Good morning, and welcome to the UnitedHealth Group F ourth Quarter and Full Year 2021 Earnings Conference Call. A question-and-answer session will follow UnitedHealth Group prepared remarks. As a reminder, this call is being recorded. Here are some important introductory information. This call contains forward-looking statements under US federal securities laws. These statements are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present expectations. A description of some of the risks and uncertainties can be found in the reports that we file with the Securities and Exchange Commission, including the cautionary statements included in our current and periodic filings. This call will also reference non-GAAP amounts. A reconciliation of the non-GAAP to GAAP amounts is available on the financial and earnings report section of the company's investor relations page at www.unitedhealthgroup.com.
Information presented on this call is contained in the earnings release we issued this morning and in our Form 8-K dated January 19, 2022, which may be accessed from the investor relations page of the company's website. I will now turn the conference over to the Chief Executive Officer of UnitedHealth Group.
Morning, and thank you all for joining us today. I'd like to start by recognizing our colleagues, the people of Optum and UnitedHealthcare, for delivering strong results throughout 2021 and creating the momentum that is carrying us through as we enter into this year. For example, performance in two key elements of our growth strategy, accelerating the transition of patients to Optum-led value-based care and strong UnitedHealthcare growth in serving Medicare Advantage consumers, are both tracking well with the expectations we shared with you at our recent investor conference. These and the broader performance across the enterprise confirm our confidence in our ability to advance our stated 16% EPS growth rate. When you look back at the prevailing themes for 2021, you see a story of accelerating growth.
Strong collaboration between Optum and UnitedHealthcare and with our many external partners helped us grow, in serving both commercial and government markets into the marketplace and significantly increase the number of people benefiting from value-based models of care. Last year, we leveraged our technology capabilities to help physician and hospital systems better serve their patients and communities, and we sharpened our focus on the consumer, working to elevate and improve the end-to-end experience. Taken together, these efforts helped us add more than $30 billion in revenue for the year, about $10 billion above our initial outlook. You should expect similar growth in the year ahead.
We see an even greater demand for integration to bring together the fragmented pieces of the health system to harness the tremendous innovation occurring in the marketplace, to help better align the incentives for providers, payers, and consumers, and to organize the system around value. A healthcare system that is more connected, more informed, more human, and more responsive to every person's unique needs. At our investor conference, we shared five key areas for growth and for differentiated experiences across our portfolio. These growth opportunities will guide our strategy this year and for many years to come. First is care delivery. More specifically, value-based care. For UnitedHealth Group, this is more than a primary care strategy. It's a comprehensive clinical strategy encompassing our growing behavioral, home, ambulatory, and virtual care capabilities.
Our second growth area is health benefits, advancing the quality, innovation, and consumer appeal of our benefit offerings and bringing our value-based strategy to life. We enter 2022 having generated strong consumer growth in Medicare Advantage and saw further progress in Medicaid and growing momentum in our commercial business. Next, health technology. Our major partnerships across the country help health systems improve their performance and returns, all to better support their missions. We're energized by the potential to bring these comprehensive, tailored solutions to a greater number of system partners in 2022 and beyond. Fourth, health financial services, vastly improving the health payment sector, streamlining and simplifying payments for providers, payers, and consumers, while reducing friction and increasing speed and convenience. Finally, pharmacy services, where people interact most often with the healthcare system.
We can better use the significant breadth, volume, and value of our foundational pharmacy services and data capabilities and integrate our medical pharmacy and behavioral capabilities. All of this to provide whole person care, support the discovery of new drugs and treatments, and support value-based models of care. In sum, we enter 2022 with heightened confidence in our ability to execute upon the objectives we set forth in late November. With that, I'll turn it over to President and Chief Operating Officer, Dirk McMahon.
Thank you, Andrew. I thought I would take a few minutes providing you with some additional details on our first growth priority, value-based care, how we have prepared for it? The investments we have made. There was significant operational groundwork and investment that went into supporting the 500,000 new patients for whom Optum Health will become accountable in 2022. Successful execution requires a lot of detailed planning, investing, and building. It has become a distinctive competency of our enterprise, which we can now increasingly apply at scale. What does it take to prepare for moving to a fully accountable arrangement? The investments can be significant. As an example, in 2021 we incurred over $100 million in preparation expense. Within this, there are three major work streams involved. Clinical training and staff preparation, technology and data enhancement, and third is network coordination.
