We see the 2020s as a decade credited for fundamentally changing healthcare, delivering a high performing technology and information enabled system of care, a system built on personalized human connections, a system founded on early interception and treatment of disease and conditions, a system that's universal, affordable, simple and effective, a system that works for everyone. Welcome to UnitedHealth Group's 2020 Investor Conference. We're coming to you today from our corporate headquarters in Minneapolis, Minnesota, where we are excited to have you join us for a tour deep into our organization. You'll see our people, our culture and mission in action and the depth of applied data, technology and science driving performance across our business. As our team engages with you today, listen for numbers like 40, 80, 90, and the story they tell about the advances we are making in improving healthcare quality, experiences and costs.
But mostly, I'd ask you to witness the experiences of people like Candace and Annabelle and the impact to their families. These examples reflect the potential of a modern healthcare system, while demonstrating our role in bringing it to life. Last year, we talked about a future view, the potential for our diversified capabilities to lead in the development of the next generation health system. Today, we are going to provide you with a behind the scenes view of the how, culture, capabilities, market positions and execution through the hands of our exceptional people and millions of critical strategic relationships. You should feel the restless mindset that compels us to adapt, innovate and evolve, transforming challenges into opportunities.
This drive and decades of development of purpose built capabilities and market positions provides an optimal opportunity to help develop a more modern healthcare platform, one that lowers costs, creates better experiences and outcomes for consumers and physicians and expands affordable access for people all around the world. Health systems have been tested these past 9 months. We've seen intense demand for knowledge, unprecedented levels of collaboration, strong movement by consumers to the home and ambulatory care settings, a powerful multidimensional private sector response to support patients, physicians and health systems, and stronger alignment by physicians to physician led fee for value systems of care. These trends are expediting pacing to a new more modern healthcare platform and it's quickly emerging right here today. In the next generation health system, your entire health history lives securely protected in the cloud.
For people with severe chronic conditions, it's updated dynamically 100 of times per day, with real time sensors providing real time actionable feedback, continuously monitored by an AI enabled care team, ready to intervene, intercepting early to enable faster identification, treatment and prevention of disease. Your care team meets you proactively in convenient and safe sites of service, both physically and virtually. They practice medicine based on the latest evidence drawn from millions of bits of randomized information, research and observe best practices translated into clinical insights with artificial intelligence and proprietary medical ontologies, recommending next best actions in care. They guide and administer optimal care pathways tailored to your unique needs and health circumstances, actively coordinating your care, delivering superior outcomes and a seamless experience at the lowest total cost. They are aligned and empowered to keep you healthy in a frictionless technology and insight enabled high performing system of care.
In the next generation health system, everything is on demand at the moment you need it, be it TAMAFlu dispensed from a lockbox at early onset of the flu or an infusion delivered in the safety of your home. Or a few minutes with a live or digital therapist to relieve stress and anxiety in the middle of the night. Access is simplified by universal identification and appointment scheduling systems. Your benefits are designed to fit within your financial means while meeting your unique needs. You don't get bills in the mail, let alone surprise ones.
Your doctor is paid in real time using value based methods tied to best known science, while you get rewarded for healthy behaviors. These approaches are making healthcare more connected, more human and deeply personal, a modern platform, a high performing system of care. That's the future of health care, and it's emerging right here today at UnitedHealth Group. We've spent years assembling an unmatched set of distinctive capabilities, market positions and capacities. And you'll realize in a moment, 2020 has been anything but a shelter in place year for us.
We've methodically extended and seamlessly connected each of these elements while broadening our reach and bringing them to scale in more local communities. And we hope after today you'll agree, no one is better positioned to contribute to this ambition at scale than us. Standing here today, we're more confident in our strategic direction than ever. The only thing that has changed in the past year is the sense of urgency we feel and the realization we need to pace even faster. For nearly 5 decades, we helped develop the leading health care financing infrastructure.
2 decades ago, we embarked on making the health system work better for everyone through services, leveraging innovation at considerably higher scale. And within the last decade, we began to engage firsthand in modern care delivery, recognizing even more is needed to be done to meet the health needs of people and the needs of their doctors and care teams. We started with a vision of helping build high performing systems of care capable of intercepting, treating and preventing disease, operating with a full range of value based arrangements, driving aligned accountabilities in local markets. This vision anchors our first growth strategy. We call it what we aim to accomplish, reinventing health care delivery.
We start with high performing primary and multi specialty care practices. We surround these deeply local foundations with our best in class national capabilities unified in local markets, including modern behavioral care, early intervention and advocacy treating the whole person brain first. Digital Clinical Home, direct to your own doctor telemedicine, supported by data analytics and best in class consumer and clinical technologies. House calls, advanced practice clinicians performing home services for seniors urgent care, eliminating unnecessary ER use ambulatory surgery, alleviating high cost facility based surgery hospital physician services, hospitalists overseeing our patients' care in the acute care setting post acute services, aligning care to patient specific needs and preventing readmissions skilled home care, care services to allow the nation's most vulnerable to live their lives to the fullest in their own homes and palliative care, navigating dignified home and end of life care. These are aligned with a broad range of local pharmacy care services, home and office infusion, retail pharmacy dispensaries, digital pharmacy and others, powered by advanced analytics and technologies, redefined administration and payment through modern health fintech and sophisticated capacities to underwrite risk at every level.
These are the key components of a modern next generation health system, and we are methodically advancing it at scale, just as we help advance modern healthcare financing through managed care. New additions to this anchor pillar in 2020 include extensions in Southern California, the Pacific Northwest, Massachusetts, Ohio and New York. Additional modern national care platforms in palliative, skilled home, post acute and behavioral health organic addition of more physicians, surgeons and advanced practice clinicians as they sought more effective and durable models of care, design and deployment of broad digital clinical services and meaningful advances and delegated risk arrangements. This modern health system is heavily aided by our 2nd growth pillar, pharmacy care services, where we're evolving high frequency touch points to synchronized whole person care with a particular focus on high cost specialty medication management and direct to consumer offerings. New additions in 2020 include multi dose packaging and expanded home and office based infusion capacities, an organic build of extensive services platforms and capabilities, including the Optum store release of our upgraded digital pharmacy opening of 60 new high efficiency retail pharmacy dispensing sites and initial deployments of our new in region high response dispensing strategy.
We provide affordable access to these modern healthcare solutions through benefits and financing strategies responsive to the unique needs and financial means of those we serve through consumer centric benefits, our 3rd growth pillar. New additions in 2020 include expanded specialty and modern medical coverages in more geographies. Organic development of hybrid on demand aligned high performing health system options and new individual coverage choices release of level 2, the first of our modern longitudinal condition risk management offerings, applying digital therapeutics and coaching to support patients with type 2 diabetes and meaningful progress improving our cost, quality and consumer NPS positions. All of these require our 4th growth pillar, accelerating insights in advanced technologies to enable more intelligent and more connected systems of care. New additions in 2020 include digital scheduling, scaling of the individual health record, development of proprietary telemedicine, architected unification of local care technology and advances in practical AI use.
And we've now made nearly 30 investments in promising start up companies, mostly technology based. And last, we've more recently introduced our 5th growth pillar, HealthFintech, providing simplified and modernized health banking and payment services for consumers and physicians. New additions in 2020 include expanded consumer account administration to more than 2,600,000 people, an extended bank charter to serve a wider array of consumer accounts and support physicians and their group practices and progress advancing digital pay and authentication capabilities to better manage reward systems for consumers and better serve high performing physician practices. Each pillar alone is instrumental in advancing health care, but United is how we will deliver the future of health. If you only take away one thing today, I hope it's this.
The modern next generation healthcare platform is emerging quickly and it works. It's simple, intelligent and built on enabled and compassionate human connections. UnitedHealth Group is leading the way, working with others with ambition to someday serve 100 of millions of more people around the world. And none of it would be possible without your support. So we thank you.
Before we turn to a deeper visualization of these strategic pillars, I want to welcome back UnitedHealth Group President and Optum CEO, Andrew Witty. Andrew took a leave in April to assist the World Health Organization's efforts to coordinate global vaccine discovery, development and distribution. Today, almost a dozen vaccines are in 3rd stage clinical trials, with a few already demonstrating promising rates of effectiveness, and efforts to advance scaled manufacturing and safe and equitable deployment of vaccines are well understood. Leading Andrew back to us. Hey, Andrew.
To join us again, and we really appreciate you being here.
No. Well, it's great to be here, albeit I wish I was in the U. S. Obviously, I'm speaking to you from the U. K.
At the moment. So looking forward to some of these quarantine restrictions lifting and getting back there in person as soon as I can.
