for Matt for Mitel Health perspective.
Lisa that's a great question.
To ask a second Doctor Deca, and also I think I'll ask the Mcmahon to make a couple of comments, but let me just preface that.
So we've obviously seen telehealth developed a set of capabilities over the last several years, we've been a very extensive user of those capabilities.
I think one other things we've seen from 2020 on the pandemic is really a kind of shift in terms of people's thinking and willingness to utilize.
Telehealth, we also think that the.
The way in which they're being utilized all is evolving and so what youre going to see from from US and it's one of the examples I might cite in terms of the opportunity for new product development between optimum.
And United Health care as you you're going to see United Health group leaning forward into a much more integrated telehealth capabilities.
We've got a number of new initiatives and deployment as we speak operating between the two companies and with that introduction, let me pass it over to why it's so maybe give you a little bit more detail on that and then I think it would be good to hear from Doug. The perspective. He has on this so why it first yeah. Thanks for the question.
As you've heard US mentioned before we're very proud of how quickly we stood up over 17000 providers during the pandemic until all solutions that really just the beginning and of course across the country, we've seen a massive shift in consumer.
Consumer adoption and willingness to engage in virtual health solutions as well as with our providers more broadly so.
So our philosophy is that not all telehealth is created equally and.
We continue to develop our new products Youll see us integrating physical care virtual care homecare.
And behavioral care in a way that is innovative and differentiated and in fact, we've already launched.
A product we call Optum virtual care that is live in all 50 states and is doing just that.
And what will really differentiate our product to those that we serve is the ability to.
Offer virtual solutions, but then if necessary.
Immediately connect them to a line from bricks and mortar solution for them for a more complex or thorough care as.
As well as identifying and Triaging, both physical and behavioral health care needs and offering comprehensive behavioral health care, we're seeing continued.
Sustainability of virtual care solutions, which as you may know peak during the height of the pandemic have declined but are still probably 10 ex where they were pre pandemic and certain conditions or behavior.
Areas like behavioral health care are now seeing about 50% utilization through virtual services. So we're very excited about where I can take this I will turn it over to Dirk yes, Thanks, Rod I think Andrew and why it pretty well drained it but let me shed a couple of things first we know that people want to meet with their doctor and we've been focused on facilitating.
Getting that with Optum care and people basically as you look at how things evolve.
Brick and mortar position.
Majority of the television today.
I would also say that I do see a tremendous opportunity for new models and new product strategies.
Lewis outcome care, and others, where we lean towards those providers, who have again, the best outcomes and provide the most efficient care. So like any other doctors in our network re United Health care can be looking for that is currently we think optum care can provide that very well that's it. Thanks Lisa.
Thanks for thanks, Thanks, why I've got to say at least I've been keeping an eye on the patient verbatim says we've been deploying the optum virtual platform that why it referred to and really the feedback is really extraordinary in terms of of how patients are all seeing this the benefit they feel for them and the ease with which they were able to engage.
With it. So so this is exactly the kind of thing you're going to see going forward I think helped them in an extremely advantaged position being able to bring together this notion of integrated telehealth with physical and behavioral health and that's going to be the path. We go and I think we're on the verge of kind of next generation of what this looks like versus what we've seen previously so.
Lisa Thanks, so much for raising the question and next question. Please.
Certainly our next question comes from the line of Kevin Fischbeck from Bank of America. Your question. Please.
Great. Thanks, I guess one clarification.
First I guess does your guidance.
Whom anything for sequestration delay, but then I guess the real question is the $1 80 that you guys are.
Still including guidance it sounds like things are starting off for the year relatively well with overall utilization coming in better than membership growing in some of the up and insight are things kind of normalizing I guess.
How do you think about that dollar EBIT.
Uh huh.
How is that progressing and for what kind of.
I am close to any other kind of see before you feel like that number might come in.
Lower than that.
Yes, no listen Kevin Thanks for the question I'll, let I'm going to ask John in a second to refer to the dollar.
Math, I guess behind that in the <unk>.
The line trends.
As far as sequestration comes in and obviously, what we're keeping a close eye on the guidance from the administration we've clearly.
<unk> seen the extensions, but the guidance range. We've given today is not caveat it by that in any way. So we are we have our assumptions on that but the guidance stands notwithstanding any outcome.
John on the dollar.
Yes, Kevin for John Rex Good morning, Let me talk a little bit about that and how we think about that progressing throughout the.
Of course of the year.
So just a few impacts here I think the first day important impact.
I suggested that.
A significant majority I would call it 70% of our projected COVID-19.
Impact is.
Really occurs in the second half of the year.
And.
Just to be Frank we just don't know enough now about what is going to happen later in the year.
Kind of have a very meaningfully different projection of what our full year results will be in terms that will they be better in terms of better than the original protection, except for what we've experienced thus far which believe expect expenses and stronger underlying business performance.
Growth across a number of businesses, we've executed well on productivity measure.
And maybe just very modestly less.
Impact in the <unk> unfavorable impact than we would have anticipated.
But.
The important component there being that is really much more a.
A back half weighted view in terms of that COVID-19 impacted that.
That is really premised upon.
Our expectation.
That.
As we get later in the year people are going to be more able to access previously deferred care and net higher acuity levels as a result of Mr. Postpone treatment and that's what we're that's what we built that's what we build into that view.
Arms of an expectation.
But that's really.
Unusual times still no question.
And therefore increased our full year estimate, but by what we know today.
Thanks, John and Kevin. Thanks, So much for for asking the question I mean, I think I think John.
Really summarized it super well.
<unk> raised our expectations for the year based on our experience so far this year and we've retained that.
John.
The dollar 18 assumption if you will in terms of what could happen, but we just we obviously don't have the detailed visibility of that yet, but we feel that's the right balance stems to take in terms of.
In terms of the rest of this year, so I hope that's clear and thanks. So much for the question Kevin next question.
Certainly our next question comes from the line of Josh Raskin from Nephron Research. Your question. Please hi.
Hi, Thanks, good morning here with that Eric Percher as well so our question this quarter again on Optum Health, Inc.
I appreciate the comments in the prepared remarks, and the Q&A, but wanted to speak to the ultimate strategy around the accumulation of employed physicians and if this is all about a move to global capitation and we're really more interested in the house right. It's more center base like what Youre talking about in Riverside, California is this more of a technology overlay than any.
<unk> for the physicians to do this and then I.
I would just ask again, how many of those 20 million I understand 250000, I'll move this year, but how many of those $20 million ultimately end up in global cap in your mind.
Josh Thanks for the question and before I pass it to why again to respond to the specifics. Let me just give you a sense of how we see this playing out and I think the answer to your question is really both so we absolutely see tremendous opportunity to continue to develop a.
So you have different clinic types and if you look at the.
I cited one particular example, but we've been open opening a wide number of different type of clinics, depending on the environment. The older locality that we're operating in and you should you should continue to expect to see that degree of customization. According to the need of the geography, it's not a one size fits all model by any means.
So you'll continue to see that but.
But at the same time, we strongly believe there is opportunity over the next few years and this is why.
We're focused in my kind of secondary Europe going deeper around technology.
How we can then help those clinics operate more efficiently how we can ensure day, Alberta connected both locally with other clinics that we may own all to a Uh huh.
High level of information support so we see this as being a highly activated network of clinics incentives. The center. The network itself will have a high degree of diversity in it because it needs to be responsive.
To the needs of the locality of the communities that we're operating in.
And of course.
No.
Sensitive to the previous comment it will have a very significant telehealth.
Capability deployed alongside it.
Why it maybe you could talk a little bit to how you see the progression within the $20 million.
Yes, Thank you Andrew and thanks, Josh Great question, we will continue to evolve.
One of the pieces that will differentiate us as.
Comprehensive care providers is just that being comprehensive and so youll see us <unk>.