The first work stream focuses on physician education. It begins well more than a year prior. It's important to provide the resources and knowledge for physicians to begin approaching their patients differently. They engage in their patient's whole health well ahead of taking on greater accountability. We find it to be an essential and sometimes complex shift from our long-held fee-for-service practices. Beyond education, we ramp up our capacity in the form of physicians, nurses, and other clinicians to meet the requirements of our business. The second area focuses on the technology systems and information needed to support patient care and effective clinical management. This includes things like patient portals and utilization management systems, as well as reporting systems for teams to effectively manage. Finally, the planning and network coordination work to support clinical oversight beyond primary care and ensure true continuity of care.
This planning and coordination includes initiatives such as identifying the patients most in need and ensuring a seamless transition to high touch clinical care services that improve health, and quickly pairing patients with a personal care navigator to assist in supporting complex health needs, appointment scheduling, and timely medication support on day one. These foundational preparations and investments have been critical in creating strong results across the variety of geographies and practices we have transitioned. We expect this expertise will serve us well as we transition even larger groups of patients in the years to come. Before handing over to John, I'd like to update you on how COVID has impacted our operations. Like other businesses, we have experienced moderately higher levels of attrition and more unplanned absences.
We had prepared for this situation through increased recruiting capacity as well as meaningfully upgraded digital capabilities to improve customer experience and reduce call volumes. As a result, in the first two weeks of 2022, traditionally our most demanding period, we were able to service the needs of our patients and customers. At the same time, we responded swiftly to the federal mandate for cash-free COVID tests for consumers, a highly complex undertaking. With four days notice, UnitedHealthcare created a customer digital experience for ease of reimbursement and established a partnership with Walmart, and now Rite Aid, that eliminates cash outlays by consumers at point of purchase. We expect more partnerships in the days ahead. As we look forward, we believe we have the right capacity in place to execute our business priorities and meet our customers expectations.
With that, now I'll turn it over to Chief Financial Officer, John Rex.
Thank you, Dirk, and Happy New Year, everyone. I'll start by expanding a bit upon Dirk's comments on the COVID impacts we're seeing. In the most recent weeks, inpatient hospitalization levels for our members are similar to the January 2021 levels, even with national COVID case rates about four times higher. For those people needing inpatient care, severity is seemingly lower as we are seeing shorter lengths of stay compared to that earlier period. At the same time, we are observing familiar correlations of care activity patterns to other periods of elevated infection rates experienced over the past two years. For example, in these early weeks of January, we are seeing slowing in primary care, elective visit, and procedural volumes. Activity over the past several weeks shows primary care visits having declined about 10%, and an even higher rate of decline in specialist visits.
As always, our prime focus is on helping people get the care they need when they need it. Moving now to our specific business performance. Optum Health's revenue per consumer grew by over 30% in 2021, driven by the increasing number of our patients served under value-based arrangements. Consistent with the expectations we shared in late November, we had a strong start to the year and continue to expect to add 500,000 new patients in accountable value-based relationships, benefiting from the groundwork laid over the past many years. OptumInsight earnings grew 25% in 2021, with operating margins approaching 28% for the year. We ended the year with a revenue backlog of $22.4 billion, an increase of $2.2 billion over the prior year.
Our expanding relationships serving health systems has been a key factor driving this growth, and we expect these partnerships to continue to grow in 2022 and beyond. Optum Rx earnings grew 6% for the year, driven by the continued expansion of our pharmacy services businesses, supply chain initiatives, and strong cost management activities, and benefiting from strong customer retention. In addition, we continue to see the impact of Optum Rx's movement to a higher value. Turning to UnitedHealthcare. Full year revenues of $223 billion grew 11%. As noted, our 2022 Medicare Advantage member growth outlook is very positive and consistent with the objectives we established at our November investor conference. Within the up to 800,000 new members we will serve in 2022, about three-quarters will be in individual and group Medicare Advantage, and the remainder in Dual Special Needs Plans.
