Q3 2022 UnitedHealth Group Inc Earnings Call

October 14, 2022

If this call is being recorded here is some important introductory information. This call contains forward looking statements under U S. Federal Securities laws. These statements are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present.

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A decision is I'm sorry, a description of some of these risks and uncertainties can be followed in their reports.

We filed with the Securities and Exchange Commission, including the cautionary statements included in our current and periodic filings.

This call will also reference non-GAAP amounts.

A reconciliation of the non-GAAP to GAAP amounts is available on the financial and earnings reports section of the company's Investor Relations page at Www Dot Unitedhealth group Dot com.

Information presented on this call is contained in the earnings release, we issued this morning and in our form 8-K dated October 14th 2022, which may be accessed from the Investor Relations page of the company's website.

I will now turn the call over to our Chief Executive Officer of Unitedhealth Group Andrew Witty. Please go ahead.

Thank you good morning, and thank you all for joining us today as.

As we approach the final stretch of 2022, let me start by recognizing all colleagues.

People with Optum, and United Health care, who continue to work diligently day in and day out for those we serve.

Their efforts allow us to deliver durable and balanced growth and to increase our 2022 adjusted earnings outlook to a range of $21 85 to $22 <unk> per share.

As an enterprise we remain focused on our mission.

Advancing our growth strategies. Our aim is to serve more people through value based care and expanded health benefits offerings, a robust foundation on which to consistently drive strong growth into 2023 and beyond.

Consumers want value, especially in the current economic environment and that means high quality care that is more accessible more affordable and more responsive to their individual needs and.

In the past quarter, we've accelerated efforts to deliver on this critical consumer proposition launching several initiatives to reach more people and more communities, while deepening relationships with those we already serve.

For example in September we announced a long term collaboration with Walmart to provide optimum technology and expertise that will enable america's largest retailer to provide value based care to consumers and its clinics.

Starting in 2023, we will jointly develop 15, Walmart health clinics in Florida and Georgia.

We will extend into additional geographies over time.

As we expand the collaboration there'll be broad opportunities to address social determinants of health by improving access to benefits such as healthy foods medications dental and vision services and more.

We also launched a distinctive partnership with Red ventures, a digital media company connecting tens of millions of consumers each month to its clients products and services through a broad portfolio of proprietary digital content platforms.

This partnership called Aveo Health combines red ventures, popular health and wellness platforms, including health line and health grades with Optum as consumer marketplace.

Optum store on the Optum <unk> prescription discount card.

Aveo health will enable us to engage with more than 100 million active monthly visitors seeking the health advice and insights they need introducing them to relevant products and services through a customized end to end digital platform.

Affordability is an essential component of value in health care.

Especially when it determines access to the lifesaving medicines people need for themselves and their families.

In July we announced zero consumer cost share on drugs for diabetes severe allergic reactions and other emergency situations starting in January for those we serve with commercial insured benefits.

There'll be broad opportunities to address social determinants of health by improving access to benefits such as healthy foods medications dental and vision services and more.

Now we are working with self funded employers who are exploring how they can provide these vital medications with zero copay. So far this benefit will be available to more than 1 million additional people and we are actively engaged in with many additional employers.

We're also improving access to essential medicines for those even without health benefits coverage.

For example, Optum store launched a new partnership with Sanofi to help consumers without insurance obtain insulated for $35, a month and there'll be able to have it delivered to their home.

This partnership called RVO Health combines red ventures, popular health and wellness platforms, including health line and health grades with Optum consumer marketplace. The Optum store on the Optum <unk> prescription discount card.

Turning to health benefits today, nearly half of American seniors are enrolled in Medicare advantage plans compared to about 25%.

Decade ago.

And M&A plays a vital role in serving those consumers who are significantly more diverse have lower incomes are more complex care needs and the average seen yet.

Our compelling reasons why seniors increasingly choose Ma.

Affordability is an essential component of value in healthcare.

Three Medicare advantage people are experiencing better health outcomes than in traditional fee for service Medicare across a wide spectrum of measures.

Especially when it determines access to the lifesaving medicines people need for themselves and their families.

In July we announced zero consumer cost share on drugs for diabetes severe allergic reactions and other emergency situations starting in January for those we serve with commercially insured benefits.

For example in MA members with diabetes have over 50% lower rates of any category of complication on over 70% lower rates of serious complication.

This is due to our ability to provide deeper more coordinated levels of care.

And this is accomplished at lower cost.

People served by May spend as much as 40% less compared to those in Medicare fee for service and this high value for people is delivered at a lower net cost to the government.

We're also improving access to essential medicines for those even without health benefits coverage.

We are confident our differentiated offerings will once again this year resonate with consumers who are even more focused on affordability value and simplicity given the rising cost of daily life.

For example, Optum store launched a new partnership with Sanofi to help consumers without insurance obtain insulated for $35, a month and there'll be able to have it delivered to their home.

Today in the United States more people than ever have access to health benefits an important milestone on the path towards universal coverage and objective we have long supported.

Turning to health benefits today, nearly half of American seniors are enrolled in Medicare advantage plans compared to about 25%.

K to go.

And M&A plays a vital role in serving those consumers who are significantly more diverse have lower incomes are more complex CAD needs and the average senior.

Much of this expanded coverage has occurred in Medicaid looking to 2023 and given the potential resumption of eligibility Redetermination is next year a high priority for our team is assuring continuity of access and care for those we serve.

Compelling reasons, why seniors increasingly choose Ma.

Through Medicare advantage people are experiencing better health outcomes than in traditional fee for service Medicare across a wide spectrum of measures.

The initiatives our team is pursuing to help assure continuous coverage include.

For example in MA members with diabetes have over 50% lower rates of any category of complication on over 70% lower rates of serious complication.

Launching direct outreach and partnering with states and community organizations to identify those at risk and help them retain that benefit coverage.

Partnering with national retailers and pharmacies to educate consumers about available coverage options and assistance, while they are shopping in store.

This is due to our ability to provide deeper more coordinated levels of care.

And this is accomplished at lower cost.

People served by M&A spend as much as 40% less compared to those in Medicare fee for service and this high value for people is delivered at a lower net cost to the government.

And engaging with employers to extend annual enrollment periods and drive education efforts to employees, who are eligible for coverage.

Underpinning our growing consumer agenda is an ambitious multiyear effort to deepen and expand our enterprise technology capabilities.

We are confident our differentiated offerings will once again this year resonate with consumers who are even more focused on affordability value and simplicity given the rising cost of daily life.