Well, you'll be back soon enough. You're highly effective from there and have been from the first day we started working together. So it's a pleasure to have you back. Hey, I just wanted to personally thank you for the tremendous work you've conducted over the course of the last 8 months. It's not lost on us that the success that we've achieved is in part due to your efforts and the efforts of the WHO.
So we couldn't be more pleased with the work and to have you be a part
of our
company and to have you back with us here today.
Well, thanks, Dave. That's incredibly kind and way too generous. But it's been a super privilege to be a very small molecule of oil in a giant global engine. And hopefully, this engine is kicking into life, and it's going to help us bring this pandemic under control and to an end just as quickly as we can.
Hopefully, it will. Anyway, I'm sure our investors are anxiously awaiting to hear from you. So I'll turn it over to you. We'll see you at Q and A. Great.
Thanks so much, Davia. See you then, and hello, everybody. It's really a super pleasure to have the opportunity to talk to you briefly today. And in advance, you hear a lot more detail and depth of all of the work that's going on across UHG, especially within, obviously, the Optum and UHC business units. It's been 8 months since I went off to work with the World Health Organization.
And just in the last couple of days, as I've begun to really re acclimatize to UHG, it's remarkable the progress that's been made in that time. I really want to complement the teams, the leaders, but really all of our colleagues who work up and down this organization for really 2 enormously impactful things they've achieved during that period. Number 1 is the way they've responded in so many different ways to the COVID challenge. But number 2 is keeping the focus on their core agendas, their agendas of service and delivery and their agendas to innovate. And that work and progress has been quite remarkable.
And a couple of examples as we see further progression into our value based care delivery, You see the way in which Optum has really taken opportunities around virtual care development, making sure that as we've seen customers and patients want to move, not surprisingly, to a more telehealth environment, Optum has been very much a leader in helping to facilitate the creation of enhanced channels, and we've seen that reflected in the kind of service levels that we can provide. Just two examples, but many, many others, and you'll hear a bunch of that as we go through the rest of these sessions. For me, the last 8 months has been really a fascinating learning experience. To go to the World Health Organization gives you a chance to work with almost 200 countries across the world. It's a particularly dramatic moment in history in terms of all of these countries facing very similar challenges because of the pandemic.
But it's been an incredible privilege to be a small part of a team that's been working to try and ensure a multilateral response to this global crisis. And I think as we have worked on that, it's been an opportunity to for me at least to meet with representatives of many countries, many health systems and have the chance to see once again some of the challenges that those countries and systems are facing and how they choose to deal with them. And one of the things that that has really reemphasized for me is that I look at UnitedHealth Group, I look at Optum, I look at UnitedHealthcare, and I really cannot think of a better organization, either a government or a private sector company, better placed, better equipped and frankly, well motivated to make the kinds of investments and changes that I believe healthcare really needs in the 21st century. And I haven't seen the way in which a pandemic, a virus has brought this extra challenge to our legacy healthcare systems where no country in the world has escaped and no country's healthcare system has ultimately been sufficiently robust to be able to withstand and react.
It really says to us the time is now for us to continue to put our energies behind developing the best, the most modern, the highest quality and the best value for money healthcare system we can. And we're fortunate, all of us, to be in positions of responsibility at a time where technology, where information and data and where systems are at levels of sophistication, which truly give us a chance to look into the future and start to reimagine how healthcare could be modernized, made better, made more value for money. And that's really what we're all trying to do within Optum and within UHC and across the whole of UnitedHealth Group. This is an enormously motivating mission for all of our colleagues up and down the company. Every single individual has an opportunity to contribute.
And I believe that the vast majority, I think maybe everybody at UHG is truly lifted by the way in which they can help in their own way improve patients and individuals and families' lives. Last 8 months through COVID has given many of them a very direct experience of how they've been able to step in and make that kind of difference. So I'm delighted to be back here at I'm looking forward to the kind of innovation that I believe this company can uniquely deliver into the United States and internationally. And I hope you will enjoy over the next few minutes, couple of hours, the kind of updates we're going to give you so that you can see a little bit more in-depth and in breadth the qualities of the company, the places in which we are focusing and the ways in which we aim to bring innovation to our customers, our patients and their families here in the United States and globally. Thank you very much.
I believe in the power of 1 to serve. I believe in the humility of 1 to
serve. The doctor patient relationship is a sacred relationship.
I truly feel that medicine is a higher calling. I'm really thankful that I have a job that allows me to live out my dream, live out my dream of being a physician of sorry, now I'm getting emotional, okay?
Healthcare, I think, is the most complex human endeavor on the face of
the earth.
We need to work in the shoes of the patients that we treat.
To me, the thing that sets Optum apart is that it's a physician led
a physician driven and that physicians need to be empowered with tools and analytics that allow them to make the best care decisions.
Our patients don't really want
to be in hospitals. They'd rather be at home, living their lives. What we're trying to do is to deliver the right evidence based care at the right time, at the right level or site of service.
It's all about aligning expertise from coast to coast around the individual patients.
Value based care means we care about keeping our patients healthy. That is the greatest value of what we do as physicians at OptumCare.
Value based care is partly about getting the patient exactly what they need when they need it, but it's also about not doing what shouldn't be done.
At OptumCare, everything we do is about value, producing the best outcomes and experience at a sustainable cost.
I don't know any other company that has the capabilities that Optum and UnitedHealthcare have to truly transform healthcare for the better in our communities and in our nation.
UnitedHealth Group can do this.
I'm looking towards the future because it's about better care for our patients.
That's the kind of system that we are designing.
I am very optimistic. If
not us, then who?
We're going to get this thing fixed.
If that happens, we all win.
We have the capabilities. We have the resources. We have the knowledge. We have the expertise. We have the clinical insights.
And more importantly, we have the culture, we have the people and we have the humility.
Good morning and welcome. I'm Caitlin Zula. You just saw a few of my physician colleagues who every day deliver high quality outcomes and better patient experiences at lower costs. They're part of a growing physician network at the heart of the most comprehensive value based care delivery organization in the U. S, encompassing primary and specialty care, ambulatory surgery, behavioral health, post acute and in home care.
These assets are increasingly connected as we continue to grow and expand our services in key markets nationwide. The physicians you just heard from and all of our 74,000 OptumCare Aligned clinicians are helping expand access to care in communities across the country. Today, you will hear how physicians across our enterprise are reinventing healthcare delivery, care that is patient centered, informed by clinical expertise, driven by data and enabled by technology, all to deliver higher quality outcomes and better experiences at lower cost. One such technology is Optum Data Exchange or ODX. This powerful interoperability engine gathers and standardizes clinical data to develop deeper insights on disease and patient health trends.
It helps our providers make more informed decisions and close gaps in care. This year, it's been the hub of our COVID-nineteen case tracking, analytics and reporting. Today, approximately 85% of OptumCare patient clinical data is available in ODX, and we're on track to reach 100% in 2021. More broadly, we bring the full capabilities of our enterprise into the doctor's office by embedding enhanced care protocols into the clinical workflow with our clinical decision support solution, OptimalCare. Developed by our physician experts, it guides both doctor and patient along the most effective clinical pathways for specific health conditions.
I'll turn it over to my friend and colleague, Doctor. Omer Baker to share more. Doctor. Baker?
Thank you, Caitlin. I'm here at one of our OptumCare Senior Clinics in Northwest San Antonio. WellMed is our largest care delivery organization with over 1,000,000 patients across 16 markets in Texas, Florida and New Mexico. We have been delivering value based care here for decades with more and more patients covered on their full risk arrangements And we are applying what we have learned here and investing to accelerate the transition of other care delivery organizations to full financial accountability for the patients and members we serve. We built optimal care because of a quarter of the health care delivered in this country does not improve outcomes or quality of life and low value inefficient care costs more with the potential for adverse effects.
This is because many providers don't have good data to inform their decisions. The issue is the constant flow of the new medical information. New medical articles are appearing at a rate of at least one every 26 seconds. If I had to read every medical journal published, I would need to read 5,000 articles per day. Doctors simply can't keep up.
It gives doctors up to date clinical information from the latest medical and scientific literature on a patient's condition right at their fingertips in the examination room. We do this through teams of expert physicians who stay on top of research and create evidence based approaches, which can be embedded seamlessly into a physician's workflow and becoming increasingly embedded into their EMRs. Optimal Care is evidence based, data driven with advanced analytics and at the point of care. It helps our physicians to focus on what matters most to them, the patients they serve and we are scaling it across the country.
Doctor. Baker is right. OsmoCare has now been deployed in over half of our care delivery care delivery organizations and continues to be rolled out across our network. We developed technologies like OptimalCare with the goal of advancing value based care And our focus is not solely on our care delivery organizations. We look for opportunities across the entire care continuum.