Given the steady strides we've made in quality performance, we have the opportunity to enroll people in our newly rated five-star plans throughout the entirety of this year. Our Medicaid membership outlook for 2022 continues to incorporate an expectation that states resume eligibility redeterminations, resulting in modest net attrition. In January, we began serving the citizens of Minnesota and continue to support the Missouri expansion this year, as well as renewed relationships with Ohio, Tennessee, and Nevada. Over the course of the year, we will look to continue to expand upon the nearly eight million individuals we serve across 31 states. We concluded 2021 with commercial membership about 200,000 people ahead of the original outlook provided. Creating this momentum is the strong response we are seeing to the new innovative products you have heard us discuss.
Products such as NavigateNOW, which use the Optum Virtual Care as a first option. Our capital capacities remain strong. Full year 2021 cash flow from operations was $22.3 billion, or 1.3 times net income. About $2 billion above the initial outlook we shared a year ago. We continue to expect our 2022 cash flow to approach $24 billion, about 1.2 times net income. We ended 2021 with a debt to total capital ratio of 38%. These ample capital capacities allow us to continue to accelerate our investments while remaining committed to an advancing shareholder dividend and supporting our expected repurchase of between $5 billion and $6 billion of stock in 2022.
Our 2022 adjusted earnings per share outlook of $21.10-$21.60 is consistent with the view we offered seven weeks ago. From this distance, in contrast to the past two years, we expect the seasonal pattern to be more consistent with our historical experience, with just under 50% of full year earnings in the first half and the first two quarters comparably even. Now I'll turn it back to Andrew.
Before we transition to the Q&A portion of the call, I hope you've already taken away the strong sense of confidence John, Dirk, and I share in the growth potential of this company, rooted in the growing number of people we're serving in value-based models, the depth of relationships we're building with local health systems, our pharmacy capabilities, and the innovation and consumer focus that's driving growth across our government programs, individual, and commercial businesses. Products and services only continues to grow. We've never been in a better position to help bring together the fragmented pieces of healthcare and create more value for the people we try to serve. With that, operator, let's open it up for questions. One per caller, please.
Thank you. The floor is now open for questions. At this time, if you have a question or comment, please press star one on your touch-tone phone. You may remove yourself from the queue by pressing the pound key. We ask that you limit yourself to one question. If you ask multiple questions, we will only be answering the first question so we can respond to everyone in the queue this morning. We'll go first to Scott Fidel with Stephens.
Hi. Thanks .
Hey, Scott. Go ahead.
Good morning. Thank you. My question was just a little follow-up just on the Medicare Advantage environment. If you could just talk about, you know, from your perspective, whether you've seen any material change in the level of competition in the market for 2022 relative to 2021. I would also be interested in if for United, whether there's been any types of shifts in the distribution channels through which you're driving your MA growth, just as we think about some of the evolving trends in Medicare. Thanks.
Yeah, Scott, listen, thanks so much for the question. Before I hand it over to Tim Noel, who runs that part of our organization, let me just reiterate how pleased we are with the overall performance through the selling cycle. The number of folks who have chosen UnitedHealthcare continues to grow super well ahead of market, growing market share once again. As we said a couple of times in our opening commentary, very much in line with the expectations that we set out for the year. Really, big picture, super positive. I'll hand over to Tim to give you a little bit more background to all of that. Tim?
Good. Great. Hey, thanks, Scott, for the question. This is Tim Noel. Yeah, you know, the way I see the MA market is it's been highly competitive for a number of years, and I don't see 2022 as a step function increase in that level of competitiveness. The trend of more entrants, better benefits has really been a multi-year one. You know, we see this trend as being one that's very good for seniors and also one that's very good for the overall growth of the Medicare Advantage industry. You know, seniors are shopping for more value as they should be. For our part, we're really focused on differentiating our offerings in the marketplace.
What we're doing is we're driving things not only around benefits, but also around capabilities. Better digital tools, ease of payment, product innovation, better and more personalized service experiences, better clinical quality, more value-based and aligned care-provider relationships are all part of that, and our approach continues to resonate in the marketplace. We really like our performance and our positioning inside a very strong and growing marketplace.