The recent combination of Optum insight and change healthcare reflects our accelerating efforts to help create more effective and simpler experiences for consumers payers and care providers, while lowering costs across the health system.

Today in the United States more people than ever have access to health benefits an important milestone on the path towards universal coverage and objective we have long supported.

I want to formally welcome our newest colleagues talented and compassionate team at change healthcare.

Much of this expanded coverage has occurred in Medicaid looking to 2023 and given the potential resumption of eligibility re determinations next year a high priority for our team is assuring continuity of access and care for those we serve.

With whom we have just started working to build upon our shared vision for a more effective and adaptive health system for all participants.

With that I'll turn it over to President and Chief operating Officer, Doug Mcmahon.

The initiatives our team is pursuing to help assure continuous coverage include.

Thank you Andrew as Andrew just mentioned, we are very excited about the recent combination of change healthcare and optimum site with a grand total of 11 days of integration work behind Us I thought I would provide a bit more commentary on how together, we can make the health system simpler and more efficient.

Launching direct outreach and partnering with states and community organizations to identify those at risk and help them retain that benefit coverage.

Partnering with national retailers and pharmacies to educate consumers about available coverage options and assistance, while they are shopping in store.

Overall change brings a robust transaction network built on strong payer and provider connectivity together our focus areas include.

And engaging with employers to extend annual enrollment periods and drive education efforts to employees, who are eligible for coverage.

First improving the quality of health care delivery by offering critical point of care insight aligned to evidence based medical standards within the workflow of physicians.

Underpinning our growing consumer agenda is an ambitious multiyear effort to deepen and expand our enterprise technology capabilities.

Second simplifying administration by fully automating claims transactions, including entity editing in the evi stream improving claim accuracy.

Lastly, we are reducing friction in the payment process by providing patient benefits and payment obligations at point of service and applying payment integrity edits upfront.

Our teams have started out of the gate working intensively together to make these vision a reality and to create the next era of growth for Optum insight. We are very confident that our combined capabilities will enable us to better serve all healthcare constituents.

I want to formally welcome our newest colleagues talented and compassionate team at change healthcare.

With whom we have just started working to build upon our shared vision for a more effective and adaptive health system for all participants.

Beyond Optum insight as you might imagine I spend a lot of time engaging customers of all sizes operating in almost every sector and representing diverse employee populations across these customers no matter the person or the industry I hear the same consistent message the need for deeper levels of support and more resources to com.

With that I'll turn it over to President and Chief operating Officer, Doug Mcmahon.

Prehensile fully meet health needs in both the traditional but also increasingly focused on behavioral health.

Overall change brings a robust transaction network built on strong payer and provider connectivity together our focus areas include.

Companies want to provide a broader range of resources and deeper levels of support for their employees and their families and the groundwork. We've been building is resonating in this rapidly evolving area.

First improving the quality of health care delivery by offering critical point of care insight aligned to evidence based medical standards within the workflow of physicians.

Here's what we're doing about it first we're tackling access we have expanded our behavioral health network by 25% over the last couple of years, including a growing complement of behavioral clinical practices owned and operated by Optum.

Second simplifying administration by fully automating claims transactions, including entity editing in the evi stream improving claim accuracy.

And as many of you know behavioral health is a 24 by seven challenge. So we are continuing to expand our portfolio of digital offerings supporting a range of needs, allowing patients to get <unk> resources when they need them.

Lastly, we are reducing friction in the payment process by providing patient benefits and payment obligations at point of service and applying payment integrity at its upfront.

Our teams have started out of the gate working intensively together to make these visions of reality and to create the next era of growth for Optum insight. We are very confident that our combined capabilities will enable us to better serve all health care constituents.

We have also made significant improvements to help consumers access vital information more easily through improved navigation tools guiding.

Guiding consumers to the appropriate condition specific level of BBB behavioral health is a challenge we are prioritizing.

Beyond the optimum site as you might imagine I spend a lot of time engaging customers of all sizes operating in almost every sector and representing diverse employee populations across these customers no matter the person or the industry I hear the same consistent message the need for deeper levels of support and more resources to com.

These new experiences have improved customer satisfaction, and we are getting people to the right care more quickly.

Behavioral health plays an integral role of the overall health and well being of the people we serve.

So you will all continue so you continue to see us increasing access quality and affordability in this clinically important and sensitive area.

Prehensile fully meet health needs in both the traditional but also increasingly focused on behavioral health.

Another tenant of our consumer focus is meeting people, where they are which includes expanding our clinical capabilities to care for people more holistically in their homes, we know that at home care settings, especially for people with mobility challenges and highly complex health needs can improve outcomes.

Elevate patient experience and result in better care.

So we bring together teams with medical behavioral and partly to have experience. In addition to our home infusion capabilities of Optum Rx Bye.

And as many of you know behavioral health is a 24 by seven challenge. So we are.

By doing so we help we help patients and their families keep multiple chronic conditions in check while significantly reducing the need for care in acute and post acute settings are real positive for them.

<unk> to expand our portfolio of digital offerings supporting a range of needs, allowing patients to get <unk> resources when they need them.

We have also made significant improvements to help consumers access vital information more easily through improved navigation tools guiding.

The expanding clinical breadth and deepening integration of our value based care offerings are moving us beyond the confines of traditional clinical settings, creating an opportunity for us to serve more people more effectively.

Guiding consumers to the appropriate condition specific level of BBB behavioral health is a challenge we are prioritizing.

These new experiences have improved customer satisfaction, and we are getting people to the right care more quickly.

With that now I'll turn it over to Chief Financial Officer, John Rex.

Thank you Derek.

Behavioral health plays an integral role of the overall health and well being of the people we serve.

As those of you listening know well numbers can tell a story.

And the story, our numbers tell us when a broad based growth and substantial near and long term potential.

So you will all continue so you will continue to see us increasing access quality and affordability in this clinically important and sensitive area.

So let me walk through some of those numbers with you.

In the third quarter Unitedhealth group revenues up 81 billion grew 12% or $8 6 billion highlighted by broad based double digit growth at both Optum and Unitedhealthcare.

Care patterns in the quarter remained similar to those of the second quarter and our planning for next year anticipates care patterns continue to normalize.

We're encouraged to see people obtaining preventive screenings at levels broadly consistent with longer term norms and we're maintaining our focus on getting people the care they need.

Elevate patient experience and result in better care.

So we bring together teams with medical behavioral and partly to have experience. In addition to our home infusion capabilities of Optum Rx.

And acuity patterns remained stable, but as always we are highly respectful of and watchful for evolving medical cost trends.

By doing so we help we help patients and their families keep multiple chronic conditions in check while significantly reducing the need for care in acute and post acute settings.