Continuing to weave together products and services.
That meet People's needs in new and innovative ways and Tele health and digital solutions are a big piece, but not the only fee.
The other the other part that I'd call out is for free.
Recently, leveraging technology to bring advanced decision support to our physicians and providers and.
You may have heard previously about optimal care. This is a value based care delivery set of decision tools that are yielding real results, giving people the best highest quality care that eliminates what we tend to call low value care and is a differentiator.
So we will continue to deploy those technologies as you know we are on track to grow by over 10000 physicians. We're now at 56000 doctors.
Affiliated contracted and employed.
We'll leverage all of those models as we go forward and we continue to evolve and employ doctors, who are really actually quite attracted to our model of value based primary care, we eliminate much of the clerical burden in our physicians and advanced practitioners practice and let them focus on the work they love.
So this is really gaining traction among our physician work for us.
And then to your point around how much of the 20 million lives that we serve today will ultimately be compensated.
We.
Anticipating that not only will.
A significant portion you heard the number 2 million today in a quarter million dollars as we mentioned growing so.
As we continue to grow we also expect that we will always offer a.
Host of modalities, including fee for service and that actually is a feeder system as we as we think about value based care being kind of the core of what we offer and fully <unk>. The core of the core if you will thank you. Thanks.
And maybe maybe I'll just ask Dan Schumacher to briefly add to two comments and talk a little bit about optimum home, which is a further dimension of this so go ahead.
Thanks, Andrew and Great question, Josh to the question around sort of center based tech based data enabled.
Different versions of that that's why I was talking about Optum at home is a is a great example of a collaboration between the United Health care and often that's in relatively early stages, but.
We focused on Medicare advantage members that are in our dual special needs plans initially and that's a full risk offering and we're doing it in markets, where we don't currently have local optum care practices.
What we're doing and the program is really both providing care, but also arranging and coordinating care for trying to address medical behavioral.
And social needs and.
The results initially had been great we've improved access for people.
More than 80%, having in home visits and more than half of them getting connected back into office space here.
Actual services referrals, and so forth as well as great.
Health quality and outcomes.
Today, we've got a little under a 100000 lives across six markets, we're looking to expand that.
Across Medicare advantage dual SNP, but also into the individual MA we're doing it with United Health care and ultimately look to do that with other health plans. So another growth vector for us if we look at building out our value based orientation.
So Josh I mean, I know that was a.
A little bit of a long answer for them or three of us, but you asked a really important question and this is really one other core elements of the future of the company.
And it's why you've heard US talk so much about Optum health Optum care and you can see that the growth potential we're at about $2 million life level now, we clearly see the capitation strategy is a highly effective strategy to deliver both quality and cost management for patients.
That movement is really significant and its really moving strongly.
With the development of the diverse sets of clinics and skills. The development of the technology support that you've just heard referred to we believe we are in a very strong position to be able to be the leader in ability to manage those patients in the best possible way.
Ensure that they are they get the kind of health care they deserve so John.
Thanks, So much for asking the question next question. Please.
Certainly and as a reminder, ladies and gentlemen, if you have any.
Question at this time. Please press Star then one our next question comes from the line of Ricky Goldwasser from Morgan Stanley. Your question. Please.
Yeah, Hi, good morning.
You think about getting utilization I mean, you you gave us some day down high utilization is tracking but could you give us a little bit more details on how it's tracking.
Across the different patient population.
So we talked about acuity level, if your expectations for acuity level to step up the second half of the year, but for the experienced today because youre starting to see individuals who are coming back are what type of acuity youre seeing for those that haven't.
<unk> received.
Care.
For the last year and I think the final one.
Just remind us.
As you think about that guidance for the full year.
Are you assuming you get utilization by year end, it's going to be adopted for 2019 baseline.
So great question, Ricky I'm going to ask Brian Thompson, who.
<unk> recently been appointed as the Chief Executive Officer of United Health care to respond to that so BT.
Hey, Thanks for the question there when I think about baseline what I can say right. Now is what we're seeing is largely tracking to our expectations and as we had signaled where we see abatement and services. It is largely offset by the increase in.
Covid related costs and that's tracked as we had expected.
When you back out the impact of some suppress utilization the underlying factor is associated with medical cost trend largely looked like they did we aren't seeing significant upticks in services in specific areas out of the norm. So I would say it looks a lot like utilization prior for the Covid implications.
Patients.
And when I think by line of business I would say generally tracking a little below baseline in both our government program closer to baseline inside our commercial business, but largely in track with what we had expected and where its a little out of line again, where perhaps infection rates were higher we saw that naturally offset with greater utilization.
First quarter, I would say largely as expected.
John do you want to add.
Yeah, Ricky good morning, it's John Rex here so.
As Brian noted one of the aspects we look for is it rising acuity.
<unk> that have deferred or share or miss treatments.
At this.
At this point, we don't have evidence of that occurring.
Ah.
It could be just that it's still too early on to have enough evidence to see it but we have not yet seen that rising acuity in the population that we serve.
Your point in terms of how we think about as we get later into the year and why that why that moves like it does and you heard my commentary.
Significant majority of the dollars 80, we have layered into the second half of the year.
That is largely because of the assumptions around those elements that we see that people are increasingly able to get the care they need.
The amount of care deferrals declined meaningfully as you get into that latter part of the year, they're accessing the system.
And and we do get into these elements, where we see rising acuity coming yet. So those are the elements that are that are premise in terms of that expectation.
At this point, though.
But really you know and the other element that Brian touched on also just in terms of your populations, yes commercial.
A little more access for the system versus the public.
Graham members. Thank you.
Thanks, John and Thanks, Ricky for the question next question. Please.
Certainly our next question comes from the line of David Windley from Jefferies. Your question. Please.
Thank you good morning, Thanks for taking my questions I wanted to ask a question about.
Integration and launch longitudinal.
Karen data versus fragmentation and the question is just so.
Andrew over many years optimism really invested a lot of money in and kind of aggregating data about about the patient status.
Karen and services delivered so that touch points with United are often could could have all that information at hand.
I guess, what I'm interested in around kind of your your build out but specifically the comments you've made about telemedicine is how important is it.
For telemedicine to enhance and augment the longitudinal and integrated nature of care versus fragmenting that by having that kind of siloed as a separate benefit. Thanks.
Alright, that's a great question.
So I think I think our bias is is increasingly and I think rightly toward <unk>.
Driving a more a more seamless simple easy to access care environment, both for the patient and the provider actually so well that speaks to is trying to avoid the fragmentation of the interface and definitely trying to avoid the fragmentation of the information that then sits behind it so.
We want to really try and create much more seamless.
Opportunity and so for example ill give you a real example, some virtual which is you've heard a little bit about mckool already today.
Of course.
Patients are looking for a way to engage with the physician they actually wanted to talk to their physician. So one other things that we're doing is building that platform, but then there might be situations, where the physician wants to bring in a specialist into that conversation now and a multi disciplinary clinic they might be in a position in normal times to go down the whole.
We'll get somebody to come down and visit.
Now in Optum virtual Theyre able to do that kind of thing. So that's an example of trying to bring that integration even within the virtual space or kind of replicate so a little bit more.
What you might expect in a physical environment and so we definitely see the need to try and drive towards that and we definitely want to try and create the fluidity of the information to ensure that physicians have what they need when they're in front of the patient when they're talking to the patient they can make the best possible choices.
So we want them to be as highly educated as possible in that context, so with willing and much we're leaning very much towards the idea of integrated seamless and that's true whether you're in the physical to virtual space and we want the two to sit together.
Thanks for the question.
Thank you Sir.
Our next question comes from line of Justin Lake from Wolfe Research. Your question. Please.
Thanks, Good morning, a lot of good topics already covered years. So just have a few quick follow ups.
First the detail on Optum care was very very helpful.