Tim, thanks so much. Scott, just to your secondary on distribution. I think it's fair to say nothing's changed in terms of our approach to distribution. In fact, I think we've never had more distributors, agents working on our behalf across the country. No change there whatsoever. We're super grateful for all of the support we get from agents and brokers and others who help us get the message across well to seniors who are looking for MA as an option. Really very positive about that environment. Let's go to the next question.
We'll go next to Josh Raskin with Nephron Research.
Hi. Thanks. Good morning. My question relates to Optum Health and the disclosures around the top line growth have been really helpful. I'm curious more on the margin side and specifically how margins trend over time when you take 100% global capitation, and maybe specifically if you're making money on the totality of that business today, and maybe how that migrates over time.
Josh, thanks so much. Let me pass that over to Dr. Wyatt Decker, who looks after Optum Health. Wyatt?
Yeah, Josh, thanks for the question. Absolutely, we are positioning Optum Health as a growth platform, and we're investing in new markets and deeper penetration into established markets. As we do that and expand the capabilities, you'll continue to see us delivering on an 8%-10% margin range. You can anticipate us to continue to generate strong performance while investing in what will be a multiyear growth platform. Thanks.
John Rex, I think, maybe add a little.
Sure. Just, Josh, getting at your point of how does that progress over time. Dirk did offer some nice commentary on the call in terms of the investments that we make as we're looking to move to capitation. You know, that does tell a kind of a multiyear story of investments as we get ready to move to capitation. That's even before any revenue comes into the picture, we're making those investments. Significant, very significant, ahead in the couple of years ahead, especially in the year ahead of those transitions before there's any kind of revenue view. That is creating kind of that impact. What, Dr.
Decker was describing there, as we seek to do that and those movements occur, we're always bearing within that fairly significant investment loads. This year was obviously fairly significant with the 500,000 members that were transitioned. We continue to accelerate, those investments continue also while we start getting leverage on those as we do more of it. We're kind of bearing that within the 8%-10% that Wyatt was describing there.
Yeah. Thank you.
Absolutely. I think both sets of comments really point to what's happening, Josh. One way that helps me think this through a little bit is to think about vintages. Every year, there's a different number of folks who transition into the capitated environment. Of course, that number grows every time, so this year will be almost double what we did last year. Last year was almost double what we did the year before. As you think about it, the margin associated or the economics associated with each vintage changes year-b y- year as those populations of folks stay in Optum Care for sustained periods of time.
You know, as you think about the longer term evolution of the economics of Optum Care, I'd encourage you to reflect on how those vintages are aging into their stabilization within the value-based environment. Next question.
We'll go next to Justin Lake with Wolfe Research.
Thanks. Good morning. Appreciate your comments on how trend is kind of starting the year with COVID. Can you give us a view of how you ended the fourth quarter and into the first quarter of five business segments? R emember correctly, commercial was running a little bit hotter than Medicare and Medicaid in the third quarter. Anything you could tell us in terms of what you think maybe a rough number might be on the cost of the new home testing requirements. Thanks.
Thanks so much, Justin. I'll ask Brian Thompson, president of UHC, to comment in a second. I think overall those trends we saw segment by segment didn't get too different as we rolled through here. I would just say as we got into the last part of the year, the last couple of weeks, as Omicron really started to show its face, you know, that still we're still kind of learning exactly what the impact of that. As you can imagine, we can see some things very quickly, like physician visits, a little harder to know exactly what kind of complexity of claims might look like in hospitals. That will become clearer the next few weeks. Let me ask Brian to go a little deeper on all of that.
Sure, Andrew. Thanks for the question, Justin. Brian here. As Andrew alluded to, I would say our results for COVID in the fourth quarter were in line with our expectations. As you said, similar to the dialogue we had for the third quarter as well as at the investor conference, with commercial largely at baseline performance in both care and caid modestly below, still with that same dynamic of Medicaid being slightly below Medicare. Not much change there. As you suggested and as we had reiterated in our opening comments, Omicron obviously emerging here in December. I think, John Rex said it well.