Looking now at the performance of our specific businesses.

Optum health third quarter revenue increased 34% year over year as revenue per consumer grew 31%.

Real positive for them.

Growth continues to be led by the increasing number of patients served under value based care relationships and expanding types of care settings offered by Optum for meeting behavioral needs to comprehensively serving people in their homes to higher acuity ambulatory surgery.

With that now I'll turn it over to Chief Financial Officer, John Rex.

Optum insight revenue grew 18% in the quarter led by continued market growth across payer and provider services and the revenue backlog increased by $1 8 billion year over year to $24 1 billion.

Thank you Derek.

As those of you listening know well numbers can tell a story and the story our numbers tell us when a broad based growth and substantial near and long term potential.

So let me walk through some of those numbers with you.

<unk> revenue grew 8% reflecting growth in people serve and continued expansion of the pharmacy care businesses, including specialty home delivery and community pharmacies.

In the third quarter Unitedhealth group revenues up 81 billion grew 12% or $8 6 billion highlighted by broad based double digit growth at both Optum and Unitedhealthcare.

Pharmacy care services revenue growth continues to show momentum growing double digits in the quarter compared to the prior year.

Care patterns in the quarter remained similar to those of the second quarter and our planning for next year anticipates care patterns continue to normalize.

New customer sales and retention have been strong.

We're encouraged to see people obtaining preventive screenings at levels broadly consistent with longer term norms and we're maintaining our focus on getting people the care they need.

Turning to United Healthcare revenue grew by 11% with all businesses contributing the number of people served domestically by our commercial insured offerings increased by more than 100000 over the past half year as we continue to experience strong growth in our newer more affordable consumer centric offerings.

And acuity patterns remained stable, but as always we are highly respectful of and watchful for evolving medical cost trends.

Looking now at the performance of our specific businesses.

Optum health third quarter revenue increased 34% year over year as revenue per consumer grew 31%.

Products, such as <unk>, which provides consumers with greater certainty and choice over their health benefits.

And also our virtual first.

People served by our Medicare advantage offerings continue to grow strongly increasing 800000, so far this year.

The recently released 2020 for plan year Star ratings were consistent with our long term planning expectations with 81% of our members in four star or better plans.

Optum insight revenue grew 18% in the quarter led by continued market growth across payer and provider services and the revenue backlog increased by $1 8 billion year over year to $24 1 billion.

A level, we expect will rise as planned refinements are finalized.

Unitedhealthcare interest 2023, serving more people in four and five star plans than any other health plan.

<unk> revenue grew 8% reflecting growth in people serve and continued expansion of the pharmacy care businesses, including specialty home delivery and community pharmacies.

The number of people we serve through our Medicaid offerings has grown by 350000 year to date.

Pharmacy care services revenue growth continues to show momentum growing double digits in the quarter compared to the prior year.

Most recently, we were awarded the opportunity to continue to serve the people of Nebraska, and Kansas Chip and long long term care programs.

New customer sales and retention have been strong.

Unitedhealthcare achieved the highest score both overall and in each of the individual categories.

Turning to Unitedhealthcare revenue grew by 11% with all businesses contributing the number of people served domestically by our commercial insured offerings increased by more than 100000 over the past half year as we continue to experience strong growth in our newer more affordable consumer centric offerings.

<unk>, our ability to deliver differentiated solutions align to our state customers needs.

And we continue to see strength in our dual special needs offerings with exceptional consumer satisfaction demonstrated by a net promoter score of 80.

Products, such as <unk>, which provides.

<unk> consumers with greater certainty and choice over their health benefits.

Our capital capacity remained strong.

Year to date adjusted cash flows from operations were <unk> $21 billion or one three times net income.

And also our virtual first health offerings.

People served by our Medicare advantage offerings continue to grow strongly increasing 800000, so far this year.

We ended the quarter with a debt to capital ratio of 38%, providing ample ability to continue to further build upon vital capabilities, which benefit both the people, we serve and the broader health system.

The recently released 2020 for plan year Star ratings were consistent with our long term planning expectations with 81% of our members in four star or better plans.

And we have returned $10 5 billion to shareholders in the first nine months of the year through dividends and share repurchases.

A level, we expect will rise as planned refinements are finalized.

As noted earlier.

Unitedhealthcare interest 2023, serving more people in four and five star plans than any other health plan.

Given the strength of our business performance. This morning, we updated our 2022 adjusted earnings outlook to a range of $2 85 to 22 O five per share.

The number of people we serve through our Medicaid offerings has grown by 350000 year to date.

So we think these numbers are telling the story of an enterprise striving to conclude a strong 2022.

Most recently, we were awarded the opportunity to continue to serve the people of Nebraska in TANF chip and long long term care programs.

The year broadly featuring diversified growth today.

And making foundational investments for our long term future.

Unitedhealthcare achieved the highest score both overall and in each of the individual categories.

Now I'll turn it back to Andrew.

Joan as is customary with the close of the third quarter, we will offer early observations about next year.

<unk>, our ability to deliver differentiated solutions align to our state customers needs.

<unk> reserve and most of this compensation for all November 29 Investor Conference.

And we continue to see strength in our dual special needs offerings with exceptional consumer satisfaction demonstrated by a net promoter score of 80.

Our businesses are growing and operating well with strong momentum and our keen enterprise focus on executing on our strategic growth priorities.

Our capital capacity remained strong.

Year to date adjusted cash flows from operations were $21 billion or one three times net income.

Among a few highlights.

The Optum health care delivery businesses are rapidly advancing their value based capacities.

Spending the scope and settings of care offered in creating a long runway for growth.

And we say our innovative and consistently highly valued Medicare advantage plans is well positioned to grow strongly again next year.

And we have returned $10 5 billion to shareholders in the first nine months of the year through dividends and share repurchases.

At this distance we view a majority of the 2023 analyst estimates as reasonably reflecting performance levels, we would expect to offer in November .

As noted earlier.

Given the strength of our business performance. This morning, we updated our 2022 adjusted earnings outlook to a range of $20 85 to 22 O five per share.

The current consensus at the top end of our likely initial earnings outlook range.

And as you have come to expect we continue to strive toward our long term, 13% to 16% earnings per share growth goal.

So we think these numbers are telling the story of an enterprise striving to conclude a strong 2022.

We look forward to discussing this with you in much greater detail in person at our Investor Conference in New York.

The year broadly featuring diversified growth today.

And making foundational investments for our long term future.