Hoping I could ask for one more piece of information here, which is the.
So it sounds like Youre going to have 18 million people out of $20 million that are still not <unk> wondering how many of these are sitting in Medicare advantage plans that arent catheter that given this is where most of the capitation happened just trying to think about the potential kind of pent up growth there.
Then on Medicare advantage it sounded like your health assessments are growing better in 2021 should we expect that you.
Should get a significant amount of that risk or headwinds that everybody's store for 2021 to reverse next year and get those revenues back and then lastly could you give us an update on earnings seasonality for the year versus a 50 50 split you talked about on the last update.
Hey, Justin Thanks, so much for the questions I'm going to ask it in a second John to talk to the seasonality and for why it to address the degree to which the.
Population, we have within the MAA.
Plan, let me just touch on the health assessment you heard in the prepared comments for very strong performance of the schools program actually higher than last year's record quarter actually in terms of performance of high schools and Youre quite right that makes us feel pretty optimistic that that headwind that we saw.
Going to dissipate pretty rapidly as we rotate into 2022.
And that gives us kind of a rising optimism, but the much of the much of that kind of.
The negative headwind that characterize the emergence of the pandemic starts to mitigate at least on that dimension.
Obviously, we don't know what's going to happen in the next few months with this disease.
But.
As we sit here today that would be the right kind of expectation to look at.
Let me go to Y at first and then John if you pick up from Wyatt and on the seasonality So Wyatt.
Yes, Justin Thanks for the question and of the of the individuals that we serve that are not in fully <unk> programs.
About about a third of them are seniors and so you can think of that as.
For the Medicare population that we serve through a variety of touch points in our care delivery assets and and then you would expect a subset of those are already in MA plan, which is to your question and so we see.
Again.
Great potential to continue to capture in a rural and care for MA patients.
Through Optum cares delivery capabilities, and you'll also see us doing that.
Deeper in the markets that we're in and bringing risks are very mature risk based platform in established markets and new markets, where today. We are primarily fee for service. So expect both geographic growth and increasing depth of penetration in the markets. We serve today. Thank you.
Good afternoon, good morning, John in terms of the seasonality.
So historically, we've been at what I'd call. It kind of 48 to 52 split in terms of first half second half I put that probably more in the zone of first half being in the 50 253 zone. This year that is really due to the how we're tracking in the day.
<unk> 80 per share an impact on it that the majority of that is occurring in the second half of the year, so that would be the really the.
Pete.
Really the reason for the seasonality looking different this year than it has looked in other years.
Thanks, John and thanks, Justin for the questions I appreciate it but just uptime for two more questions. Operator, so let's go to other excellent.
Certainly our next question comes from the line of a J Rice from credit Suisse. Your question. Please.
Hi, everybody maybe.
Maybe drill down a little bit on Optum insight.
Obviously, you had a really good margin trend this quarter I wonder because I know there was discussion last year during the pandemic some of the John Muir type of deals were somewhat on hold as it was tough to just sell a health system on that given.
Social distancing and so forth does the fee.
Fact that you don't have investments for those is that helping you on the margin.
Right now and are those now basically reopen that you can go out and bid and maybe another aspect of the optimism side story. As you think ahead now to change health coming on board.
Should we assume that there is a pause in selling activity of some sort while you integrate that.
And position the company to be even stronger in that business fee was stronger or I know, there's a lot of synergy.
To be coming on line with that one day, so how should we think about how John.
<unk> health coming online in effect for the trajectory of that business.
Thanks, So much for the question I'm going to ask Robert Musselwhite to make some comments in a second around the progression of the margin in the quarter, which obviously, we're very very pleased to see that and it was due to a ton of hard work on a number of different dimensions, but the robot can describe for you just on those.
Those large contract agreements like the one we have with Jo mill.
Yes, there was a there was a bit of disruption last year, but I would say that is absolutely back on stream now in terms of a line of business for us.
We have some a very a very very exciting pipeline.
And on.
And that pipeline exists both in the short medium and longer term. So so that's an area you're going to hear more from a zone.
And is absolutely back in full swing.
In terms of change obviously, we.
We are very keen to continue to work through the regulatory process. We expect this to close in the second half as we've previously indicated.
And you should not expect any disruption from us bringing change on board to really anything that we're doing and especially not in terms of all selling activity. So we are absolutely.
To operate Optum insight fully as if we were not in the transaction and even post transaction I would fully expect the ongoing sales energy of the company to be not disrupted so nothing really would not lead you to expect anything on that front with that Robert would you go into a bit more detail.
These around the day.
For the evolution of the margin during the last quarter share.
Sure.
Hey, Jay.
Listen we were pleased with the quarter. It was a really good quarter on the top line and that of course drove profitable growth contributed to margin, but specifically on margin.
You also are really seeing the results of a lot of the modernization work. We did across 2020. So last year, we undertook a significant review of the business across the operations and drove finding multiple ways to drive stronger and more efficient performance and help find ensure that the investments, we're making we're invested appropriately against that.
Key growth opportunities.
And so if you look at those initiatives multiple automation initiative using advanced techniques and AI NLP machine learning it really drove a lot of short term productivity.
But it also drives a situation where we feel like we've made sustainable margin improvements for the longer term and that puts us in a position to.
Be more competitive in that that actually rolls over to exactly what you were mentioning being more competitive on the large engagements and as Andrew said, we feel really optimistic about.
That pipeline and where it's headed the disruption was more in timing and not really of interest during the pandemic in fact during the pandemic.
There is growing recognition among our health system.
Relationships that.
This was a very productive way to work with ofgem and a really important need for them as they face.
Some disruption even coming out of the pandemic to their finances and ways that we can sustainably support.
Support them in a really holistic way so we feel like that's a great path forward. We're excited about the business and feel like we've made some important changes that put us on a really good track going forward.
Thanks for all but hey, Jay Thanks for asking the question inside I think he's really on the cusp of a very exciting few years thanks to the.
Significant work that was done last year the increase in rate of opportunity that we see to bring a new significant contracts and then obviously the pending.
Change acquisition creates some really exciting momentum for this business. So this is an area.
We anticipate.
Two for material growth going forward.
Operator last question. Please certainly our final question comes from the line of George Hill from Deutsche Bank. Your question. Please.
Oh, Hey, good morning, guys and thanks for squeezing me in at the end.
Andrew I'd just be interested.
Here your commentary about the outlook for commercial bundles I know, we're all talking a lot about.
Our risk sharing what do you know what I call a risk syndication in the Medicare advantage space and the bundling of risk in the Medicare advantage space, but I'd be interested in the company's outlook for the commercial business and interest increased uptake of kind of.
Risk sharing tools net market. Thank you.
Yes, no great so listen.
In the commercial space and I'm going to ask Bill Golden to come in here real quick but.
I think in the commercial space is just as just as possible for us to start to design innovative products and we've already begun to do that between Optum and UHC, Let me ask bill to dive into that a little bit more detail bill.
Yes, Thank you and thanks for the question, Yes, I would say we're in the early stages of <unk>.
Provider aligned products, where we're taking advantage of net risk base.
As an example in our southern California, Optum care partnership Harmony really continues to be a cornerstone of those offerings. We're learning a lot with that product not only regarding how it's.
How it's priced in but.
But more importantly, the <unk>.
The experience for the members and so we're using that as a cornerstone in as a as a.
Yes.
Program to continue to rollout throughout the country with other areas.
We're very optimistic about the opportunities that that will show in the future, but still in the very early stages of our global cap with the commercial business.
Thanks, Bill and George Thanks, So much for the question is clearly an area.
We expect to see more in the future, but as Bill says, it's early days and.
We'll see how that progresses with that everybody. Thank you so much for spending the time with US. This morning, as we move through what we all hope of a latter stages of this pandemic you can expect us to continue to focus on the areas, where United Health Group can do the most to improve health care, including adding even greater value at the end.