While there's certainly some differences in contagiousness and severity, the impact of abatement following these swells and infections is consistent with what we've seen in Delta and other strains prior, double digit declines in both physician visits as well as specialist visits. We're continuing to see that dynamic play out. What we may not have anticipated in increased testing and costs are offset with beneficial unanticipated levels of abatement. That seems to be holding here in the early stages of Omicron. To your point with respect to at-home testing, you know, our focus right now is really the consumer experience. As you know, these rules came out just a week ago. Our goal has been how can we ensure that our members know where they can go and get access to those at-home tests without a cash outlay.
We've really been pleased with the various retailers that we've been working with, Walmart and Rite Aid in particular, but many to follow, of getting this capability stood up in a matter of four days. We're encouraged by that, and at the same time, creating a really easy digital experience for those that do shop and need reimbursement. When they go to UnitedHealthcare and myuhc, they're able to easily understand how to get that reimbursement. That's been our focus. I think isolating the cost of the COVID test from this distance isn't really instructive. I think if and when it remains durable is a function of not only supply and demand, but how this plays out over the course of the year. Again, I'm comforted by this offsetting dynamic of care deferral that has followed any of these unanticipated waves. Thanks, Justin.
Brian, thanks so much. You know, I also just wanna express thanks to the folks at Walmart and Rite Aid and others who will join shortly in helping get this preferred network up so quickly. The fact that we were in a position with our partners to be able to respond to patient need from Saturday, the very first day that this was requested from the federal government, I think speaks well to the capabilities of the private sector, the participants within the healthcare sector to respond and solve problems on behalf of the country. I think that's an example which we see repeated across the landscape, and we're very proud of being able to work with Walmart and Rite Aid in this particular case. Next question.
We'll go next to Kevin Fischbeck with Bank of America.
Great. Thanks. I just really wanna go back to the MA conversation for a second. Can you talk a little bit about how you're thinking about the margins in that business and whether you think any differently about the appropriate margin or acceptable margin in that business now that you've got an ability to earn, you know, additional earning streams through the capitation and the value-based care arrangements that you have? Thanks.
Thanks so much, Kevin. Let me John Rex just to reflect on that. Thanks.
Yeah. Kevin, good morning. It's John here. When we think about our business structure, we have separate businesses across the company. As you know well, extremely important to us is retaining bright lines across those businesses. We serve over 100 payers in Optum Care. We serve many payers across the OptumInsight businesses. When we think about our business, they stand alone from a margin perspective, all of our businesses. That's very important to how we operate the company, how we serve others, and how we approach the marketplace.
Absolutely. John, thanks so much. Kevin, thanks for the question. It's also really important to remember that every single one of our service lines, business lines, competitive environment we're in. I don't think there's really any space where we have definite service. You know, we are constantly being tested in terms of our ability to serve, making sure that we are priced competitively and the like. Successful separation between the two businesses, which has performed extremely well, and most importantly, consistently delivers great value to patients, consumers, system partners who we are privileged to work with, and increasingly is scoring well in areas like NPS and other measures of consumer experience and service experience. Next question.
We'll go next to Stephen Baxter with Wells Fargo.
Yeah. Hi, thanks. Wanted to come back to the rapid testing question. I guess, are you guys thinking about this as a definite net cost? Are you thinking there are potential offsets from, you know, less expensive other testing? There does seem to be a push and pull between the supply and the market of rapid tests today, and then the Biden administration distributing one billion of these tests for free. I guess, how are you thinking about the supply that your partners are gonna have access to as you have these discussions? Thanks.
Stephen, thanks so much for the question. As Brian alluded to earlier on, I mean, at this point, you know, a little hard to know exactly, obviously, partly because of the demand and supply dynamic, exactly what the kind of scale of the testing program could be. You know, given you would logically expect that if there was a high sustained demand, there's probably a lot of Omicron or some kind of variant in the system that would probably lead to what Brian was talking about earlier with abatement elsewhere in the system. You know, at this level, I think we kind of expect these two things to somewhat offset. You know, obviously we don't know, but you know, at this level, I think it kind of makes sense.