Here's how. During the pandemic, we rapidly enabled over 17,500 doctors to provide over 1,000,000 patient telehealth visits since March and are expanding the use of remote patient monitoring and digital behavioral health. I'm proud to say our outpatient surgery business continues to grow rapidly. The more than 1,000 physicians that we have added this year have helped us nearly double the growth rate of our centers, providing new complex surgeries. By aligning with specialists, we're maximizing our opportunity to deliver surgical care in the right setting.
And we're partnering with more health systems more comprehensively. This includes our innovative partnerships with John Muir Health in the Bay Area of California and now Boulder Community Health in Colorado. Here we bring together enterprise capabilities in revenue cycle management, advanced analytics and care coordination to support better patient care and long term sustainability for local health systems. We're now actively engaged with a number of other interested health systems in our growing pipeline. And with our expanding post acute care capabilities, we're helping hospitals efficiently transition patients to appropriate skilled nursing facilities, where they spend 40% fewer days on average compared to traditional fee for service Medicare.
UnitedHealthcare now works with more than 137,000 physicians in over 1100 hospitals in value based arrangements. In recent years, we've been accelerating the path to provider risk sharing, addressing cash flow needs and building payment predictability for smaller independent primary care practices. The special part of our organization is that together we're even better. Optum and UnitedHealthcare are bringing innovative benefit offerings to more markets. And of course, OptumCare is integral to our strategy.
We started our journey 12 years ago. Today, we operate in 44 states. We continue to expand our services even during the pandemic when many fee for service practices have struggled with drops in patient volume. We now provide value based care at varying levels in all of our local markets, serving 3,600,000 people in value based arrangements, more than twice as many as 4 years ago. It's even better to see how it works for real patients.
Pamela Craig lives in San Antonio and is a patient at WellMed, where we currently serve over 1,000,000 patients. Pamela survived several near death experiences beginning with an episode of severe respiratory failure. While a tracheotomy tube saved her life, it also forever changed the way she lives. I would like to introduce you now to Pamela, her brother Mike and her physician Doctor. Liliana Oakes to see our model in action.
They were going to put their own hospice. They didn't have much hope for me, but she did.
Pamela came into our care for the support of our palliative care team in 2018. So she came with a whole package of uncontrolled symptoms that required a lot of attention, emotional, physical, spiritual support. So what WellMed does is it puts together an entire team and understand the population and the patients in a way that can bring the appropriate patient needs are. We just engage into a relationship to try to get to know her, her hopes, her fears, who she was, what she wanted to accomplish, empower her and bring the confidence to Mike that they were going to learn to live in a different stage in their lives.
I don't have to have daily nursing because they've trained my brother on how to do everything for me. They've trained me on how to do things for myself.
This is my sister. This is my blood. Whatever it takes, I'll do for her.
Her. When we entered the home, what we are allowing them is take control of their health, supporting them and avoid inappropriate utilization of hospitals or ER visits.
I want to be in my house. I want to be with my brother. I want to be with my family. I don't want to be in a facility.
We can take care of you at home safely, and we're going to be here to do it regardless of the time of the day. We see them as part of our family. The same dignity you would like to have in your own family is the same model of care we wanted to deliver to our patients.
It's here. I got better. I got
We need to remember that people are not illnesses. People are people. People have stories. People have families. People have a lot of goals in life.
It's a success story. From being somebody so frail to, hey, I'm going to plan to go to the casino and over the holidays, that is an amazing story.
And it doesn't stop at Pamela. Across OptumCare, physicians and nurses are meeting patients every day with the same level of compassion and personalized care. In fact, when we talk to patients, 90% of them said they would send their friends to an Optum doctor. This kind of trust is important, especially for the seniors we serve. People ask us, what's different about OptumCare support for seniors?
Here to help answer that question is one of WellMed's leaders, Jimmy Keenan. Jimmy joins us from San Antonio at 1 of our senior centers in front of a beautiful mural that was painted by the seniors. What makes OptumCare's approach to senior care unique and effective for taking care of this important and growing population?
What we do is we put the patient at the center of everything we do with the physician or the advanced practice clinician. And as a nurse, I appreciate that because so many times people focus on the chronic condition. We focus on the whole patient and we take every aspect of their care to ensure that we are keeping them as well and optimally healthy as we can. And we use the full breadth and depth of Optum when you think about the technology we have, when you think about the specialty services we have. We are able to wrap all of that around our patients and help them achieve a healthier life.
And I know you provide more than medical services. What other senior focused services do you provide at WellMed?
Well, as I'm here at my senior center, what I like to tell about our senior centers, when you walk in, you just get that feeling of joy. We have tremendous senior centers across Texas and Florida. And when you enter one of our senior centers, you don't see people playing bingo, you see people that are engaged and active and socializing. We have personal fitness trainers that work with them on their health. We have art classes.
We have Zumba classes. We offer classes on nutrition and healthy eating. And all of these things mean so much to the senior who might be isolated otherwise.
The pandemic has been hard for all of us and I imagine more so for your seniors. How have you flexed to support seniors during this pandemic?
One of the most important things that we did immediately was to outreach to our seniors and let them know that we were going to be there for them throughout the pandemic. We asked them not only do you have enough medication, but we asked them do you have enough food? And through that, we found that many of our seniors were afraid to go out and purchase groceries and were down to literally their last can of soup to eat. We were able to quickly work together to go out and shop for their groceries and deliver those to them. It meant the world to them.
Jimmy, thank you. What incredible, inspiring and important work. That's our patient centric care model at work and its success is driving strong growth. Through both organic growth and adding new practices over the last year, we've increased the number of patients we serve through value based contracts by 300,000. And as we expand our presence and integrate our broad capabilities across our primary care markets, this progress is accelerating.
Let's start on the West Coast. We continue to develop and connect our practices in Southern California, where we serve 30 different payers and over the past 2 years have nearly doubled the number of people we serve through value based arrangements. This momentum is also playing out on the East Coast. 5 years ago, we had no presence. Today, over 3,200 OptumCare Physicians serve 3,500,000 patients up and down the Northeastern corridor, where a connected care approach is driving strong results.
Since we first introduced you to our Riverside practice in New Jersey, we have linked the primary care team with our ambulatory surgery, urgent care and behavioral health capabilities. The results are inspiring. Among Medicaid members in New Jersey, we see 15% lower emergency department visits with significantly fewer hospital admissions and lower pharmacy costs than local market averages. We have more than tripled the number of patients we serve in this market over the past 3 years. And we continue to expand our presence across New Jersey, New York, Connecticut and Massachusetts.
For more on how our enterprise is uniquely positioned to drive differentiated value and growth, here is Erin Satterwhite to talk about pharmacy care services. Erin?
Thanks, Caitlin. Today, Americans take more medications, manage more chronic illness and often struggle to afford the drugs they need. They need an advocate focused on meeting their needs, and we are that advocate. Our pharmacy care services model goes far beyond managing supply chain logistics. It's a comprehensive platform that distinctly provides care through the most frequent consumer touch point in healthcare, the pharmacy.
Data and analytics combined with the expertise of 120,000 UnitedHealth Group clinicians power deeper insights that help us to care for people more holistically. Embedded technologies connect the pharmacy, physician and consumer and make it easier for people to access the therapies that they need affordably. We make costs more transparent with advanced digital capabilities in a convenient, seamless consumer experience. Today, we'll show how this comprehensive approach works in real life, how we uniquely manage high cost specialty drugs and help the growing number of people with complex conditions, including challenges with behavioral health. We meet the people we serve where they are, in communities across the country.
I'm Rena Newman with Optum Pharmacy Operations. I'm here in Bend, Oregon at one of our community pharmacies. Pharmacies like this one are on-site within community mental health centers. They support the unique and growing needs of people with mental illness, substance use disorders and other complex conditions. What makes this model different is the hands on personal approach of our integrated team.
This works because it brings together the whole care team, the pharmacy team, the clinical care team and the patient. The reality is that 1 in 5 Americans has a mental illness. In fact, 1 in 25 suffers from severe and persistent mental illness like schizophrenia, bipolar disorder or major depression. These individuals are often insured through Medicaid, Medicare or both and unfortunately people with severe mental illness on average have a life expectancy of 25 years less than those without the illness. To help them, we will end 2020 with more than 5 60 pharmacies after opening 60 over the course of this year.
Together, these pharmacies serve nearly 1,000,000 of our society's most vulnerable people, people like Candace. Candace started coming to our pharmacy 2 years ago. She lives with bipolar and borderline personality disorder as well as post traumatic stress disorder. At the age of 28 she was living with her parents because she wasn't able to live independently.