I hope you're getting a sense of an organization that as has long been the case is focus sharply on executing with excellence in all we do so that we can meet and exceed our commitments to our customers clinicians consumers and the communities we serve.

Now I'll turn it back to Andrew.

Thanks, John .

As customary with the close of the third quarter, we will offer early observations about next year.

While reserve and most of this compensation for all November 29 Investor Conference.

And of course to our employees and to you our shareholders.

Our businesses are growing and operating well with strong momentum and our keen enterprise focus on executing on our strategic growth priorities.

With that operator, let's open it up for questions one per caller. Please.

Yes.

Among a few highlights.

Thank you if you would like to ask a question simply press the star key followed by the digit one on your telephone keypad also if youre using a speakerphone. Please make sure. Your mute function is turned off to allow your signal to reach our equipment. Once again press star one at this time, we will pause for a moment.

The Optum health care delivery businesses are rapidly advancing that value based capacities expanding the scope and settings of care offered in creating a long runway for growth.

And we see our innovative and consistently highly valued Medicare advantage plans is well positioned to grow strongly again next year.

At this distance we view a majority of the 2023 analyst estimates as reasonably reflecting performance levels, we would expect to offer in November .

And we'll first hear from a J rice of credit Suisse.

Yes.

Thanks, Hi, everybody thanks for the comments.

The current consensus at the top end of our likely initial earnings outlook range.

As you think about 'twenty, three and youre going through the process of.

And as you have come to expect we continue to strive toward our long term, 13% to 16% earnings per share growth goal.

Pricing discussions with your commercial.

Employer groups and so forth.

Or is the basic concept.

We look forward to discussing this with you in much greater detail in person at our Investor Conference in New York.

John You said continue to return to normal utilization is the basic view is that we would project our medical cost trend off of this year.

More in that traditional four 5% range mid single digits and we've heard some discussion about maybe there being a unusual bump up in addition to the medical traditional medical cost trend.

Allocate something for providers dealing with their labor issues as you are.

And of course to our employees and to you our shareholders.

Your discussion with employers is that something youre seeing getting put in place.

With that operator, let's open it up for questions one per caller. Please.

Okay.

So hey, Jay Thanks, so much for the question and obviously key a key aspect of planning for next year.

Yes.

Thank you if you would like to ask a question simply press the star key followed by the digit one on your telephone keypad also if youre using a speaker phone. Please make sure. Your mute function is turned off to allow your signal to reach our equipment. Once again press star one at this time, we will pause for a moment.

But youll focused on.

Just let me make a couple of broader comments and I might just ask Brian Thompson to reflect a little bit more detail on that as well.

And from the United Healthcare perspective, obviously for the last couple of years, there's been a lot of focus on the effect of Covid as you think about.

And we'll first hear from AJ Rice of credit Suisse.

Impacts on medical cost trend I think as we've rolled through this year honestly I think it's become much less about Covid does now I think there is a blend of possibly a little bit of COVID-19.

Yes.

Thanks, Hi, everybody thanks for the comments.

As you think about 'twenty, three and youre going through the process of.

<unk> in the system, but the cost of living effects things like inflation things like capacity constraints in the system as the labor market tightness has affected different parts of the system at different moments.

Pricing discussions with your commercial.

Employer groups and so forth.

Is the basic concept.

John You said continuing to return to normal utilization is the basic view is that we would project that a medical cost trend off of this year.

I think this whole issue has become actually more complicated in some ways because there's more more influences on what you need to think through going forward, but with that maybe sold high level perspective, maybe Bryan you might just go a little deeper in terms of how you've been in translating some of that is <unk> been thoughtful about pricing going forward sure Andrew. Thank you and thank you for the quest.

More in that traditional four 5% range mid single digits and we've heard some discussion about maybe there being a unusual bump up in addition to the medical traditional medical cost trend.

Hey, Jay Brian Thompson here as we do look forward I would say that we have planned in price for our cost trend a little higher than historical norms I think to some of the points that Andrew made some of them are pretty obvious and inevitable in the first just being the reality that 2022 is a lower starting point. In addition to that contributing is labor and inflationary.

Allocate something for providers dealing with their labor issues as you are.

Your discussion with employers is that something youre seeing getting put in place.

Okay.

So hey, Jay Thanks, so much for the question and obviously key a key aspect of planning for next year.

And just being respectful of what we don't know again, probably the pacing of care patterns and how they returned to normal certainly included in that I would certainly suggest that at the same time, we're working really hard to manage down the impact of these trends on both our consumers and employers alike, and you mentioned, how we're negotiating with our provider partners.

But youll focused on.

Just let me make a couple of broader comments and I might just ask Brian Thompson to reflect a little bit more detail on that as well.

From the Unitedhealthcare perspective, obviously for the last couple of years, there's been a lot of focus on the effect of Covid as you think about.

Sure.

I would say, we've really seen emergence of value based arrangements.

Impacts on medical cost trend I think as we've rolled through this year honestly I think it's become much less about Covid does now I think there is a blend of possibly a little bit of COVID-19.

At a faster pace than perhaps historically, so we're not just seeing unit cost to accelerate at a higher rate and in addition, just more product designs that are meaningfully lowering those price points for end consumers, whether it's virtually enriched products, we mentioned that a little bit we've talked a lot about <unk> and how that consumer choice model is really driving not only a lower price point, but first dollar.

Effect in the system, but cost of living effects things like inflation things like capacity constraints in the system as the labor market tightness has affected different parts of the system at different moments.

I think this whole issue has become actually more complicated in some ways because there's more more influences on what you need to think through going forward, but with that maybe saw high level perspective, maybe Bryan you might just go a little deeper in terms of how you've been translating some of that is <unk> been thoughtful about pricing going forward sure Andrew. Thank you and thank you for the <unk>.

<unk> is really emerging as a priority for those folks that we support and serve everyday. So those are some elements and dynamics not only in the product side, but how we're looking to our forward view of costs, yes, it's Brian . Thanks, So much and I think a J one of the one of the key points.

Points Im sure Youll have taken away from what Brian is saying there's look there's a degree of.

There was some unavoidable pressures in the macro environment, everybody is well aware of but we're really doing something about that on behalf of our members and our clients and our customers. Our focus is to bring innovation into the marketplace, whether that's through the way we design plans like <unk> and United Health care. The way, we develop the value based platform and Optum care all of.

Hey, Jay Brian Thompson here as we do look forward I would say that we have planned in price for our cost trend a little higher than historical norms I think to some of the points that Andrew made some of them are pretty obvious and inevitable. The first just being the reality that 2022 is a lower starting point. In addition to that contributing is labor and inflationary.