Section of Optum, and United Health care, applying our technology and expertise to create a better functioning more responsive and cost efficient health care system, and making health care work better for consumers.
We look forward to connecting with you again on these priorities in the weeks and months ahead and once again. Thank you for your attention. This morning Bye bye.
Thank you, ladies and gentlemen for your participation in today's conference. This does conclude the program you may now disconnect good day.
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Ladies and gentlemen, thank you for standing by and welcome to the United Health Group first quarter 2021 earnings Conference call. At this time all participants are in a listen only mode. After the speaker's presentation. There will be a question and answer session to ask a question. During this session you will need to press star one on your telephone as well.
For today's program is being recorded and now I'd like to introduce your host for today's program Andrew witty. Please go ahead Sir.
Good morning, and thank you for joining us to discuss our first quarter results and positive outlook as we continue to execute on Unitedhealth group's long standing mission and strategies.
The exceptional dedication of the people of Optum and United Health care again defined this period, they've adapted swiftly and creatively to demanding and rapidly changing circumstances.
Implemented new ideas and importantly remain focused on serving people exceptionally well.
As a result adjusted earnings per share were $5 and 31 sentence.
Reflecting strong execution of both Unitedhealthcare and Optum.
In light of our strong start to the year balanced with continued respect for the potential pandemic related effects. We have previously described.
We are increasing our full year adjusted earnings outlook to a range of $18.10 to $18.60 per share.
I'll touch briefly on two highlights among many in the quarter to illustrate the increased momentum all colleagues at Unitedhealth group of driving.
People served with our employer and individual offerings grew nearly 100000 in the quarter.
Even within the context of a challenging U S employment environment.
This underscores the growing consumer orientation affordability and breadth of our products.
Optum insight revenues increased 14% and operating come increased 45% compared to the year ago period as more normal activity levels among health care system customers returned.
Leading to expansion in how we help them advance clinical and operational excellence.
Significant innovation in automation in the Optum insight businesses drove strong productivity gains.
We have the right capabilities assets and strategies in place and we remain Restless day innovate evolve and further integrate our offerings to serve more people more effectively both directly and with our many external partners throughout the health care environment.
To achieve this we'd be sharpening our focus in three key areas first delivering even greater value to those we serve throughout the health care system by better harnessing the collaborative capabilities of Optum and United Health care.
We believe we can develop new products and services, which support people more effectively by bringing to bear greater application and adoption of the combined offerings of these two distinct and complementary organizations.
Optum Kaz work supporting Medicare advantage patients illustrates this well and I'll speak more to this shortly.
The second area of focus increasing the application of our technology and related resources to improve care for people and the operational health systems.
There are benefits for everyone and helping to make the health care system more more like an actual system <unk>.
Improving the natural flow accessibility and use of information is essential to that goal.
All within a secure and protected framework.
We can help cat, we can help care providers and payers better serve patients by more effectively simplifying key administrative processes.
By providing timely access to relevant information.
The third focus is making health care work better for consumers.
Ambitious to meet the rising expectations of health care consumers and we will continue to improve our offerings, including in such critical zones has greatly simplified intuitive and satisfying consumer digital experiences.
And advanced health care banking and payment services that enable people to find price and pay for cat digitally.
You'll hear more from US about these approaches in the months ahead, but today I'd like to focus on the first.
Unlocking greater value for customers at the intersection of Optum, and United Health care, including through our ability to develop new useful service offerings.
One of the most effective ways of doing so is through stronger alignment of the high quality clinical services of Optum care to address the needs of patients we serve for odd nearly 90 health plan customers.
A key foundation is increasing the clinical outcome accountability of our Optum care practices.
Of the 4 million patients who opt in cash serves in some form of accountable arrangement today 2 million are being served under fully capitation arrangement and.
And this demonstrates the strong growth in progress.
But up some cash so 20 million patients in total.
This is one reason why we view the potential of Optum care is only beginning to be harnessed.
These accountable arrangements drive measurably better patient outcomes and experiences all at lower cost.
For example, seniors served by Optum care physicians under such arrangements spend on average one third fewer days in the hospital and have 40% fewer days in skilled nursing facilities than seniors in traditional Medicare.
We expect the gross and the number of Optum care patient served under accountable arrangements to accelerate.
A further example of using our combined expertise to advance more beneficial service offerings is the recent opening of our first of its kind opt them integrated care facility in Riverside County, California.
While we have a long offered and continue to actively develop our senior focused clinics. This new clinic and community Center offers a comprehensive range of primary care led services, including a pharmacy.
Under a single roof and importantly, it is especially orientated around support in Medicaid Medicare commercial and individual members of all ages.
This comprehensive health and provides improved care access with modern onsite services, including annual wellness visits chronic disease management support coordinated care with trusted specialists and laboratory imaging and pharmacy services.
The adjacent community Center includes a full service, Jim and meeting rooms for health education.
We see Optum and our payer partners is uniquely positioned to be able to offer these types of impactful venues and look forward to learning from the community and expanding the services.
To sum up we continue to organize and apply the unique capabilities of this organization in ways that enable us to execute on the goals we established for 2021.
And beyond and to continue to deliver all now 13% to 16% long term earnings growth objective.
Now I'll turn it over to President and Chief operating Officer, Doug Mcmahon to give more color on initiatives to drive greater performance across the organization.
Thanks, Andrew as Andrew noted, we continue to drive growth by supporting more affordable simpler quality care across Optum and Unitedhealth care.
These are themes you've heard us cover before and we continue to see the benefits of this approach for people for the people we serve.
Let me turn those themes into some specific examples across optum and United Health care that illustrates how our approach is working.
First is how we've been simplifying the consumer experience over the past year.
We have driven greater engagement with seniors by increasing adoption of digital tools.
Active users of our digital offerings have risen double digits with similar increases in online transactions.
This has led to greater adoption of our digital therapeutics offerings in the first quarter high risk chronic disease patients and our home monitoring program logged over one 5 million biometric measurements, such as glucose level, enabling at 99% medication compliance and an NPS of 84.
We've also made it easier for people to get and maintain behavioral health support by expanding traditional and virtual provider network and combine them with modern digital therapeutic services.
Behavioral health needs have increased significantly during the pandemic and as a result, we have seen substantial adoption and our digital behavioral platform that provides on demand emotional support.
Logging a rise of over 100% utilization.
Always accompanying our work to simplify health care is optum and United Health Care's sharp focus on delivering high quality care.
We've talked to you before about the advances we are making to integrate patient specific health data and plan information directly into the physician's workflow.
Clinicians can see gaps in care enacted close them during the patient visits.
During the patient visits in addition to other steps that facilitate more efficient care and better outcomes.
We now support over $8 million of the insight enabled digital interactions each month with rapidly expanding physician adoption.
Delivering high quality care has been central in our response to the Covid pandemic. Our most recent effort to help members access vaccines is a Prime example, we launched a vaccine locater tool, helping people find and sign up for a vaccination and we've made millions of outbound contacts to engage members and help them get the information they need.
Sure.
Lastly, making care more affordable remains central for the people, we serve and the health system overall and is essential for increasing access for instance, through our medication sourcing program high cost providers now source drugs at a network specialty pharmacy, including <unk> for charge market rates only for the drop.
Early work on this has generated substantial savings for our customers.
Our work to make health care simpler higher quality and more affordable drive strong growth for our business.
At the end of January for example, United Health Care was awarded an Oklahoma sooner care Medicaid contract to serve nearly 200000 people.
Oklahoma previously operated under a fee for service program the <unk>.
For the firms the value, we bring to state partners and consumers and reflects our commitment to expand access to care for all Americans.