At 17, I was diagnosed with bipolar 1 disorder and PTSD, and then I was diagnosed with borderline personality disorder.
She takes a lot of meds, and she'll take some of the same ones throughout the day. So it's always a struggle to keep everything on course, so to speak. It was really challenging for her to take her meds consistently because
there were several of them and they were hard to organize. She needed to find someone who she trusted, especially her psychiatrist and her therapist and then of course getting the support from her pharmacy too. Just building trust with all her providers, I think was key to then having her start to turn around.
I was talking to Brianna about my concerns with the medicine and she said, okay, well, we have one of our nurses that can package them for you. You bring in your bottles. She holds on to them. She packages up your pill cases, but it's still the same thing where they fall open all the time and I just don't take
them. So they're like, well, there's another option, it's called Genoa. Genoa has been amazing because they allow me to care for my patients in a way that I couldn't before. We have adherence packaging, which allows us to put all of their medications for the morning, both their physical as well as behavioral health in one spot. And we sync their medications up so that they don't have to remember when one is due and another is due.
They're all going to be due at the same time, and we're going to help them get to that point, as well as mailing out all of these things at no charge to the client. Each month, they give me a number of dollars that I can spend on my marketing and on my clients. We always have water for our clients. If somebody needs to take something, then we want to make sure that I have a way for them to do that. If needs to be with food, I want a way for them to do that.
So these things that I'm allowed to do now open up so many doors, and I can set them up for success.
I'm seeing the old pandas coming back. You know, what I saw before the bipolar came out, before the diagnosis, before the meds. I'm seeing her more like that now than I have in the last 13 years because you never thought that would be back.
We can work with her. We can work with her therapist, we can work with her providers to make sure that we have that wrap around care to really help somebody thrive. And that's what I feel like really blossomed in campus.
I have my little team now, I joke. It's my therapist, my psychiatrist, Genoa and my folks. I feel like an adult now.
As Candace proves, when people take their medications as prescribed, their health and their lives can improve. We see this happen every day with our patients. Our hands on personalized approach drives a more than 90% medication adherence rate. To put that in perspective, the medication adherence rate for chronic medication is around 50%. Our high adherence rate produces 40% fewer hospitalizations, 18% fewer emergency room visits and meaningful reductions in total cost of care.
Most important, patients are healthier and they love the experience. Our net promoter score is in the 90s. So we're expanding this unique integrated care pharmacy model to even more high risk individuals in a number of ways through value based contracting with mental health centers across the country, by proactively reaching out and serving more high risk UHC members in their local geography, and by bringing this high touch scalable model to other complex populations like seniors managing multiple chronic conditions and HIV patients who need help coordinating their therapies. This is how we're advancing our societal mission, one person at a time.
Thank you, Rina, and thank you to the rest of our community pharmacy team who ensures some of the most vulnerable people in our society are getting the support that they need. In addition to helping people like Candace live healthier lives, we also serve the growing number of people who need specialty drugs. These therapies offer tremendous hope for patients, but are very expensive. Our innovative specialty solutions improve outcomes for patients and better manage the total cost of care for plan sponsors. To do this, we tightly coordinate the pharmacy care with the medical treatment, bringing effective care to complex patients who are often seeing multiple providers and have multiple prescriptions.
We create a 3 60 degree view of a patient's utilization and costs using data across pharmacy and medical benefits. This helps us to support better care decisions to meet the specific needs of each patient. Through clinical decision support tools, we help clinicians better understand a patient's benefits to identify the best drug, the best price and the best site of care, which increasingly is a patient's own home. In fact, home based care can save as much as $37,000 per patient per year. That is direct savings to the patient and the benefit sponsor versus what it would cost for the same treatment in a less appropriate setting.
This year, as the number of home infusion patients we serve has grown by double digits, we've had 1,000 infusion nurses making 20,000 visits per month to patient homes. Let's see how it works for one patient.
Thanks, Erin. I'm Erica Knox. I'm a nurse practitioner and lead operations for infusion services at Optum. We provide care in infusion suites all across the country. They are convenient for patients and offer effective treatment at lower cost.
In addition, as Aaron said, we now treat most patients in their home. For patients with acute needs being discharged from the hospital, we can have a nurse in the home in 4 hours or less. So far this year, our nurses have spent 400,000 hours serving patients in this way, using drugs carefully prepared and shipped from our pharmacies across the country, patients like 9 year old Annabelle. Annabelle became one of our home infusion patients earlier this year. She had been receiving infusions in an inpatient setting, but when COVID hit, her family and care providers became concerned about her potential exposure to COVID.
You see, Annabel had received a donated kidney from her mother and had a compromised immune system. Let's hear from the family how we eased their concerns, quickly transitioned Annabel to home care and made sure Annabelle's treatment didn't miss a beat.
I like to do art. I like to read. I like to write. I like to dance. I like making comics.
I actually made one about the kidney transplant. It was 1 page, 2 page, and then the back.
Annabelle had a kidney transplant 3 years ago, at the end of 1st grade when she was 7 years old. When the pandemic first started in early March and that's when school started closing and everything shut down, I was really panicked. I had a child who was immunosuppressed. Even on the best of days, I worry about her. But Optum really put me at ease because after my initial phone call to say, are we candidates for home infusion, they picked up all the pieces and it was like an orchestra.
It was very well synchronized. Nurse
Tara is
the best. She draws Annabel's blood for her monthly labs, and she administers the belatocept infusion. It's about 1 hour from start to finish, which compared to a traditional hospital setting, this is a home run. She's a friend when she comes, and I look forward to having her around. If I'm worried about anything medically, she's a 1 on 1 expert.
She gave me this mask chain before I went to school.
Right before the start of school, we realized that all kids would need to wear masks. So, nurse, Tara, handmade her a little mask chain with pink beads. Annabel's health today is amazing. People often comment to me, I can't believe she had a transplant 3 years ago. She looks amazing.
I'm just really grateful that Optum did not treat me just as another customer they had to deal with during this time. To be understood as a concerned mom meant a lot to me. I really just want to say to Optum, thank you very much.
We help thousands of people like Annabel start home infusions every year and the experience is so much better for our patients. This helps to drive our consistent strong results and makes us work harder to expand our capabilities. So this year, when the pandemic sparked greater demand for home infusions, we were ready. We expect this demand to grow going forward as more people benefit from the convenience, comfort and value that we deliver. Now let's talk about how 2020 has brought the broader value of pharmacy care services into sharper focus.
Joining me is Doctor. Sumit Dutta, Chief Medical Officer for OptumRx. Hi, Doctor. Dutta.
Hi, Erin. How are you?
Doing great. I was hoping you could share with us how the pandemic has put a spotlight on home delivery services.
Yes, the pandemic has changed the way that people prefer to obtain their medications. The advantages of home delivery have become even more clear. Home delivery is convenient, it's safe, it's fast. Our expansive footprint focuses on that important last mile to the patient's home. We achieve 20% better adherence.
Customer satisfaction has improved. In fact, our Net Promoter Score improved 7 points over 2019. Innovations like multi dose packaging help patients who take more than one drug a day stay adherent on their medications.
And we know that's really important because we serve a lot of folks who happen to have polychronic disease.
And they take a lot of medicines.
Yes, unfortunately. Could you also highlight some of the things that we're doing around digital innovation and how that's helped people this year?
Absolutely, Aaron. Let me give you two examples. The pandemic has brought increasing acceptance of the use of virtual care. I recently had a virtual dermatology visit, and I loved it. I didn't need to take time off work.
I didn't have to drive to the clinic and I didn't have to pay for parking. That's what we have offered for many years through our virtual consults with pharmacists where members can ask questions about drug interactions, dosing, side effects. Also, we have developed Optum Perks Cash Card, which is available digitally to all Americans, whether they have a pharmacy benefit or not. We deliver savings of up to 80% off retail prices. This solution is free, easy to use and available at 67,000 pharmacies across the country.
Wow. And we also do things at the point of prescribing when people are getting new prescriptions.
Yes. Another solution that delivers consumer value is My Script Finder. This is a digital tool available in mobile and web applications. It helps members and providers find the best medication based on their benefits at the best price. This leads to an average savings of $40 per prescription.
Thank you, Sumit. I hope this glimpse into our pharmacy model has given you good insight into how we are adapting and innovating to meet evolving consumer needs. We connect with people over 700,000 times a day and use each interaction as an opportunity to care for the whole person. We will continue to grow our distinctive pharmacy care services to advocate for more people like Candace, Annabelle and our more than 59,000,000 members and for everyone else we serve. And if anything, 2020 has shown us more than ever before, caring for people means meeting them where they are, through digital and home based care.