Which are designed to develop to deliver high quality care at more affordable levels for folks and then ensure that that is something you can rely on year after year after year. So a stability of confidence in the health care that they can come to expect so that's that's how we're really viewing this it's obviously a dynamic.

Costs, and just being respectful of what we don't know again, probably the pacing of care patterns and how they returned to normal certainly included in that I would certainly suggest though at the same time, we're working really hard to manage down the impact of these trends on both our consumers and employers alike, and you mentioned, how we're negotiating with our provider partners.

Environment, but we're extremely focused as you can tell on making sure we have strong responses to it. Thanks, a J next question. Please.

I would say, we've really seen emergence of value based arrangements.

Next we will hear from Josh Raskin.

Nephron research.

Hi, Thanks, good morning.

Can you refresh us on the components of Optum health and sort of how much of that revenue is now coming from Optum care and then how many of those consumers are.

Within Optum health or actually Optum care consumers and maybe how many are in some form of risk arrangement and then how many are in full capitation I think you've given some of those numbers just looking for a refresh.

Ian Thanks, so much.

And I think a J one of the one of the key points I am sure Youll have taken away from what Brian is saying is look there is a degree of.

Yes, Josh good to hear your voice and thanks, so much for the question.

There was some unavoidable pressures in the macro environment everybody's well aware of but we're really doing something could biodot on behalf of our members and our clients and our customers. Our focus is to bring innovation into the marketplace, whether that's through the way we design plans like <unk> and United Health care. The way, we develop the value based platform and Optum care all.

Very good very strong quarter continued strong performance from Optum health overall.

I'll pass the second to a doctor Wyatt Decker to give you a little more flavor on that just just let me pick out one of those aspects, which is the question you ask about the fully capitate. It lives within so if you think about Optum care, obviously, a subset of Optum health has about $20 million or so folks who we.

Of which are designed to develop to deliver high quality care at more affordable levels for folks and then ensure that that is something you can rely on year after year after year, so a stability of confidence.

We look after through that platform, probably still little under 15% of that number.

In the health care that they can come to expect so that's that's how we're really viewing this it's obviously a dynamic environment, but we're extremely focused as you can tell on making sure we have strong responses to it. Thanks.

And fully capitation arrangements, so that really tells you.

Despite the very strong impact that's having you can see the way that's reflected through the sustained 34% growth in average revenue per consumer served in Optum health a lot of that is influenced by the capitation.

Hey, Jay next question please.

Next we will hear from Josh Raskin of.

Shift, but it's still a really small fraction of the total number of lives that we look after and that part of our organization. So lot of runway there and that's what really underpins our long term confidence in sustained growth, particularly in <unk>, which is a key piece of Optum health and maybe now pass to why to give you a little bit more context of how it all fits together.

Nephron research.

Hi, Thanks, good morning.

Can you refresh us on the components of Optum health and sort of how much of that revenue is now coming from Optum care and then how many of those consumers are.

Yes, Thanks, Andrew Thank you Josh for the question absolutely correct is the importance of capitation and value based care to both our strategic business model to continue to offer comprehensive health care solutions to our nation's citizens as well as to our optimistic outlook on growth today over <unk>.

Yes, Josh good to hear your voice.

So much for the question. So very good very strong quarter continued strong performance from Optum health overall.

<unk> of our revenue are derived from value based care construct and that will continue to grow as Andrew pointed out we have ample.

I'll pass the second to adopt to Wyatt Decker to give you a little more flavor on that just just let me pick out one of those aspects, which is the question you ask about the fully capitate lives within so if you think about Optum care, obviously, a subset of Optum health has about 20 million or so folks who.

Ample pathways for growth Youll see us going deeper and broader in the markets that we serve today as well as going into new markets like the Pacific Northwest and the northeast and what I'm excited about is increasingly we're bringing together the platforms that we have talked about historically in that Derek touched on today, So think of home and community.

We look after through that platform, probably still little under 15% of that number.

And fully capitation arrangements, so that really tells you.

<unk> is helping us bring value based contracts to a broader set of populations and servicing more comprehensively. Those we serve at Optum care. So you'll hear me talking a lot about optum health in our cafeteria and value based risk lives because increasingly we're bringing all of the services behavioral virtual finance.

But it's still a really small fraction of the total number of lives that we look after and that part of our organization. So lot of runway there and that's what really underpins our long term confidence in sustained growth, particularly in <unk>, which is a key piece of Optum health and maybe now pass to why to give you a little bit more context of how it all fits together Joe at what yes.

It'll as well as clinics to bear to grow our value based population. Thank you. Thanks.

Josh. Thanks, So much next question. Please April .

Next we'll hear from Nathan Rich with Goldman Sachs.

Hi, good morning, Thanks for the question.

Thanks, Andrew and thank you Josh for the question.

I think non COVID-19 utilization has been running a bit below baseline. This year, but you mentioned kind of care patterns continuing to normalize how are.

Absolutely correct is the importance of capitation and value based care to both our strategic business model to continue to offer comprehensive health care solutions to our nation's citizens as well as to our optimistic outlook on growth today over two thirds of our revenue are derived from value based care construct and that will.

Are you thinking about that concept of normalization for both the fourth quarter and could you maybe just talk about the factors that you think could have the biggest impact on the recovery in non COVID-19 utilization volumes as we get into next year.

<unk> to grow as Andrew pointed out we have ample.

Yes listen Nathan Thanks, Thanks for the question as I said, a little earlier I think a good way to think about it versus what has historically been a COVID-19 narrative becomes much more of a blended narrative around things like capacity constraints in the system.

Cost of living and Pete folks' ability to.

Desire to access the system right now, which is an area. We are working super hard to try and ensure sustained.

<unk> is helping us bring value based contracts to a broader set of populations and servicing more comprehensively. Those we serve at Optum care. So you'll hear me talking a lot about optum health in our cafeteria and value based risk lives has increasingly we're bringing all of the services behavioral virtual finance.

Plus of course volatility in things like Covid and.

Flu, particularly as you go through Q4 Q1 over the next few months. So I think all of that is essentially in the mix.

We're taking I think a reasonably balanced view of how this is going to play out we've seen now for the bulk of this year.

<unk> as well as clinics to bear to grow our value based population. Thank you. Thanks, Josh. Thanks. So much next question. Please April .

Reasonably stable pattern of cash utilization across the portfolio with.

Next we'll hear from Nathan Rich with Goldman Sachs.

<unk> taken a normal year view for flu. So we're not we're not particularly staking ourselves I have to say flu is either going to be very low as we've seen in the last couple of years old very high. We just don't know there's really no evidence to support any decision at this point in time. So we've taken a very balanced view as we look forward into things of flu, which as you well know.