The demand and supply, obviously, that has been a challenge across the system. Very established experienced supply chain partners in this, the shape already of companies like Walmart and Rite Aid, and I'm sure they're very much focused on ensuring as much supply as they can get. I think it's inevitable that we're gonna continue to see outages, as you go through these, geographic kinds of surges that we've characterized this pandemic from the get-go. Next question.
We'll go next to Ricky Goldwasser with Morgan Stanley.
Yeah. Hi. Good morning. As we think about the MA environment, you know, you're growing above market. Can you talk a little bit about the role that Optum Care plays in the ability to gain share? Maybe do you have any data points that compare the stickiness or attrition among United MA members that are within the Optum Care network?
Ricky, thanks so much. Before I hand that to Brian to maybe reflect on a little bit, you know, one of the things that I think we really are pleased about is the way in which Optum Care has developed a whole set of capabilities to deliver really enhanced focus on MA patients. Obviously, these patients have high medical need very often. They need high touch. I've been super impressed with the development, not just in the clinic, but also through the at-home programs where we're able to continue to make sure folks are looked after properly. Actually, particularly as we've gone through the pandemic environment, people's preference to have care delivered in the home has become clearer and clearer.
Brian, maybe you could reflect a little more on how that plays through in terms of, the attractiveness of, what you're able to offer.
Sure. I appreciate that. I think Tim really laid out a long list of things that we focus on to make sure that we remain competitive in this space. As I think about Optum Care, specifically, first and foremost, for us, it's predictability. But beyond that, where we have our best satisfaction, which in turn leads to our best persistency, our members that stay with us the longest, is with our Optum Care partners. I think first and foremost, that's a benefit for us.
I think beyond that, our journey on quality from, as you might remember, just a short decade ago of under 10% to almost nearly 100% was certainly at the support and help from Optum Care, not only in our relationship with them, but how we establish incentives with providers outside of Optum Care. The list is pretty long, and I would say Optum Care.
Wyatt, would you like to maybe add from your perspective?
Yeah. Well, BT, you touched on it, but, our focus on the consumer and patient experience is relentless, and, we are continuing to deploy new capabilities all the time. Andrew, you mentioned home and community. When you look at the quality of the care that we provide, as Brian mentioned, it's now 99% of UHC members with Optum Care are in four star or higher level plans. We don't stop there. Now we have unveiled our virtual care platform that brings behavioral care to the forefront, brings virtual care and physical care, and connects people to their own trusted providers. You'll see us continuing to focus on how we meet the needs of our members, and how we reduce friction for our patients.
Great. Thanks, Wyatt. Thanks so much for the question, Ricky. Next question.
We'll go next to A.J. Rice with Credit Suisse.
Thanks. Hi, everybody. Obviously, labor pressures across the healthcare industry is a big topic. You have involvement in that in Optum Health as well as in UHC in your discussions with your non-affiliated providers. I wondered how that's impacting your business. Perhaps the shift of people to Optum Health from UHC may be a mitigating factor, but any comments about what you're seeing as you try to add your clinicians in Optum Health and then also what you're hearing from your provider networks and how that might impact your outlook in UHC.
Thanks, A.J. Let me ask Dirk to start that one off.
Yeah. Thanks, A.J. You know, look, let me just take this a little bit more broad. As we look across our labor markets, it's a hot market for things like clinical talent, technology and customer service. You know, one of the things we and Optum did really early in the process is we scaled up our recruiting capacity. We retained, we set up retention for some key staff. You know, one of the other things is we've had pretty decent retention 'cause we have a pretty good mission along those lines. You know, a lot of additional staffing, a lot of sort of getting ahead of this proactively has been our major action.
As it relates to other providers in UnitedHealthcare, we talked about this in the last earnings call. You know, our contracts are negotiated, you know, every three years. It's sort of from our perspective, yeah, we're hearing that there's shortages, but, you know, we're working with those folks on the shortages and, you know, there's a little bit of inflation, but we ultimately price for that. You know, like anything else in the market, the market will settle that out. You know, we're just being very aware of what the implications on a little bit tight labor market are. You know, hopefully it'll loosen up as we pace forward.
Great. Thanks so much, Dirk McMahon. A.J. Rice, thanks so much for your question. Next question?
We'll go next to Matt Borsch with BMO Capital Markets.