In pharmacy, we saw the number of digital users rise nearly 10% because we are reaching people the way they want to be engaged. Next, you'll learn more about our expanding digital capabilities across the enterprise and how these capabilities are helping improve experiences, outcomes and affordability. Phil?
We're entering a new era of healthcare. As you just saw, people can now receive much of the care they need in the comfort and safety of their home. Therapies can now be accessed digitally and data driven insights help us intercept disease and personalized clinical care. You've heard us talk for years about our technology investments. Our individual health record brings data together from literally thousands of sources.
Personalized tools and rewards help people maintain and improve their health. Connected devices are expanding remote monitoring. The nerve center helps people better manage chronic conditions and advanced data analytics tools drive more informed care decisions and can even predict disease. We're going to share today how we are harnessing and bringing together our investments in technology and digital capabilities to build a more connected, intelligent health system. Let's jump in.
Advancing virtual and home care has always been an important piece of our strategy and it accelerated this year as patients and doctors quickly moved to virtual visits. COVID tested us and we were ready. At UnitedHealthcare alone, we facilitated over 22,000,000 telehealth visits this year compared to less than 1,000,000 in 2019. I'd like to ask my colleagues, Doctor. Christy Henderson and Doctor.
Sourav Bhatnagar to share more about UnitedHealthcare's Digital Health at Home Strategy.
Thanks, Phil. Doctor. Henderson, we've been infusing leading technologies at this company for many years and that really prepared us for this year. And in 2019, what we had seen was only 0.1% of our Medicare members use telehealth services. This year alone, we've seen that number skyrocket to 40%.
And while you and I both know as clinicians that telehealth alone doesn't change the way that the member interacts with a physician, what we're doing is really complementing it in new and futuristic ways to advance the healthcare ecosystem.
Yes, it's so exciting, Doctor. Bhatnagar. In response to this demand, we expanded telehealth access from 6,500,000 Medicare Advantage and Dual Special Needs Plan members within a matter of days at the onset of the pandemic. And now we're refining that experience to make it better for our members. In this spring, we're launching UnitedHealthcare's new digital health at home experience to about 4,000,000 of our Medicare Advantage members.
I know you're excited to share more about that. You've been a pioneer in shaping that vision of what the digital health at home can be. Could you tell us about what that would look like for a member?
Absolutely. So what digital health at home does is on MyUHC, it brings together data streams into one location, including the individual health record and nerve center. And what it starts to do is really build that personalized and complete member health profile in this one location. And what it also does is it makes that data interoperable so that it can connect to our large provider network that we have. And on top of that, it puts other additional tools into the hands of those providers such as point of care assist.
And then we're also taking the same data and then sharing it with our clinical care teams such as an advocate or a nurse or a care management team so that regardless whichever door, whether it's physical or digital that a member knocks on, they get that same best care.
It's amazing and so powerful for our members. What I'm most excited about is that that connects resources that we have across our entire system and puts them in the hands of our members. And so what that would look like is a member could log into MyUHC, They could check their health history. They could enter health data using biometric devices that they may have at home to manage their chronic disease. They can also schedule an appointment for a telehealth visit or they can even now shop online for over the counter medications.
It's pretty amazing how far we've come. And during COVID, we leaned in and accelerated this work for this end to end experience. And now we're including health related services. So this is what it looks like. That same login that we talked about, we can now have the member go in and they can order a preventive health kit.
So tests like colon cancer screening or a hemoglobin A1C for their diabetes can send a kit to their home. The results are right there online on their dashboard. And if those results happen to show something where they need to take an action, they can go online, schedule an appointment, even have a telehealth visit. So it's that easy. We're super excited about where this is going to go to be able to serve our members.
And let's talk a little bit more about those members with complex conditions that you also talked about. And what we're doing is really infusing our high touch care management services that we have with the same technology so that a member in their home can get cloud connected devices, whether it's a biometric scale, a blood pressure cuff, glucometer, a pulse oximeter. And what it does is for a member like William, who's answering some of these daily care management pathway questions, It takes this data from this from a smart device, whether it's a smart tablet or a phone, and it takes these questions plus those same data streams, infuses it all into nerve center and then puts it into the hands of our nurses and care teams. And what nerve center really is and you're seeing some of it here is it's a knowledge engine. So what it does, it starts to gather and analyze all these various data streams, whether it's claims data, utilization data, gaps in care data, preventative services data, over 4,600,000 alerts were driving over 4,600,000 alerts were driving smarter and more personalized health through nerve center.
And what we're really excited about is what Digital Health at Home does is it takes those same data streams along with much more and it puts that into the hands of our members like never before. So whether a member is interacting with at home services such as house call or intelligent routing services, the member gets that same great care.
It sounds exactly like what Phil was talking about. It's truly an intelligent connected health ecosystem. I'm looking forward to scaling the digital health at home over this next year to really be able to serve our members better and enable our providers to drive digitally based value based care. Thank you.
Thanks, Christy and Saurabh. That's a great picture of how our home health approach goes beyond telehealth to creating a complete picture of the patient's needs and providing personalized recommendations. Our solutions go beyond physical health. 1 in 5 adults suffer from mental illness each year. And as that number has grown during the pandemic, the system has struggled to keep up.
Optum Behavioral Health is one of the nation's largest mental and behavioral health provider networks, now with over 235,000 providers and growing. We have expanded virtual care and app based solutions for depression and anxiety, as well as telepsychiatry and pharmacy behavioral services. Doctor. Reena Pandey, our Chief Medical Officer at Ableton will share more on how our platform helps connect people to the support they need.
Thanks so much, Phil. You are absolutely right. Mental health is such a serious issue and far too many people today are unable to get the care they need. At ABLE TO, we are delivering structured high impact mental health care to people when and where they need it most. We're leveraging data and analytics to align each person's unique needs with a personalized behavioral health program that offers the right blend of human and digital support.
That care is delivered by our very own nationwide community of licensed clinicians trained to deliver our evidence based protocols through the ABLEto technology platform. So how does it work? Let's take the example of Sue, a UnitedHealthcare member with type 2 diabetes who is also dealing with depression. ABLETO might proactively identify Sue as someone at increased risk for a behavioral health challenge and might reach out to her to make her aware of programs covered by her benefits and to help her coordinate an initial visit with one of our clinicians. ABLETO's platform really tries to simplify that experience by assessing patients and guiding them to the right treatment choice based on their clinical needs and their personal preferences.
On the one end of the spectrum, that care might be delivered through our digital solution with the support of a coach or for more complex cases like Sue's, her care team would build an A weight program tailored to her needs with care delivered virtually through telehealth sessions. At the core of all ABLEto programs though is a foundational protocol based on decades of clinical evidence incorporating cognitive behavioral therapy and other evidence based interventions that are really designed to manage both physical and mental health care. The results of ABLE II's programs really speak to the impact we can have people's lives. Over the last decade, we have consistently been able to demonstrate that our high quality care reduces depression by nearly 50% to 60% and anxiety symptoms by approximately 45%, while at the same time improving physical health like diabetes self management measures and even medication adherence and altogether resulting in 45% fewer hospital stays. As you can probably tell, it gives me great pride to know we are able to serve the needs of our mental health patients across the country, helping them access high quality evidence based care that delivers truly meaningful clinical outcomes.
Thank you, Rina. These technologies are not only transforming the way care is delivered for people, they're also helping advance the practice of medicine by introducing new clinical support, such as digital therapies. Our research and development pipeline is generating innovative treatments with vast potential to prevent, delay and avert disease progression. And we've only just begun to scratch the surface. Here's Doctor.
Deneen Vojta to discuss how we're delivering tomorrow's treatments today for people with type 2 diabetes.
Good morning. I'm here in the QUERI lab, our home for research and development. We know pharmaceuticals can be lifesaving, and innovations in many therapeutic classes are accelerating. But they are not the be all and end all, particularly in a disease like diabetes. Even with these advancements, we have not been able to offset the rising incidence and costs of diabetes in this country, nor was I able to avoid breaking my finger.
Level 2 is a special purpose care delivery organization that uniquely applies digital therapeutics, virtual expert care and facilitated self-service to help patients put their diabetes into remission and not just accept the inevitability of more drugs, complications and disability. Digital therapeutics have the potential to radically change diabetes care by creating an ongoing direct connection to patients to ensure that care is optimized at all times, including medications, behavioral habits and daily activities. In Level 2, our patients are equipped with a continuous glucose monitor, which is a digital therapeutic that helps them and their level 2 doctors see the impact of certain foods, activity, stress and medications on their lives. And our remote specialists are armed with patient level signals generated from our AI algorithms that are fueled by massive curated data sets, including the individual health record and these continuous glucose monitor readings. And these signals enable our doctors to intercept disease before it progresses and complications develop.