Hi, good morning, Thanks for the question.

I think non COVID-19 utilization has been running a bit below baseline. This year, but you mentioned kind of care patterns continuing to normalize.

Are you thinking about that.

On Sept of normalization for both the fourth quarter and could you maybe just talk about the factors that you think could have the biggest impact on the recovery in non COVID-19 utilization volumes as we get into next year.

Can affect Q4 or Q1s.

Differentially year to year.

Essentially how we're tackling all of US we feel very confident.

Yes listen Nathan Thanks, Thanks for the question as I said, a little earlier I think a good way to think about versus what has historically been a COVID-19 narrative becomes much more blended narrative around things like capacity constraints in the system.

By the way, we were planning for the next quarter and particularly as we roll into next year and.

And obviously we will.

Of course, correct as things like flu reveal themselves to us. Thanks.

Thanks for the question next question.

Cost of living and Pete folks' ability to.

Justin Lake Wolfe Research.

Desire to access the system right now, which is an area. We are working super hard to try and ensure sustained.

Thanks, Good morning couple.

A couple of members of questions first would love to hear your thoughts on.

Plus of course volatility in things like Covid and.

So for what happened with Medicaid membership in your mind post.

Flu, particularly as you go through Q4 Q1 over the next few months. So I think all of that is essentially in the mix.

Post redetermination.

Kind of starting and then any kind of early view on Medicare advantage, given the open enrollment kicked into gear.

Taking I think a.

A reasonably balanced view of how this is going to play out we've seen now for the bulk of this year.

For 2023 in terms of the market.

Thanks.

Reasonably stable pattern of cash utilization across the portfolio with.

Thanks, Justin so.

Ask Tim Spilker, then some novel to comment in a second just a couple of kind of introductory thoughts really on your questions.

As I said in my prepared comments at the beginning of the call. Justin Redetermination is a really important potential issue for next year and it's something that as an organization. We are going to we are really leaning into we're very focused on and thats. Because we are concerned that through a redetermination cycle jewelry in 'twenty, three and 'twenty four.

Can affect Q4 or Q1s.

Differentially year to year.

Depending on when the public health emergency comes to an end could lead to a situation where folks get dislodged from that coverage.

Essentially how we're tackling all of US we feel very confident.

By the way, we were planning for the next quarter and particularly as we roll into next year and.

That would be a huge setback in terms of the progress that's been made over the last many years to extend coverage. So we are really focused on how we can ensure that people retain coverage Tim will talk in a second around some of the ways in which we feel confident we can help but it is a really important area and it's an area where we hope later.

And obviously we will.

Of course, correct as things like flu reveal themselves to us. Thanks.

Thanks for the question next question.

Justin Lake Wolfe Research.

Thanks, Good morning couple.

Tire industry and its participants all lean in to make sure that people don't get lost in the system as things go through the Redetermination cycle. So that's going to be a super important area. Let me ask Tim spill could go little deeper on that and then pass straight to mill to talk about open enrollment.

Couple of membership question first would love to hear your thoughts on.

So for what happens with Medicaid membership in your mind post.

Post redetermination.

Kind of starting and then any kind of early view on Medicare advantage given the open enrollment kicked into gear would you think for 2023 in terms of the market. Thanks.

Hey, Thanks for the question. So first maybe just some of the <unk>.

So we're assuming the phe will end in January and Redetermination will resume in Q1.

Thanks.

Thanks, Justin so.

And we will share more detail in November around the specifics, but we're very respectful of the variety of factors that are in play certainly the pacing.

Ask Tim Spilker, then some though to comment in a second just a couple of kind of introductory thoughts really on your questions.

That will vary by state and then of course, how consumers respond and behave in terms of the change so as Andrew mentioned, we're working hard with our customers. This will be a big lift for states.

Really long term effort over the course of 12 months to 14 months. So we're trying to do our part through data sharing through outreach to consumers engaging communities engaging providers and really connecting with individuals where they access care. So places like pharmacies.

Depending on when the public health emergency comes to an end could lead to a situation where folks get dislodged from that coverage.

That would be a huge setback in terms of the progress that's been made over the last many years to extend coverage. So we are really focused on how we can ensure that people are retained coverage Tim will talk in a second around some of the ways in which we feel confident we can help but it is a really important area and it's an area, where we hope they enter.

Proud of that work.

And we're proud of our ability to be able to support members as they go through this change with that ill hand, it over to Tim.

Yes, good morning, Justin Thanks for the question Timna all here. So first if I may start with kind of an end cap on that 2022.

John mentioned in the opening remarks that right now we've thrown about 800000 Medicare lives and that's consistent with the guidance. We gave at Investor Conference last year and then we are on pace to end. This year 22 with full year growth of 900000 lives. So feel good about the way our value proposition is resonating.

Hey, Thanks for the question. So first maybe just some of the numbers. So we're assuming the phe will end in January and Redetermination will resume in Q1.

In 'twenty, two and feel like that momentum well on head into 2023, so great feedback from the broker community around our product positioning our investing our emphasis on investments in the most utilized benefits like drug it's unlike dental benefits.

And we will share more detail in November around the specifics, but we're very respectful of the variety of factors that are in play certainly the pacing.

So feel very good heading into AEP tomorrow.

That will vary by states and then of course, how consumers respond and behave in terms of the change so as Andrew mentioned, we're working hard with our customers. This will be a big lift for states.

With respect to the industry over the long term basis, we've kind of guided two 8% to 9% Medicare advantage industry growth I don't have any reason to see it differently.

And from this vantage point for 2023, and once again I like my chances to outperform the industry in 'twenty, three and a half share gaining growth.

Thanks, Tim next question please.

So we're proud of that work and.

And we're proud of our ability to be able to support members as they go through this change with that ill hand, it over to Tim.

Stephen Baxter of Wells Fargo.

Yes, hi, Thanks wanted to ask about Optum insight as you work to grow this business and add new anchor partners and they would love to hear what you're hearing from your health system customers given the challenges they're facing how is the pipeline developing can you remind us I guess, how much revenue coverage you have for next year at this point and then just lastly, any update on expectations for change.

Yes, good morning, Justin Thanks for the question Timna all here. So first if I may start us with kind of an end cap on that 2022.

John mentioned in the opening remarks that right now we've gone about 800000 Medicare lives on and Thats consistent with the guidance, we gave at Investor Conference last year.

And post the divestiture of claims expense. Thank you.