Yeah, thank you. I guess I was hoping that you could maybe just talk a little bit more about the Medicaid redeterminations and what you're expecting in terms of the timing and the impact, because I know you touched on modest. I'm just, you know, wondering how you're seeing the mitigating factors there.
Yeah, Matt, thanks so much. I'm gonna ask Tim Spilker, who leads our C&S organization, to respond to that. Tim, could I pass over to you?
Yeah. Hey, thank you for the question. You know, at the investor conference, we indicated that we thought states would resume redeterminations in mid-2022. I think based on what we're seeing at this point, that assumption seems even more likely than we thought at that point. Important to note, though, that we're also working closely with our state customers to better understand the timing and the approach that they will take once they do resume. Probably most importantly, you know, based on the breadth of UHC's products, across commercial coverage, exchange, as well as Medicaid, we're confident that we'll pick up our fair share as folks transition from Medicaid to other types of coverage. Thanks for the question.
Tim, thanks so much, and Matt also, thank you. Next question.
We'll go next to Nathan Rich with Goldman Sachs.
Hi, good morning. Thanks for the questions. Just following up on some of the comments on Medicare Advantage. A couple of your peers are talking about changing, you know, how they go to market next year, both from a benefits design as well as a distribution standpoint. You know, I know it's early to talk about 2023, but I'd just be curious, you know, how this, you know, informs your approach as you strive to maintain that value differential that your plans provide.
Thanks so much, Nathan, for the question. Let me ask Tim Noel to make a couple of comments on that.
Yeah. Thanks, Nathan, for the question. You know, as we think about 2023, certainly a little bit too early to get into a lot of depth there, given as we haven't even seen an indication of rates from CMS yet. However, you know, when I think about broad strategic goals around distribution and product, I'm not seeing any, you know, shift in the stance that we've gone to market with in 2022 and even 2021 and years prior. We are, you know, very comfortable with our multi-channel distribution approach. As I indicated earlier, our approach around differentiating our products in a very robust industry continue to resonate. No deviation from what's been a successful formula for us and providing really great value to consumers.
Yeah, I think that's exactly it, Tim. Nathan, the focus on sustained delivery of value is incredibly important, I think from the underpinning of how UnitedHealthcare have done so well in this environment. It's really important from a distribution broker perspective. People understand what we're offering, but it's not volatile. It's even more important after people sign up. People get what they expect. That is really, you know, that served us super well. We believe the way in which we put together this benefit package really serves the needs of the members. It really speaks to why it's so popular and it's why at United, we've been able to grow market share consistently year after year after year. We'll do so again this year.
We'll deliver our objectives in MA growth, and we're extremely positive about this part of our performance. Next question.
We'll go next to Gary Taylor with Cowen.
Hi, good morning. Just wanted to return to Optum Health for a minute around the fourth quarter. You know, if we look year to date, OI was growing, you know, 35% almost every quarter. It was up about 17% this quarter. I think, for next year, you have it, you know, growing almost 30%. Was there anything else in the quarter? I know, Wyatt talked about some of those incremental investments. I guess it makes sense a little more of those could have been in the fourth quarter. Anything else on the cost side at Optum Care or anything at the MedSurg or the ASC business to call out, impacting 4Q?
I think overall, no, but let me ask, Wyatt just to give you a little bit more detail.
Yeah. Thanks, Gary, for the question. By far the biggest component that you're referring to is what we've touched on, which is the investment in future growth and the platforms for managing 500,000 new risk lives in 2022. We saw some modest uptick in our labor costs that were not really material to our performance, but just 'cause I know that's on people's minds. As we continue to address that. You'll see us continue to invest in technologies like our virtual care delivery platform, behavioral health care, and home and community. It isn't just the risk lives in a senior clinic model. It's this comprehensive care delivery model that has multiple components of investment that will yield fruit not only in 2022, but in following years. Thank you.
Thanks, Wyatt. Next question.
We'll go next to Lance Wilkes with Bernstein.
Yeah, thanks. I wanted to talk a little bit about Optum Rx and I just wanted to get a sense as to, you know, the rate of growth of especially home delivery and what the margin profile is looking like there, and maybe what the outlook is for especially generics and biosimilars and impacts on margin. Thanks.