These AI algorithms never go to sleep and are continuously screening for changing risk profiles or new care needs. Level 2 is committed to delivering this far better care using fewer caregivers. The notion that a patient physician encounter is necessary for every interaction is health care's choke point. AI supports facilitated self-service, allowing the patient themselves to handle most of their needs, but stepping in when higher level of expert care is required. To give you an example of one of these AI derived microtherapeutic recommendations, a patient could be asked to move the timing of her metformin from the morning to after dinner to allow her to lower her blood glucose levels while she sleeps.
And much of the follow-up is automated. So when a medication is changed, a technology enabled assistant connects with the patient to confirm the new regimen is working and monitors for any side effects. This alleviates the burden on the physicians and their staff. So once again, Level 2 is focused on disease remission and not just slowing its progression. To that end, about a half of our patients thus far have been able to reduce the number of drugs they take every day.
Early results have been so positive, we are starting to carve out risk for people living with diabetes and get paid a premium to manage their condition holistically over time. This suggests a potential market opportunity for this type of care, which could ultimately be measured in the tens of 1,000,000,000 of dollars. And diabetes is just the first condition in a growing pipeline of UnitedHealth Group's special purpose care delivery organization level 2. We expect to deploy at scale other conditions, including chronic kidney disease and heart disease. We are really just getting started on this broader opportunity to leverage digital therapeutics, virtual expert care and facilitated self-service at scale.
Stay tuned.
Thank you, Deneen. We've built the infrastructure needed to deliver a more intelligent health system, and we're making it real through technology that improves the consumer experience, enables clinicians and improves health outcomes. We are a healthcare company, and our leadership in technology sets us apart. We're the only company that can take massive number of data sources, combined with analytics and deep clinical expertise and directly deliver critical insights to care providers and people at the exact moment they need it. This is how we are helping transform healthcare through the power of technology.
Now, let's take a look at how we are doing it through modern benefit designs.
Thanks, Phil. It's great to see how we're using technology to personalize care to help consumers be healthier. We're also deeply committed to simplifying health care and making it more affordable for people through a variety of modern benefit designs. To guide this effort, we always start with listening to consumers to better understand their needs. One thing we hear often is the need for affordable options while maintaining access to high quality doctors.
In response, we've developed commercial products like Primary Advantage, which offers $0 PCP copays and 1st dollar coverage. In addition, our buying product makes it easier for consumers to know in advance how much their care is going to cost as they can purchase coverage for certain conditions on demand as they need it. And for seniors, we offer $0 and low premium plans as well as $0 co pays along with extras that seniors want most like renew and dental, vision and hearing coverage. The strength of our network and clinical capabilities combined with OptumCare means we're uniquely positioned to create more provider led plans that reward for value versus volume. In our Signature Value Harmony and Canopy plans, consumers can save up to 20% on premiums compared to traditional PPO offerings as well as get $0 co pays for primary and urgent care.
This is exactly the type of high value healthcare option consumers want. Looking at the individual market, we're growing our products and services to fill gaps in employer sponsored coverage, provide affordable coverage options in the case of a job loss and offer non medical coverage for dental, vision and hearing. Finally, in our global business, we're simplifying the experience by digitizing all aspects of our benefit offerings. Our Banerica insurance businesses in Chile, Colombia and Peru have deployed our integrated digital platform, which helps resolve members' care and administrative needs, while simplifying the experience and eliminating administrative costs. And speaking of digital, we're seeing a monumental shift in how consumers want to receive care and we're responding by bringing it to them through easy to access telehealth options, virtual visits and home health services.
We're creating a specific product that allows our members to pick their own virtual care doctor and expanding the use of virtual visits from delivering care to people who are sick to also preventing illness before it starts. Here to show you more about this unique product offering is Jessica Paik from our Commercial National Accounts Business.
Thanks, Christa. Like you said, a significant amount of in person care has shifted to virtual care and we believe that trend isn't going away anytime soon. We know about 30% of our members do not have a primary care physician or PCP. Based on our research, these people have on average nearly 10% higher health costs, which means we know people aren't getting the care they need, leading to poor health outcomes and missed opportunities to lower costs. So we developed a plan that helps members get connected to a PCP.
Our virtual primary care offering provides a faster, more convenient and coordinated healthcare experience. Patients begin by selecting a virtual PCP from among our top provider panels to establish an ongoing relationship. This is notable because it helps to improve access to care in underserved areas. People can also schedule online appointments on myuhc.com with their virtual PCP and interact with their care team on a 20 fourseven basis. So think of that 2 am fever, that medication that you might have a potential side effect or just that simple health question that you may not want to go in person to see a physician, but if you can access a physician online that you know and access clear information to understand your costs before starting the visit, this is a natural evolution of getting questions answered.
Then, if in person care is truly needed, the virtual PCP can refer the patient to a nearby high quality low cost option for things like labs, imaging specialists and other services. And then once the member visits with the local care provider, they can share their medical record information with the doctor. So just like traditional primary care, virtual primary care covers everything from basic health screenings to minor urgent care visits like pink eye, to managing chronic health conditions such as asthma, high blood pressure or high cholesterol. We launched virtual primary care earlier this year to about 600,000 members and we plan to expand this. We expect this offering to meaningfully contribute to our goal of having every member with a designated PCP, improving outcomes and lowering the total cost of care.
Thanks, Jessica. This is a great example of how we're creating affordable and simple products to meet the needs of our members. In addition to our members, we also want to simplify the process for providers. You heard how the IHR brings thousands of unique data elements and our new platforms like point of care assist are taking in that data and integrating it directly into the physician's workflow. This allows physicians to proactively identify gaps in care, suggest lower cost medications and even recommend in network referrals all while the patient is sitting in their office.
Regan Ristich from our provider operations team is here to explain.
We've been working with the largest EMR companies in the nation to integrate actionable intelligence directly into their systems, so physicians have seamless access. No one else is doing this in the industry and it's already making a big difference to the growing number of nearly 570,000 healthcare professionals who now have access to point of care assist. Let's look at how point of care assist works for Juan Sanchez, a 68 year old male with a history of congestive heart failure and diabetes. When Juan visits his primary care physician, Doctor. Claire Smith, she can review his individual health record, which summarizes Juan's health history.
This allows Doctor. Smith to view events in his care journey beyond the current visit through data not available in the traditional EMR. Important gaps in care are displayed like preventative screenings or needed prescription fills. Point of Care Assist provides data in the workflow making it simple for physicians to refer to specialists who are high quality and lower costs. In this case, Doctor.
Smith knows quants should be assessed by an endocrinologist, so a referral order is created. Doctor. Smith can see information for an endocrinologist she typically refers to and confirms the in network status that the services do not require prior authorization or referral and sees the estimated cost for Juan for his visit. As she starts the process, she notices that Doctor. Padma does not meet UnitedHealthcare's premium criteria.
She scrolls down to see another physician, Doctor. Ito, who is a Tier 1 premium care physician, is more cost effective and is 6 miles closer to 1. The value generated by providing actionable data at the point of care is significant. We're helping physicians spend more time delivering care and helping patients focus on their health. Payers see a 30% increase in redirection of care to lower cost sites and consumers benefit from improved care and lower out of pocket costs with an enhanced care experience for their doctors.
We will continually refine point of care assist and over time believe it will fundamentally change the way healthcare decisions get made by doctors and their patients at the point of care.
While technology is essential to achieving our vision for healthcare, we never lose sight of the human touch. For some, it's meeting the needs beyond the clinical setting by addressing affordable housing and food insecurity. This year, our total housing investment reached more than $500,000,000 For other patients, we bring care into the home. That could be a nurse conducting a clinical visit through our house calls program or providing concierge like support through our advocate for me and navigate for me programs. We want to make sure our people are working to improve the care experience and nowhere is this more relevant than our commercial special needs initiative.
Patients with rare or complex conditions often face unique challenges. These families have 13 times the normal number of claims. They see 5 times as many specialists and they have 10 times the number of issues with their claims. These are some of the most clinically complex and expensive cases in the health system. Our special needs initiative focuses on 4 main areas: removing administrative barriers, getting families to the doctors and clinics that truly understand rare and complex conditions, helping families find social services and supporting the health of the entire family.
Here's just one family's story.
When you have a special needs child, it's just trying to make it through the day. Every day is tough and you never know what's going to happen next.