We look forward to working with our new partners in Oklahoma and sharing with you on future calls new examples as our work on simplicity quality and affordability continues to create improvements and new growth opportunities with that now I'll turn it over to Chief Financial Officer, John Rex.
Before I review the performance of our businesses as in recent quarters I'd like to provide an update on the care patterns, we're seeing as the pandemic continues to evolve.
Over the course of the first quarter total care activity, including COVID-19 related care.
<unk> marginally below seasonal baseline.
Pacing of elective care activity through the quarter generally track and in opposite directions with the rise in declining of Covid incidence rate, which were much higher in the early part of the quarter than in the latter part.
To put this in perspective February and March showed COVID-19 related care at about half the level experienced in January.
Since the quarters end, we have again began to see a rise in COVID-19 related care, while at this time not approaching the January level.
Outpatient care activity was moderately below seasonal baseline for the full quarter running in counterpoint to that COVID-19 incidents patterns over the three months and reflecting a well below average influenza and respiratory illness season.
And total inpatient activity was modestly above seasonal baseline with over 55000, COVID-19 related emissions during the quarter compared to 65000 in the fourth quarter 2020.
Moving to business unit performance off.
<unk> health first quarter revenue and earnings increased 35% year over year.
Revenue per consumer served grew 31% over the year ago quarter.
The growth in this metric continues to reflect the expanding number of people served under value based care arrangements and the increasing acuity of the care services we offer.
Optum insights revenue grew 14% in the quarter and earnings of 45% due to growth in our services and technology offerings and improved productivity.
The revenue backlog at $20 8 billion grew one $6 billion over the first quarter 2020.
As more normalized business activity started to return among our provider and payer customers.
<unk> revenue and earnings were relatively consistent year over year and in line with our expectations.
<unk> scripts declined modestly from the year ago quarter, a period during which we provided advanced medications to the people we serve as the pandemic began.
Pharmacy care and specialty services continued to grow strongly in particular home infusion and our community behavioral health pharmacies.
Turning to United Health care first quarter operating results reflect strong execution and continued membership growth.
In addition to the growth in commercial and Medicare advantage offerings noted earlier people served in managed Medicaid programs grew by nearly $1 $1 million over the year ago quarter.
Of the 900000, new seniors, we expect to serve within Medicare advantage. This year about 775000 are in individual and group and 125000 dual special needs offering.
Other importance to the senior customers reserve our house calls clinicians have been considerably more April compared to this time last year to provide their vital services.
We conducted nearly 600000 home visits in the quarter as more seniors and caregivers were vaccinated and comfortable having in person visits.
That's up by a third compared to first quarter 2024.
Four times higher than what was achieved in the second quarter 2020.
Our liquidity and capital positions remain strong with first quarter cash flows from operations at $6 billion or one two times net income.
As we look forward toward the combination with change healthcare, we intend to maintain our long standing capital policy. These.
These include our approach to returning capital to shareholders via share repurchase and in advancing dividend with ample capacity to continue building upon our strategic growth platform.
We now expect adjusted earnings per share in the range of $18.10 to $18 60 day.
An increase of 35 cents from the outlook, we offered at our Investor Conference.
This outlook continues to include an estimated $1 80 per share of unfavorable COVID-19 related effects there.
The substantial majority of which we still expect to occur in the latter part of the year largely as carriers more freely able to be delivered to people.
Now ill turn it back to Andrew.
Thanks, John The story you heard about this quarter is the story you've heard for many years and will continue to do so about you know the United Health Group, a focus on better serving people and organizations and health care using the combined capabilities of Optum and United Health care to improve cash cost and experience.
And an unwavering attention to execution excellence in all that we do.
Operator, let's open it up for questions one per caller. Please.
Certainly our first question comes from the line of Matt Force from BMO capital markets. Your question. Please.
Hi, yes, good morning, congratulations on the quarter.
I have a question for for you on the.
Prior year Reserve development, which is obviously very large number can you just talk to you.
Where that.
Emanated from in terms of components, whether by program or by quarter in 2020, and how that may be influencing your posture on forward reserving.
Great. Thanks for the credit I'm glad you asked that I know a lot of people probably have that in mind, John you should answer that I think.
Sure Matt Good morning, It's John <unk>, Let me give a little color on that so yes prior year development of $1 billion favorable versus $850 million into for Q.
As Im sure you expect that emanate heavily from the second half.
2020.
A lot from the fourth quarter it was favorable really across the businesses.
The elements there that would be driving that would be largely long.
Care deferral activity that that would have occurred in the quarter.
I think when you think about kind of impact to.
To the company and P&L impact certainly there are significant mitigating factors that I know, you're well aware MLR MLR rebates risk corridor arrangement reserve re establishment that occurs.
When I look at it and take it all together with those mitigating factors.
P&L impact would have been in a similar zone to last year's force first quarter with those elements coming in thank you.
Thanks, John Thanks, Matt next question please.
Certainly our next question comes from the line of Kevin Fischbeck from.
Bank of America your question.
Oh I'm sorry.
Sorry, our next question comes from the line of Robert Jones from Goldman Sachs.
Great. Good morning, Thanks for the question and congrats to Andrew and Brian on the on the new roles I actually just wanted to ask one on Optum Health I think you said 35 percentage of the growth. There was driven by global cap. You also shared 2 million risk patients and Optum care are now in global cap. Just curious if you could give a little bit more on kind of where you think this number could get to.
The number of patients in global cap arrangements.
Within Optum care. This year and then maybe over time and then it would be helpful to understand a little bit just how many of the 20 million patients you highlighted are actually in MA today. Thanks, so much.
Listen Robert Thanks, So much for the question before I ask Wyatt Decker too to add.
You put your finger on a really key part of the growth strategy going forward.
Lately.
We're going to see over this year and next year and accelerate and move towards more appetite to patients within.
The Optum care universe as I mentioned in my prepared comments.
Tremendous.
Opportunity as we look at those 20 million and growing number of patients who we look after migrating towards what we believe to be a better mechanism to help them manage both their care I'll come on and also the cost implications. So you'll see that continue to accelerate as as we expand our optum can.
Net works.
We are rapidly transitioning all capabilities clinic by clinic to be able to do this.
And it's one of the areas I think we feel extremely optimistic about future momentum, but to give you a little bit more detail Doctor Deca, who leads Optum health. Please.
Yes. Thank you Robert for the question, Andrew I think you set it up nicely.
<unk> care has become the nation's preeminent ambulatory delivery of value based care. It is physician led and increasingly you'll see us bringing comprehensive services to bear to meet the needs of all of our patients for a particular focus on value based and in particular focus on <unk>.
The fully capitate individual.
Yeah.
We will continue to grow over 250000 lives. This year and you can expect that to accelerate in the years to come as we continue to attract individuals through organic growth as well as through our partnership with UHC and as Andrew mentioned nearly 90 other providers. Thank you.
Thanks, and thanks for all but for the question next question. Please.
Certainly as a reminder, ladies and gentlemen, if you have a question at this time. Please press Star then one.
Our next question comes from the line of Lisa Gill from J P. Morgan.
Okay.
Hi, Lisa go ahead.
Good morning, and thank you for taking the question.
I'm just curious how we think about digital and telehealth impacting medical cost and what you've seen thus far and what's the future of all post the pandemic only think about.
Helping to control costs from Matt for Mitel Health perspective.
Lisa that's a great question.
I'll ask a second Doctor Deca, and also I think I'll ask the Mcmahon to make a couple of comments, but let me just preface that so.
So we've obviously seen telehealth developed a set of capabilities over the last several years, we've been a very extensive user of those capabilities.
I think one other things we've seen from 2020 and the pandemic is really a kind of shift in terms of people's thinking and willingness to utilize.
Telehealth, we also think that the.
The way in which they're being utilized all is evolving and so what youre going to see from from other than its one of the examples I might cite in terms of the opportunity for new product development between optimum.