Are on pace to end this year 22 with full year growth of 900000 lives. So feel good about the way our value proposition has resonated in 'twenty, two and feel like that momentum well on head into 2023, so great feedback from the broker community around our product positioning.

Hey, Stephen Thanks, So much for the question I'm going to ask Dennis Schuh Mecca to response to first of all of that question then John Rex will pick up the point on the change accretion piece. So Dan go ahead.

Sure. Thank you Steve I appreciate the question.

Obviously health system partners are under a lot of pressure and we talked about some of them from the macroeconomic backdrop in terms of shifting site of care and labor shortages wage inflation things like that so as we engage with the market we find that.

Our investing our emphasis on investments in the most utilized benefits like drug it's unlike dental benefits.

So feel very good heading into AEP tomorrow.

Health systems are very responsive because we present an opportunity to be able to address some of those short term needs. But then really importantly on the mid to long term, we become a key accelerant in some of their.

With respect to the industry over the long term basis, we've kind of guided to 8% to 9% Medicare advantage industry growth I don't have any reason to see it differently from this vantage point for 2023, and once again I like my chances to outperform the industry in 'twenty, three and a half share gaining growth.

Our transformation initiatives things like their preparedness for value based care as an example, or how they engage digitally with patients and so those are some of the areas that we've been expanding our reach we have a robust pipeline and that pipeline has been growing and conversations have been advancing and what's been really encouraging is from our existing real.

Thanks, Tim next question please.

Stephen Baxter of Wells Fargo.

<unk>, we've been able to drive really strong outcomes and that gives us confidence around the performance.

And so we're excited to see how that develops over time and that will continue to be a contributor in terms of.

The pipeline developing can you remind us I guess, how much revenue coverage you have for next year at this point and then just lastly, any update on expectations for change accretion post the divestiture of claims expense. Thank you.

Our backlog it represents about a quarter of our backlog and not surprisingly less in terms of current revenue contribution and as it relates to coverage into next year, we have.

Hey, Stephen Thanks, So much for the question I'm going to ask Ben Shoemaker to response to first part of that question then John Rex will pick up the point on the change accretion piece. So Dan go ahead.

Well north of half coverage on revenue as we look into next year. Thanks, Don jump.

On accretion for change so yes, it will be accretive next year in terms of the magnitude of that really.

Sure. Thank you Steve I appreciate the question.

Important factors and considerations are when it closes within the year certain expectations in terms of the integration costs that we will.

Investments, we will like to make in the business.

When we get that done earlier in the year versus later in the year for a close and then what it had in terms of impact on the out year, an important consideration as we bring that as we bring that and I think of a full out year view.

Transformation initiatives things like their preparedness for value based care as an example, or how they engage digitally with patients and so those are some of the areas that we've been expanding our reach we have a robust pipeline and that pipeline has been growing and conversations have been advancing and what's been really encouraging is from our existing real.

Also as I'm sure you are very aware of the <unk>.

Stitcher that occurred in terms of with the closing also having an impact on the magnitude of that so two important things there maybe just actually.

Knowing that you've got models to do here also and as you think about it <unk> and how that might play in the <unk>.

So we wouldn't expect change to be additive to Optum insight operating earnings in the fourth quarter.

<unk>, we've been able to drive really strong outcomes and it gives us confidence around the performance.

And so we're excited to see how that develops over time and that will continue to be a contributor in terms of.

Elements on that one in the second half for changes I know you understand well as it's lower half seasonally in terms of earnings first half typically considerably stronger than the second half. So then impact there and how that comes in.

Our backlog it represents about a quarter of our backlog and not surprisingly less in terms of current revenue contribution and as it relates to coverage into next year, we have.

Clearly there will be transaction cost that we'll be incurring here.

So really as you think about your modeling purposes, roughly in the zone of $800 million of revenue coming in to the Optum insight.

Well north of half coverage on revenue as we look into next year. Thanks, Ben jump.

On accretion for change so yes, it will be accretive next year in terms of the magnitude of that really.

Segment without any impact on operating earnings.

Of course coming back on my comments is how we think about impact going forward.

Important factors and considerations are when it closes within the year certain expectations in terms of the integration costs that we will.

We will look to.

To the point to the extent possible do any acceleration on other important integration activities. So we can bring the potential benefits of the combination of Optum insight and changed the health system more quickly.

Investments, we will like to make in the business.

See that potentially in the over $100 million, though in terms of incremental cost that we might look to do and pull that ahead, but all of that is incorporated in the 2020 and the outlook that we provided this morning that 'twenty two outlook.

Also as I'm sure you're very aware the divestiture that occurred in terms of that with the closing also having an impact on the magnitude of that so two important things there maybe just actually.

'twenty three.

Observations also.

Thanks, John and I think John Tees up a really.

Knowing that you've got models to do here also and as you think about it <unk> and how that might play in the <unk>.

The important point.

I just want to reemphasize, which is within the guidance. We've given you today for the close out of 22 and 'twenty three not only are we anticipating obviously continued very strong growth in revenues and the consequential flow through the business.

So we wouldn't expect change to be additive to Optum insight operating earnings in the fourth quarter.

A few elements on that one in the second half for changes I know you understand well as it's lower half seasonally in terms of earnings first half typically considerably stronger than the second half. So then impact there and how that comes in clearly there will be transaction cost that we'll be incurring here.

But you're also seeing us create the space to make sure we can make the right investments so whether that seed and making sure we get the integration of change done as promptly as we can whether it's how we invest in our consumer capabilities, which really started to get going in Q3 and will continue through Q4 and beyond or whether it's in <unk>.

So really as you think about your modeling purposes, roughly in the zone of $800 million of revenue coming in to the Optum insight.

Increasing our investment in our employees to make sure that we are responsive to the cost of living pressures. So.

Segment without any impact on operating earnings of.

Of course coming back on my comments is how we think about impact going forward.

Really important.

So you see that.

And very much taken into consideration as we sold through our <unk>.

We will look to.

Well going forward.

The other thing I would just also add is that.

I think you all understand how important the change integration is for Optum insight. This is a great moment to bring together tremendously complementary skills capabilities technologies perspectives on the marketplace and so as we roll through the next two or three quarters, we really anticipate kind of new Optum ins.

Emerging from this integration and very excited to have Neil de crescenzo as well Dan Shoemaker working together to lead. These two organizations as this as this work goes out and so a lot of a lot of LNG potentially being released in this space and as John said.

'twenty three.

Observations also thanks.

Thanks, John and I think John Tees up a really really important point.

I just want to reemphasize, which is within the guidance. We've given you today for the closeout of 22% and 23.