So Keiko's very first issues were feeding, and then she had neurological issues.
And we were paying so much money for the different types of therapies that she was going to. And even the therapists were saying we weren't quite sure if this was helping her anymore.
I was on the phone with doctor after doctor, nurse line after nurse line.
And so at some point, we just pretty much gave up and decided we're just going to try and make it through each day on our own.
There are 7,000 rare diseases that affect 350,000,000 people worldwide. The majority of those affected our children. The health care system is not well coordinated to help these children. What happens is they tend to go from physician to physician, specialist to specialist, and there's nobody coordinating their care or helping them find their solutions. Our care advisors are the connection to the families to help them navigate the system and find their way.
My name is Cindy Hurwitz, and I'm a registered nurse in the Family Engagement Center for the Diagnostic Advocacy team. So I looked at claims and a lot of different sources and I thought maybe Keiko would be a good candidate because her diagnosis was unspecific.
Cindy was great. So Cindy coordinated everything. You would call her. If she didn't know an answer, she'd hunt it down. She offered support.
She offered emotional support. She offered all the needs you could want in one phone call.
What used to take 5 to 8 years to help families get an answer, now we can do in 3 to 5
weeks. We were able
to get procedures done within minutes instead of within months.
We've partnered and identified with the best children's hospitals across the country and are sending these families that we find there so they can get help. It's the power of data, data analytics and clinical insight married together. We help the Hirano family by ensuring that we could identify the rare disease that's affecting their daughter. And finally, we were able to help them close those gaps in care.
So right away, our first primary physician noticed something that every physician before that had missed. After we had the procedure, her speech had improved. She was getting more sleep. Her sleep apnea issues had disappeared as well. So, she was more rested.
Keiko every day now. She smiles a little more, she runs a little faster. She's just full of light.
I don't know of any other company that's trying to do it, has an interest in doing it or has
the power and ability to do it. The Jeranos are just one of the more than 115,000 families we've helped through this program. We've seen our NPS go from negative 5 to above 70 after we engage with these families and we save them over $23,000,000 in out of pocket costs. Next year, we're extending this service to adults with complex conditions. So there you have it, affordability, simplicity and quality supported care.
That's UnitedHealthcare's true value and differentiation in the market. Now, let's take a quick look at how we're making it simpler and easier for consumers to manage the financial aspects of their health care.
Paying for products and services has never been simpler or more seamless. A click of a button or a wave of our phone sets off a chain reaction. A payment is made and received instantly. Rewards programs are updated. A record of the transaction gets sent.
And rich data is used to drive loyalty and deepen relationships between a customer and a vendor. In a moment, it's done conveniently and transparently. Now imagine the day when the financial side of healthcare is this easy. Good morning. I'm Norman Wright, Optum's Chief Marketing and Customer Experience Officer.
You've learned a lot today about how UnitedHealth Group is building and investing in the next generation health system. Now I'd like to discuss how we're bringing that strategy to the financial side of healthcare. Before I came to Optum, I worked in financial services for many years where I saw FinTech really take hold. Now I'm often asked, what can healthcare learn from that? And can healthcare ever be as simple and as fast?
Well, my answer to that is an emphatic yes. And as the largest healthcare financial provider in the country, we're working to make it real. And we haven't talked about our financial services strategy with you in some time. So today, I want to update you on our capabilities and how they're foundational to a high speed electronic payment network that will reach across health care. Over the last several years, we've built a broad based health banking and payment business with connections across our enterprise and the entire health system.
In 2019, we processed more than $170,000,000,000 in health claims through our digital payment gateway. Today, we have payment connections with the vast majority of all providers across the country, 1,800,000 of them. And earlier this year, in a time of great need, we used these connections in partnering with the Department of Health and Human Services to quickly deliver more than $100,000,000,000 in CARES Act funding. Now we're working to bring everything together to a single smart payment gateway that provides affordable options that are transparent and fast for both providers and for patients. So joining me this morning is the CEO of Optum Financial, Curt Adams.
Curt, it's good
to see you. Great to see you as well, Norman.
So tell us more about this vision and let's start with what it means for providers.
Well, like you, I have a background in payments and banking, and that's why I came to UnitedHealth Group. I was drawn by its capabilities and its vision to transform an entire industry for the better. Healthcare is the largest industry where payment innovation hasn't reached meaningful scale, and as a result, providers are spending far too much time dealing with cumbersome payment processes, billing and collections, time they would rather be spending with their patients. Today, you've heard a lot about our obsession with improving provider experience. Our strategy is simple, put new technologies and tools in providers' hands that reduce administrative burden and deploy technology behind the scenes that pays them quicker, all while making it easier for patients to pay their bills.
Imagine that by the end of a workday, a doctor is fully and accurately paid both by the patient and their health plan. And then imagine the time and resources saved by not having to send out bills and chase down payments. We're in the early stages of building this out. The good news is we're laying the rails to get the high speed trains running and make this a reality.
So that's exciting stuff, Kurt. And it's great to hear another example of how we're using technology to allow doctors to do what they do best, which is really caring for their patients and to bring back the joy of practicing medicine. Now speaking of patients, we're zeroed in on decreasing complexity and increasing affordability. And we've all heard stories, and we know people who are struggling to navigate the financial side of health care. So Kurt, let's talk about how we're making this real for
individuals. Well, Norman, we have an incredible opportunity to bring our capabilities together to help people pay for care and get rewarded when they make healthy choices, similar to good driver discounts. Our consumer centric digital platform, Rally, is one great way we connect health and finance. Rally has delivered $1,900,000,000 in incentive payments back to members for healthy behavior. UnitedHealthcare's Care Cash debit card rewards members when they seek care for high quality, lower cost providers, and our Sweat Equity fitness rewards program reimburses them when they participate in qualified fitness activities.
Our opportunity now is to bring it all together, payments, rewards and health coverage for a simple experience that drives loyalty and better health. Imagine a day when people only need one convenient mobile platform for all their health related transactions, connected to any account they choose, credit, debit, checking or any other popular payment channel. That is the future we're working
Innovation in financial services cuts across every part of our enterprise, across UnitedHealthcare's Benefits businesses and Optum's growing portfolio. We're going beyond incremental changes and far beyond point solutions to transform a key segment of the healthcare economy that's in urgent need of change.
What you have heard from us today is the result of years of strategic investments that have enabled us to build a diversified, adaptable company serving the entire healthcare value chain. All of our growth priorities are designed to win the loyalty and trust of employers and consumers and reduce the total cost of healthcare. I'm hopeful that what was clear from this morning's presentations were some recurring themes that cut across the 5 growth priorities. 1st, our unique digital services are powering connected care, enabling an integrated approach that makes it easier for people to access quality and efficient care. 2nd, we are meeting people where they are in their care journey, in their homes or community pharmacies, telehealth, or right at the point of care.
3rd, we're focused on making things simpler for providers and patients, delivering information and transparency, so they can get the right care at the right place and for the right price. And lastly, we're addressing some of the most complex issues in healthcare, from supporting families with special needs to introducing new digital therapies targeting difficult to treat chronic conditions. On their own, each of the 5 growth priorities you heard about this morning has the potential to positively impact entire sectors of the system. But more importantly, taken together and powered by the people of UnitedHealth Group, we are well positioned to help drive transformative change across the healthcare landscape. And we'll continue investing in the capabilities and resources to develop and fuel our growth.
During my time at UnitedHealth Group, I've held roles at both UnitedHealthcare and Optum and know firsthand the impact we can have when we bring the combined talents and capabilities together to tackle challenges and better serve our customers, members and the system as a whole. We're inspired by the opportunities ahead. Now, I'd like to turn it over to our Chief Financial Officer, John Rex.
Good morning and thank you for spending your day with us in this virtual gathering. Of all of the surprises 2020 has brought, large and small, good and bad, the one I least expected is this, I never thought I would miss that Sheraton Hotel, but I do. I miss seeing you gathered in the ballroom, the hallway conversations, the dinners, the Q and A, the Expos, the seminars, thousands of human connections packed into one day. And as many of you have told me, it's another chance to get a real sense of the people with whom you are entrusting capital to deliver healthcare innovation and performance. It's not just about the information you pick up, it's more fundamentally about human connectivity.
But then came 2020 and we all quickly learned to operate in very different ways. And while this format is less than ideal from my perspective, it's a lot better than it would have been, say, 15 years ago when this would have been a soul crushing long conference call. I've thought a lot about why we turn to virtual tools and when, what they mean and what they could mean. For some reason, it brought to mind these. I don't know how many of you had walkie talkies when you were kids or if your children have them.