And United Health care as you you're going to see United Health group leaning forward into a much more integrated telehealth capabilities.
We've got a number of new initiatives and deployment as we speak operating between the two companies and with that introduction, let me pass it over to why it's so maybe give you a little bit more detail on that and then I think it would be good to hear from Doug. The perspective. He has on this so why it first yeah well thanks for the question.
As you've heard US mentioned before we're very proud of how quickly we stood up over 17000 providers during the pandemic until all solutions that really interest is the beginning and of course <unk>.
The country, we've seen a massive shift in <unk>.
<unk> adoption and willingness to engage in virtual health solutions as well as with our providers more broadly so.
So our philosophy is that not all telehealth is created equally and as we continue to develop our new products, you'll see us integrating physical care virtual care home care.
And behavioral care in a way that is innovative and differentiated and in fact, we've already launched.
A product we call Optum virtual care that is live in all 50 states and is doing just that and and what will really differentiate our product to those that we serve is the ability to.
Offer virtual solutions, but then if necessary.
Mediately connect them to our live in bricks and mortar solution for them for a more complex our thorough care.
As well as identifying and Triaging, both physical and behavioral health care needs and offering comprehensive behavioral health care, we're seeing continued.
Sustainability of virtual care solutions, which as you May know peaked during the height of the pandemic have declined but are still probably 10 ex where they were pre pandemic and certain conditions or behavior or areas like behavioral health care.
Are now seeing about 50% utilization through virtual service. So we're very excited about where I can take this I'll turn it over to Dirk.
Thanks, Brett I think Andrew and why it pretty well drained it but let me shed a couple of things first we know that people want to meet with their doctor and we've been focused on facilitating that with Optum care and with people basically as you look at how things evolve.
Brick and mortar physicians at the vast majority of the television today.
I would also say that I do see a tremendous opportunity for new models and new product strategies.
Lewis outcome care, and others, where we lean towards those providers, who have again, the best outcomes and provide the most efficient care. So like any other doctors in our network re at United Health care are going to be looking for that's running we think optum care can provide that very well that's it. Thanks Lisa.
Thanks, Doug. Thanks, Thanks, Wyatt I got to say at least I've been keeping an eye on the patient verbatim says we've been deploying the opt in virtual platform that why it referred to and really the feedback is really extraordinary in terms of of how patients are all seeing this the benefit they feel from it and the ease with which they're able to engage.
With it. So so this is exactly the kind of thing you're going to see going forward I think helped them in an extremely advantaged position being able to bring together this notion of integrated telehealth with physical and behavioral health and that's going to be the path. We go and I think we're on the verge of kind of next generation of what this looks like versus what we've seen previously so.
Lisa Thanks, so much for raising the question and next question. Please.
Certainly our next question comes from the line of Kevin Fischbeck from Bank of America. Your question. Please.
Great. Thanks, I guess one clarification.
First I guess does your guidance assume.
Anything for sequestration delay, but then I guess the real question is the dollars 80 that you guys are.
Still including guidance it sounds like things are starting off the year relatively well with overall utilization coming in better than membership growing in.
Some of the up and insight are things kind of normalizing I guess.
How do you think about that dollar EBIT.
How is that progressing and for what kind of time.
I'm close to any other kind of see before you feel like that number might come in.
Lower than that.
Yes, no listen Kevin Thanks for the question I'll, let I'm going to ask John in a second to refer to the dollar rate.
Math, I guess behind that and the underlying trends as far as sequestration comes in obviously, what we're keeping a close eye on the guidance from the administration. We've you know we've clearly.
Seeing the extensions, but the guidance range. We've given today is not caveat it by that in any way. So we are we have our assumptions on that but the guidance stands notwithstanding any outcome.
John on the dollar <unk>.
Yes, Kevin for John Rex Good morning, Let me talk a little bit about that and how we think about that progressing throughout the.
Of course of the year.
So just a few impacts here I think the first day important impact.
I suggested that.
A significant majority I'd call it 70% of our projected COVID-19.
Impact is.
Really occurs in the second half of the year.
And just.
To be Frank we just don't know enough now about what is going to happen later in the year.
Kind of have a very meaningfully different projection of what our full year results will be in terms of will they be better in terms of better than the original protection, except for what we've experienced thus far we believe expect expenses and stronger underlying business performance.
Growth across a number of businesses, we've executed well on productivity measure.
And maybe just very modestly less.
Impact in the <unk> unfavorable impact than we would have anticipated.
But the important component there being that is really much more a.
A back half weighted view in terms of that COVID-19 impact and that's really premised upon our ex.
Spectation.
That.
As we get later in the year people are going to be more able to access previously deferred care and net higher acuity levels. As a result of Mr posted on treatment and that's what we're that's what we built that we build into that view.
Terms of an expectation.
But that's really.
Unusual times still no question.
And therefore, it's increased our full year estimate, but by what we know today.
Thanks, John and Kevin. Thanks, So much for for asking the question I mean, I think I think John really summarized it super well, we've raised our expectations for the year based on our experience so far this year.
And we've retained that.
The dollar <unk> assumption, if you will in terms of what could happen, but we just we obviously don't have the detailed visibility of that yet, but we feel that's the right balance stems to take in terms of.
In terms of the rest of this year, so I hope that's clear and thanks. So much for the question Kevin next question.
Certainly our next question comes from the line of Josh Raskin from Nephron Research. Your question. Please hi.
Thanks, Ed Good morning here with that Eric Percher as well so our question this quarter again on Optum health and.
Appreciate the comments in the prepared remarks, and the Q&A, but wanted to speak for the ultimate strategy around the accumulation of employed physicians.
This is all about a move to global capitation and were really more interested in the house right. It's it's more center base like what Youre talking about in Riverside, California is this more of a technology overlay that enables the physician could do this and then.
I would just ask again, how many of those 20 million I understand 250000, a move this year, but how many of those $20 million ultimately end up in global cap in your mind.
Josh Thanks for the question and before I pass it to why again to respond to the specifics. So let me just give you a sense of how we see this playing out and I think the answer to your question is really both.
We absolutely see tremendous opportunity to continue to develop a variety of different clinic types and if you look at the.
I cited one particular example, but we've been open opening a wide number of different type of clinics, depending on the environment that all the locality that we're operating in and you should you should continue to expect to see that degree of customization. According to the needs of the geography, it's not a one size fits all model by any means.
So you'll continue to see that.
But at the same time, we strongly believe there is opportunity over the next few years and this is why.
I focused in my kind of secondary Europe going deeper around technology.
How we can then help those clinics operate more efficiently how we can ensure day, Alberta connected both locally with other clinics that we may one or two.
High level of information support so we see this as being a highly activated network of of clinics in centers. The centers. The network itself will have a high degree of diversity in it because it needs to be responsive.
To the needs of the locality of the communities that we're operating in.
And of course.
Yes.
Sensitive to the previous comment it will have a very significant telehealth.
<unk> capability deployed alongside it.
Why it maybe you could.
Talk a little bit to how you see the progression within the $20 million.
Yes, Thank you Andrew and thanks, Josh Great question, we will continue to evolve.
One of the pieces that will differentiate us as.
Comprehensive care providers is just that being comprehensive and so youll see us <unk>.
Continuing to weave together products and services.
That meet People's needs in new and innovative ways and Tele health and digital solutions are a big piece, but not the only fee.
The other part that I'd call out is we're increasingly leveraging technology to bring advanced decision support to our physicians and providers and <unk>.
You may have heard previously about optimal care. This is a value based care delivery set of decision tools that are yielding real results, giving people the best highest quality care.
It eliminates what we tend to call low value care and is a differentiator. So so we'll continue to deploy those technologies. As you know we are on track to grow by over 10000 physicians. We're now at 56000 doctors.