We've incorporated into our guidance points.

O'neill, we anticipate and obviously continued very strong growth in revenues and the consequential flow through the business.

Space to potentially make the right investments going forward.

Next question.

You're also seeing us create the space to make sure we can make the right investments, so whether that seed and making sure we get the integration of change dominant as promptly as we can whether it's how we invest in our consumer capabilities, which really started to get going in Q3 and will continue through Q4 and beyond or whether it's in <unk>.

Okay.

Scott Fidel of Stephens.

Hi, Thanks, good morning.

No that continuity of care has been a big focus here, especially with Redetermination is coming back and just interested in that context, how you're thinking about potential footprint expansions in the ACI exchanges for 2023 and beyond.

And our investment in our employees to make sure that we are responsive to the cost of living pressures so really important.

You see that.

It looks like also there's been some favorable policy developments in some competitive changes to that could be positive for the market. So just interested in your thinking on exchange strategy for both next year and longer term. Thanks.

And very much taken into consideration as we sold through.

Well going forward.

The thing I would just also add is that.

I don't want it.

You all understand how important the change integration is for Optum insight. This is a it's a great moment to bring together a tremendous set of complementary skills capabilities technologies perspectives on the marketplace and so as we roll through the next two or three quarters, we really anticipate kind of new optum insight emerging from this.

So I really appreciate that question as you know this is an area where we'd be building up very substantially over the last couple or three years, and maybe ask Brian to give you a little bit more detail on that sure Andrew. Thanks for the question Scott and we agree totally we see the exchanges is really emerging as a meaningful place in a broader coverage crowd.

Integration and very excited to have Neil de crescenzo as well Dan Shoemaker working together to lead these two organizations as this.

Terry across this country and it's certainly important to us to be more relevant each and every year in fact, while we're expanding into four new states in 2023, our footprint is expanding meaningfully I think we're going from around 40% to the addressable market here, leaving 2022 to nearly two thirds by the end of next year and again by the start of next year I should suggest so.

Where it goes out and so a lot of a lot of LNG potentially being released in this space and as John said.

Incorporated into our guidance points.

Face to potentially make the right investments going forward.

Again reasons aligned with yours, it's important that we are where folks are and as we manage through this redetermination process working not only with our employer partners, our distribution partners and our states, but making sure we have product ourselves to make sure that these folks can get enrolled and we're encouraged by our progress we like how we're positioned here, leaving 2022.

Next question.

Okay.

Scott Fidel of Stephens.

Hi, Thanks, good morning.

Continuity of care has been a big focus here, especially with Redetermination is coming back and just interested in that context, how you're thinking about potential footprint expansions in the ACI exchanges for 2023 and beyond.

Both from a footprint receptivity and growth and a performance perspective, and looking forward to expanding again 23, alright. Thanks. So much Brian . Thank you for that question next question. Please.

It looks like also there's been some favorable policy developments and then some competitive changes to that could be positive for the market. So just interested in your thinking on exchange strategy for both next year and longer term. Thanks.

Kevin Fischbeck of Bank of America.

Great. Thanks, I wanted to go back to trend again, if I can.

So I really appreciate that question as you know this is an area where we'd be building up very substantially over the last couple of three years and maybe ask Brian to give you a little bit more detail on that sure Andrew. Thanks for the question Scott and we agree totally we see the exchanges is really emerging as a meaningful place in a broader coverage cry.

Can you give a little more color in the quarter about how trend looked across the three different payers and when you talk about normalization in 2023 should we expect all three of them to be kind of back to normal or do you have a view that the government, which has been lagging a little bit, we'll still kind of take a little bit longer to get back to normal.

Okay.

Kevin Thanks, so much for the question, maybe ask Brian to make a couple of comments on that.

So the question that Kevin maybe I'll start with a service type and it's really a focus on inpatient that has been the driver and it really was the driver last quarter as well so when I look at third quarter, it's largely a repeat of what we saw in the second quarter.

Inpatient some variation.

I would say all other service type so largely near at or even slightly above normal levels to your question, though on lines of business I might just suggest other than inpatient commercial pretty much a normal care patterns Medicare seeing some interesting developments I'd say, maybe signs of more durable shift inside of service, particularly urgent cares a little lower.

Sure.

Give me a little higher but <unk> is a little lower net certainly a good trade for the system overall outpatient surgeries in Medicare seem to be back to normal, but again as I had mentioned mentioned inpatient a little bit lower and again Medicaid consistent with the other lines of business lower in patient and physician starting to trend back. So again thats largely a repeat of that.

Okay.

Kevin Fischbeck of Bank of America.

Great. Thanks, I wanted to go back to trend again, if I can.

What I had suggested last quarter inpatient really being the most notable element inside it.

Brian Thanks, so much and thank you for the question. Kevin next question. Please April .

Next we'll hear from Lisa Gill of Jpmorgan.

Alright, thanks very much for taking my question when we think about membership in the commercial market I'm just curious how and players are currently talking to you about that trend going into 'twenty three and if you can just give us an update on your thoughts around if we move into a recessionary type of environment, what that could mean for the health plan business.

Okay.

Kevin Thanks, so much for the question, maybe ask Brian to make a couple of comments on that sure. Okay. Thanks for the question, Kevin maybe I'll start with a service type and it's really a focus on inpatient that has been the driver and it really was the driver last quarter as well so when I look at third quarter, it's largely a repeat of what we saw in the second quarter beyond inpatient some variation.

Lisa Thanks, so much for the question and ill pass I ask you to our new head of Eni All commercial insurance business done Kita done in July two tenths of that yeah. Thanks, Andrew for the introduction and Lisa Thanks for the question.

<unk>.

I would say all other service type cell largely near at or even slightly above normal levels to your question, though on lines of business I might just suggest other than inpatient commercial pretty much a normal care patterns Medicare seeing some interesting developments I'd say, maybe signs of more durable shift inside of service, particularly urgent cares a little lower.

Hi.

As you know at this point in the year, our national accounts business for 2023 is largely resolved, but the other segments of our business are not resolved as we look at that National accounts performance. We're very pleased with what we've seen in terms of a very strong renewal year and also a strong sales year, which leaves us.

Sure.

Give me a little higher but <unk> is a little lower net certainly a good trade for the system overall outpatient surgeries in Medicare seem to be back to normal, but again as I had mention mentioned inpatient a little bit lower and again Medicaid consistent with the other lines of business lower in patient and physician starting to trend back. So again thats largely a repeat of that.

I'm confident in a growth year for national accounts for 2023, the other lines of the business are yet to resolve specifically.

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