Lance, thanks so much for the question. Let me ask, Heather Cianfrocco, who looks after Optum Rx for us to respond. Heather?
Thanks. Yeah, I would definitely say that the specialty and home delivery business are contributing to earnings and our margins. We've seen growth in specialty from a few things. First of all, it's been rate of capture. Second, we've seen you know, growth with our PBM clients, which of course drives growth when they use our specialty services. Well, as we've really been investing in automation. I'll give you an example of that. You know, our home delivery and our specialty businesses today are really benefiting from our investment in digital and a better consumer experience. In fact, today, 50% more of our specialty consumers are using our online and digital experience to fill their meds and refill their meds.
We're glad to see that it's resulting in a better consumer experience, but it's also contributing to the earnings of the business. I guess I'd tell you as I look forward on that business, I think about two things. The first one is continued automation and improvement in experience integrated with the rest of our pharmacies. Think about investing it with our multi-dose, our investment in regional integrated pharmacies closer to members' homes so that we can get medication to them faster. We're processing and filling over 80% of prescriptions same day today. We'll continue to see that cost
Per script and refill cost per script improve quarter- after- quarter, like we've seen over the last quarter. To your point, I think the other really exciting part about our specialty business is that in 2022, we're gonna see you know a robust pipeline of generic specialty coming to market, mostly in the oncology space. Then we know in 2023, we'll see additional opportunities in not just specialty generics, but additional brands and specialty classes and biosimilar. Together you know with the automation, the consumer service, and the clinical programs that we offer in the specialty business, together with just more options affordably to our consumers you know we'll continue to see that contribute meaningfully to Optum Rx growth and earnings and margins.
Heather, thanks so much. You know, I'd just add to that. I think the work that's going on inside the Optum Rx team, particularly around some of the specialty areas, as well as the development of our new GPO and readiness for what is likely to be a very interesting period of loss of exclusivity on a lot of very significant pharmaceutical products, some of which are in categories which have really not had competition for many years. I think it sets up the next 24, 36 months, a very interesting period. We're super committed to delivering medicines at the lowest possible net cost to our members and their clients. It's an area where we expect significant potential as we roll through the next two or three years.
I think Heather's organization's doing some great foundational work for a next wave of opportunity in the pharmaceutical space. We have time for one last question, operator, if we could maybe go to the last question.
We'll take our last question from Steven Valiquette with Barclays.
Thanks. Good morning. There was so much focus over the past year on the $0.80 EPS headwind for the company related to COVID in 2021. Is the $0.80 essentially where that final number shook out for last year? Or was there any deviation in either direction on any key components as we think about the reversal of roughly, you know, half of that total headwind in 2022? Thanks.
Steven, thanks so much. Let me ask, John to respond to that.
Yeah, good morning, Steven. Yeah, it was materially in that zone of $1.80 where it fell out. Look, if I were to tell you where we thought it was gonna be back in November, we said it and the components that would comprise that $1.80 and how they actually fell, and they went through all those components. Yeah, certainly, a number of them played out a little bit differently than we would've thought back at that period.
Perhaps the important learning we got over that period, though, were just the various correlations that we see across the components, as different case rate volumes would occur over the course of the period and such, and the impacts on care activity levels and other areas. Definitely, probably didn't step into the year a year ago predicting there would be a summer wave, actually, even. But the correlations held very true over that period. It was the important factor for us. Yes, within that zone of the $1.80 and
You know, and the components as they played out certainly were instructive and are instructing how we even think about 2022 and the impact that we've talked about for that too also.
Yeah. Great. Thanks so much, John, and Steven, thanks very much for that last question. I'd like to thank everybody for taking the time to participate in the call this morning, and we certainly appreciate your time and attention. I hope that what you've heard from John, Dirk, and our colleagues on the call today helps you see why we're so confident in our ability to continue to deliver high quality growth while helping to improve the lives of the people we serve. We look forward to sharing our progress with you again in April. In the meantime, thanks so much for your attention, and Jennifer, thanks for hosting the call. Goodbye.
Thank you. This does conclude today's conference. We thank you for your participation.