<unk> affiliated contracted and employed and we will leverage all of those models as we go forward and we continue to evolve and employ doctors, who are really actually quite attracted to our model of value based primary care, we eliminate much of a clerical burden in our positions in it.
Vance practitioners practice and let them focus on the work. They love. So this is really gaining traction among our physician work for us.
Then to your point around how much of the 20 million lives that we serve today will ultimately be appetite.
We anticipate that not only will a significant.
Portion.
The number 2 million today in a quarter million dollars as we mentioned growing so so as we.
Continue to grow we also expect that we will always offer.
A host of modalities, including fee for service and that actually is a feeder system as we as we think about value based care being kind of the core of what we offer and fully <unk>. The core of the core if you will.
Do you.
Thanks, and maybe maybe I'll just ask Dan Schumacher to briefly add to the comments and talk a little bit about Optum home, which is a further dimension of it.
So go ahead.
Thanks, Andrew and Great question, Josh to the question around sort of center base ex base data enabled.
Different versions of that that's why I was talking about Optum at home is a great example of a class a collaboration between United Health care and often that's been relatively early stages, but.
We focused on Medicare advantage members that are in our dual special needs plans initially and that's a full risk offering and we're doing it in markets, where we don't currently have local often peer practices. So.
What we're doing and the program is really both providing care, but also arranging and coordinating care, so trying to address medical behavioral and social needs and.
The results initially had been great we've improved access for people.
With more than 80%, having in home visits and more than half of them getting connected back into office space here.
Actual services referrals, and so forth as well as great.
Health quality and outcomes.
Today, we've got a little under a 100000 lives across six markets, we're looking to expand that.
Across Medicare advantage dual SNP, but also into the individual MA we're doing it with United Health care and ultimately look to do that with other health plans. So another growth vector for us if we look at building out our value based orientation.
So Josh I mean, I know that was a.
A little bit of a long answer for them. The three of US, but you asked a really important question and this is really one other core elements of the future of the company.
And it's why you've heard US talk so much about Optum health Optum care and you can see that the growth for the potential you know we're at that 2 million life level now, we clearly see the capitation strategy is a highly effective strategy to deliver both quality and cost management for patients.
That movement is really significant and its really moving strongly and with the development of the diverse sets of clinics and skills. The development of the technology support that you've just heard referred to we believe we are in a very strong position to be able to be the leader in ability to manage those patients in the <unk>.
Best possible way and ensure that they are they get the kind of health care they deserve.
So John Thanks, so much for asking the question next question. Please certainly.
Certainly and as a reminder, ladies and gentlemen, if you have any questions. At this time. Please press Star then one our next question comes in line of Ricky Goldwasser from Morgan Stanley. Your question. Please.
Yeah, Hi, good morning.
If we think about you for utilization I mean, you you gave US a day down high utilization is tracking but could you give us a little bit more details on how it's tracking.
Across the different patient population.
Also we talked about acuity level, if your expectations for acuity level to step up second half of the year, but for the experienced today, because youre starting to see individuals who are coming back.
What type of acuity youre seeing for those that haven't.
We received.
Cash flow.
For the last year and I think the final one.
Just remind us.
Do you think about that guidance for the full year.
Are you assuming that utilization by year end, it's going to be adopted for 2019 baseline.
So great question, Ricky I'm going to ask Brian Thompson, who.
It's recently been appointed as the Chief Executive Officer of United Health care to respond to that so BT.
Hey, Thanks for the question there.
Think about baseline what I can say right now is what we're seeing is largely tracking to our expectations and as we had signaled where we see abatement in services, it's largely offset by the increase in.
Covid related costs and that's tracked as we had expected.
When you back out the impact of some suppress utilization the underlying factor is associated with medical cost trend largely looked like they did we aren't seeing significant upticks in services in specific areas out of the norm. So I would say it looks a lot like utilization prior for the Covid.
Patients.
<unk>.
And when I think by line of business I would say generally tracking a little below baseline in both our government program closer to baseline inside our commercial.
<unk> business, but largely in track with what we had expected.
And where it's a little out of line again, where perhaps infection rates were higher we saw that naturally offset with greater utilization. So first quarter I would say largely as expected.
Yeah.
John do you want to add.
Yeah, Ricky good morning, it's John Rex here so.
As Brian noted.
One of the aspects we look for is it rising acuity.
Patients that have deferred or cash.
MS treatment then.
At this point, we don't have evidence of that occurring.
Could be just that it's still too early on to have enough evidence to see it but we have not yet seen that rising acuity in the population that we serve.
And your point in terms of how we think about as we get later into the year and why that why that moves like it does and you heard my commentary a day.
A significant majority of the dollars 80, we have layered into the second half of the year.
That is largely because of the assumptions around those elements that we see that people are increasingly able to get the care they need.
The amount of care deferral declined meaningfully as you get into that latter part of the year. They are accessing the system.
And and we do get into these elements, where we see rising acuity coming yet. So those are the elements that are that are premise in terms of that expectation.
At this point, though.
But really you know and the other element that Brian touched on also just in terms of your populations GAAP commercial.
A little more access for the system versus the public program members. Thank you.
Thanks, John and Thanks, Ricky for the question next question. Please.
Certainly our next question comes from the line of Dave Windley from Jefferies. Your question. Please.
Thank you good morning, Thanks for taking my question I wanted to ask a question about.
Integration and launch longitudinal.
Karen data versus fragmentation in the questions just so.
Andrew over many years optimism really invested a lot of money in and kind of aggregating data about about the patient status.
Per care and services delivered so that touch points with United are often could could have all that information at hand.
I guess, what I'm interested in around kind of your your build out but specifically the comments you've made about telemedicine is how important is it.
For telemedicine too and.
Enhance and augment the longitudinal and integrated nature of care versus fragmenting that by having that kind of siloed as a separate benefit. Thanks.
Right that's a great question.
So I think I think our bias is is increasingly and I think rightly toward.
Driving a more a more seamless simple easy to access care environment, both for the patient and the provider actually so well that speaks to is trying to avoid the fragmentation of the interface and definitely trying to avoid the fragmentation of the information that then sits behind it so.
We want to really try and create much more seamless.
Opportunity and so so for example ill give you a real example.
Some virtual which is you've heard a little bit on the cool already today. So of course you know.
Patients are looking for a way to engage with the physician.
They actually want to talk to their physician. So one other things that we're doing is building that platform, but then there might be situations, where the physician wants to bring in a specialist into that conversation now.
In a multi disciplinary clinic they might be in a position in normal times to go down the whole get somebody to come down and visit.
Now in Optum virtual Theyre able to do that kind of thing. So that's an example of trying to bring that integration even within the virtual space. So it kind of replicate so a little bit more what you might expect in a physical environment.
So we definitely see the need to try and drive toward that and we definitely want to try and create the fluidity of the information to ensure that physicians have what they need when that in front of the patients when they're talking to the patient and they can make the best possible choices. So we want them to be as highly educated as possible and not <unk>.
Text. So we're leaning much we're leaning very much towards the idea of integrated seamless and that's true whether you're in the physical to virtual space and we want the two to sit together.
Thanks for the question.
Thank you.
Certainly our next question comes from line of Justin Lake from Wolfe Research. Your question. Please.
Thanks, Good morning, a lot of good topics already covered years, but just have a few quick follow ups.
First the detail on Optum care was very very helpful.
Hoping I could ask for one more piece of information here, which is the.
So it sounds like Youre going to have 18 million people out of $20 million that are still not capitate. It wondering how many of these are sitting in Medicare advantage plans that arent cafeteria that given this is where most of the capitation happened just trying to think about the potential kind of pent up growth there and then on Medicare advantage it sounded like your health assessments.
Growing better in 2021 should we expect that you should.
You should get a significant amount of that risk or a headwind that everybody store for 2021 to reverse next year and get those revenues back and then lastly could you give us an update on earnings seasonality for the year versus a 50 50 split you talked about on the last update.
Hey, Justin Thanks, so much for the questions I'm going to ask it in a second John to talk to the earnings seasonality in for why it to address the degree to which they the population we have within the MA and PA.
Plan, let me just touch on the health assessment you heard in the prepared comments for very strong performance of the schools program actually are higher than last year's record quarter actually in terms of.
Performance at high schools, and and you're quite right that makes us feel pretty optimistic that that headwind that we saw is going to dissipate pretty rapidly as we rotate into 2022.
And that gives us kind of a rising optimism, but much of the much of that kind of.
The negative headwind that characterize the emergence of the pandemic starts to mitigate at least on that dimension.
Obviously, we don't know what's going to happen in the next few months with this disease.
But.
As we sit here today that would be the right kind of expectation to look at.
Let me go to Y at first and then John if you pick up from Wyatt and on the seasonality So Wyatt.
Yes, Justin Thanks for the question and of the of the individuals that we serve that are not in fully cafeteria and programs.
About about a third of them are seniors and so you can think of that as.
For the Medicare population that we serve through a variety of touch points in our care delivery assets and and then you.
A subset of those are already in MA plan, which is to your question and so we see.
Again.
Great potential to continue to capture and enroll and care for Ma patients.
Through Optum cares delivery capabilities, and you'll also see us going.
Deeper in the markets that we're in and bringing risk are very mature risk based platform in established market to new markets, where today. We are primarily fee for service. So expect both geographic growth and increasing depth of penetration in the markets. We serve today. Thank you.
Good afternoon, good morning, John in terms of seasonality.
So historically, we've been at what I'd call. It kind of 48 52 split and firms are first half second half I put that probably more in the zone of first half being in the 50 253 zone. This year that is really due to the how we're tracking in the day.
<unk> 80 per share an impact on it that the majority of that is occurring in the second half of the year, so that would be the really the.
Pete.
Really the reason for the seasonality looking different this year than it has looked in other years. Thanks.
Thanks, John and thanks, Justin for other questions. Appreciate it but just have time for two more questions. Operator, so let's go to other and excellent.
Certainly our next question comes from the line of a J Rice from credit Suisse. Your question. Please.
Hi, everybody maybe.
Maybe drill down a little bit on Optum insight.
Obviously, you had a really good margin trend this quarter I wonder because I know there was discussion last year during the pandemic some of the John Muir type of deals were somewhat on hold as it was tough to sell.
So a health system on that given.
Social distancing and so forth does the fact that you don't have investments for those is that helping you on the margin.
Right now and are those now basically reopen that you can go out and bid and maybe another aspect of the optimism side story. As you think ahead now to change health coming on board.
Should we assume that there is a pause in selling activity of some sort while you integrate that in.
And position the company to be even stronger in that business for even stronger or I know, there's a lot of synergy are assumed to be coming on line with that one day. So how should we think about how change health coming on line effect for the trajectory of that business.
Hi, Jay Thanks, so much for the question I'm going to ask Robert Musselwhite to make some comments in a second around the progression of the margin in the quarter, which obviously were.
Very very pleased to see that and it was due to a ton of hard work on a number of different dimensions, but the robot can describe for you just on those.
Those large contract agreements like the one we have with Jo mill.
There was a there was a bit of disruption last year, but I would say that is absolutely back on stream now in terms of a line of business for us.
Have some a very a very very exciting pipeline.
And.
And that pipeline exists both in the short medium and longer term. So so that's an area you're going to hear more from a zone.
And it's absolutely back in full swing.
In terms of change obviously, we are very keen to continue to work through the regulatory process. We expect this to close in the second half as we previously indicated.
And you should not expect any disruption from bringing change on board to really anything that we're doing and especially not in terms of all selling activity. So we absolutely.
We continue to operate Optum insight fully as if we were not in the transaction and even post transaction I would fully expect the ongoing sales energy of the company to be not disrupted so nothing really would not lead you to expect anything on that front with that Robert would you go into a bit more detail.
Please around the.
The evolution of the margin during the last quarter.
Sure.
Hey, Jay.
Listen we were pleased with the quarter. It was a really good quarter on the top line and that of course drove profitable growth that contributed to margin, but specifically on margin.
You also are really seeing the results of a lot of the modernization work. We did across 2020. So last year, we undertook a significant review of the business across the operations and drove finding multiple ways to drive stronger and more efficient performance.
And health fine ensure that the investments, we're making we're invested appropriately against our key growth opportunities.
And so if you look at those initiatives multiple automation initiative using advanced techniques and AI NLP machine learning it really drove a lot of short term productivity.
But it also drives a situation where we feel like we've made sustainable margin improvements for the longer term and that puts us in a position to.
Be more competitive in that that actually rolls over to exactly what you were mentioning being more competitive on the large engagements and as Andrew said, we feel really optimistic about.
That pipeline and where it's headed the disruption was more in timing and not really an interest during the pandemic in fact during the pandemic.
It was growing recognition among our health system.
Relationships that.
This was a very productive way to work with Optum and a really important need for them as they face.
Disruption, even coming out of the pandemic to their finances in ways that we can sustainably support.
Support them in a really holistic way so we feel like that's a great path forward. We're excited about the business and feel like we've made some important changes that put us on a really good track going forward.
Thanks for all but hey, Jay Thanks for asking the question you know inside I think he is really on the cusp of a very exciting few years thanks to the.
Significant work that was done last year the increase in rate of opportunity that we see to bring a new significant contracts and then obviously dependent.
<unk> acquisition creates some really exciting momentum for this business. So this is an area I fully anticipate us looking.
Looking to for material growth going forward.
Operator last question please.
Our final question comes from the line of George Hill from Deutsche Bank. Your question. Please.
Oh, Hey, good morning, guys and thanks for squeezing me in at the end Andrew I'd just be interested to hear your commentary about the outlook for commercial bundles I know, we're all talking a lot about.
Our risk sharing what do you know what I call a risk syndication in the Medicare advantage space and the bundling of risk in the Medicare advantage space, but I'd be interested in their company's outlook for the commercial business and interest increased uptake of kind of.
Risk sharing tools net market. Thank you.
Yeah, no great so listen.
In the commercial space and I'm going to ask Bill Golden to come in here real quick but.
I think in the commercial space is just as just as possible for us to start to design innovative products and we've already begun to do that between Optum and UHC, Let me ask bill to dive into that a little bit more detail bill.
Yes, Thank you and thanks for the question, Yes, I would say we're in the early stages of <unk>.
Provider aligned products, where we're taking advantage of net risk base.
As an example in our southern California, Optum care partnership Harmony really continues to be a cornerstone of those offerings. We're learning a lot with that product not only regarding how it's.
How it's priced in but.
But more importantly.
The experience for the members and so we're using that as a cornerstone in as a as a.
Yes.
Our program to continue to rollout throughout the country with other areas.
We're very optimistic about the opportunities that that will show in the future, but still in the very early stages of our global cap with the commercial business.
Thanks, Bill and George Thanks, So much for the question is clearly an area.
We expect to see more in the future, but as Bill says it's early days.
We'll see how that progresses with that everybody. Thank you so much for spending the time with US. This morning, as we move through what we all hope although the latter stages of this pandemic you can expect us to continue to focus on the areas, where Unitedhealth group can do the most to improve health care, including adding even greater value at the end.
Section of Optum, and Unitedhealth care, applying our technology and expertise to create a better functioning more responsive and cost efficient health care system, and making health care work better for consumers.
We look forward to connecting with you again on these priorities in the weeks and months ahead and once again. Thank you for your attention. This morning Bye bye.
Thank you, ladies and gentlemen for your participation in today's conference. This does conclude the program you may now disconnect good day.