They never worked quite like I thought they should. My friends and I, for instance, had to shout back and forth across the street to tell each other to listen to them. What I realize now is that we didn't have anything special to say or do we needed walkie talkies for. We just thought using them was different and fun. You've seen many innovations and advances in technology on display here today, but the tool should never be the point.
For us and especially those of us in healthcare, it has to be about the human connection, the human element. If the tool makes something work better for people, we're all over it. So for example, our ambition is not the sheer number of virtual visits we can perform, but how we can use this means of connectivity to make a difference for patients, their doctors, hospital systems and payers. Connectivity is core to what we seek to deliver as a business. From within the flow of the healthcare system, connecting people with the tools, data and services that are directly relevant and a value to them in ways that make it easier to understand and interact, continually adapting and modernizing these connections as even more effective means become available.
We change to serve people, not the other way around. That approach is at the heart of what has enabled this company to adapt and grow over the years and what supports the growth opportunities we see ahead. We allocate our time, energy and capital to align with these principles and our mission. That is how we orient our decision making. It is what enables us to serve more people, serve them better, and in so doing, grow our business and the value of your investments.
Let me share a few examples of how we connect people and ultimately grow. If ever the phrase meet people where they are was apt, it's within our Genoa pharmacies, which you saw earlier. Conventional pharmacy approaches weren't reaching the people now supported by Genoa, patients with mental illness, substance abuse disorders and even more complex conditions. The personal engagement between a Genoa pharmacist and a patient at a community health center. That human connection, if you will, drives over 90% medication adherence, which in turn improves quality of lives in part by reducing hospitalizations.
That explains why it is a growing contributor to OptumRx. Or take our care delivery businesses, already with over 50,000 physicians. By the end of 'twenty one, we expect to partner with upwards of an additional 5,000. Now there is a lot of discussion about the evolving role of the physician, but it is clear to us that care delivered by an individual doctor engaged with an individual patient will remain central for years to come, no matter what support channel is used. The capability to connect people with the right kinds of tools, services and medicines that lead to better outcomes will only grow in value over time.
This connectivity stretches beyond primary care. We continue to amplify our focus on post acute care, where our technology and advanced AI have reduced readmissions by as much as 20% and days in skilled nursing facilities by 40%. We can turn to virtual only tools or the best surrounding care team when needed in our care settings or in the home. And we are able to customize and provide sophisticated data to identify the best facility for what a highly specific and deeply individual circumstances. We bring our full capabilities direct and indirect, to improve outcomes and costs.
I remember shouting into one of these walkie talkies and getting no response, nothing but static. It was frustrating, but it passed quickly. But for millions of Americans, the real world they live in is non responsive. They feel isolated and stressed, feelings exacerbated over the past 9 months. So we have accelerated the introduction of connectivity capabilities into our behavioral health business.
Our self-service apps today are helping millions manage stress and anxiety on demand when they eat it, through digital or telephonic means, whatever, however and whenever it works for patients. We are connecting nearly 20,000,000 people with behavioral health care providers for live sessions, driving lower costs for patients. But far more than that, it translates to a significant improvement in quality of life for people and their families. Or consider the ways we help employers enhance connections with their employees. The breadth of UnitedHealthcare's innovative benefit designs is connected to the strength of OptumCare's clinical capabilities, allowing us to offer innovative provider led plans in the commercial market.
Beyond creating value for the employer and the employee, these plans create a relationship with a physician where one may not have existed. And as you heard earlier, we have also introduced health plans which center first on creating virtual physician relationships. For a whole segment of the population, this approach creates lasting physician patient connections that otherwise just simply wouldn't occur. That's where the real value for people comes from because laying the pipes isn't enough. It's about creating effective, durable flow.
One of the many lessons we learned during the pandemic is how the health system and hospitals in particular work better when they can focus on their mission of giving each patient the best care possible, one patient at a time. Optum Insights has been at the core of enabling that focus to occur, 1 hospital, one health system at a time. Optum Insights can help stand up and improve telehealth service, navigate reimbursement in times of uncertainty and use analytics and predictive modeling to improve operational performance, all important services, all enabling a hospital to focus on what it does best. You will continue to see us focus on these types of enterprise wide relationships, supporting the growth of OptumInsight and the strength of hospital patient connectivity. All right, I think you get the point.
Assembling the best assets and capabilities is an important foundation. The painstaking part is ensuring they work together and are connected in a way that improves care in an open and inclusive, modern and informed connected system. But that's where the enduring value is created and where we can uniquely contribute and excel, helping to build a better and deeply connected health system, the health system of the future, one which will drive our growth well into the next decade. Now, let me connect you with some numbers so you can see how it all adds up. In the beginning months of the pandemic, at a time of high uncertainty, you saw a step forward without hesitation, rapidly providing billions in liquidity to help stabilize care delivery systems and to provide assistance for our customers.
And we maintained and delivered on a commitment to address economic imbalances the pandemic would create across the healthcare system. During this period, we also continued to strategically deploy capital and innovate from within, continuing our efforts to evolve and serve as a modern and informed healthcare platform. We expect to finish 2020 with adjusted net earnings per share approaching $16.75 Our overall annual earnings performance winds up being largely consistent with the original indications we offered a year ago, even as the quarterly progression was different than one could have imagined, as was the mix of performance across our businesses. We approached 2021 with a strengthened view regarding our underlying growth prospects. Our businesses are performing well and not only have we learned from and adapted to this environment, we have strengthened our capacities and advanced new capabilities and services we expect will grow strongly well into the future.
That being said, we're anything but complacent. We are mindful of the disrupted environment created by the pandemic and the elements that might play into next year. Among these, the damage to the U. S. Economy and overall business activity, testing and treatment costs, people's ease of access to and acceptance of needed care at normal activity levels, and the potential for more acute health conditions to emerge from the deferral of care in 2020.
Now, that's pretty broad. So let me get more specific to give you a sense of how we see our underlying growth. Our initial 2021 outlook for adjusted earnings per share of $17.75 to $18.25 incorporates just over $2,000,000,000 or about $1.80 per share at the midpoint, an estimated negative impact from COVID-nineteen related effects. This figure includes our view on several key factors, including for testing and treatment, our view is for direct COVID-nineteen care costs to be comparable to 2020. However, we expect there to be considerably less offset than in 2020 from other care services being deferred, as we expect health systems will remain largely able to deliver the care people need.
And we do not incorporate widespread usage of a meaningfully less expensive testing standard. Our view is also grounded in the fact that certain populations, particularly seniors, have deferred care this year. Some have not seen a doctor at all in 2020, impacting their health and our ability to close gaps in care and properly document health conditions that surely still exist. This could affect final risk scores and 2021 reimbursement levels, even as these seniors return to more normal care patterns. We assume vaccines only become pervasively distributed and administered among the U.
S. Population fairly deep into 'twenty one. And we expect more people currently furloughed will ultimately lose employer coverage and that states resume Medicaid redeterminations, both of which impact the number of people served. This past year reminded all of us things can turn out differently. But we think it is important to lay out for you the possibilities visible to us today.
Fundamentally, what we see is this, taking into account these factors implies a strong underlying growth rate, well supportive of our long term 13% to 16% adjusted earnings per share growth outlook. One of the opportunities we have each year at this conference is to convey the unique significance of having an Optum and UnitedHealthcare, businesses that are both distinct in their market focus, while connected in their impact on meeting human needs across the care system. And most years, we configure much of that morning session with a business unit perspective. This morning, we shared a view going across our enterprise to show how we expect to serve more people more comprehensively in any environment and demonstrate the intersection and commonality that drives enterprise growth across multiple and even more connected businesses. In short, to show the profound impact this organization can have when focusing and linking all of our resources on improving specific elements of the health system, and how our distinct businesses can grow strongly as a result.
But we understand the business unit view is still essential for you. So let me go through some key elements now. Since you have the numbers already, I won't read them off, but will offer brief perspectives. I'll start with Optum. Growth will be led by OptumHealth and our rapidly expanding care delivery businesses.
This growth is largely organic with revenue per OptumHealth consumer served expected to increase about 20% in 'twenty 1. And we expect to realize strong double digit growth on this metric for years to come. This momentum is a result of the investments and work we have engaged in for well over a decade. OptumCare continues to become more capable in delivering highly effective care and a better patient experience at meaningfully lower cost. Among factors driving this growth, more accountable care arrangements that actually have substantive accountability.
For example, the movement to global capitation and a decisively multi payer approach, with OptumCare serving over 80 health plans, and addressing more complex conditions such as the higher acuity care we are able to deliver in our surgery centers, deepening the services offered in more established specialties such as orthopedics and broadening into new areas such as cardiovascular. At OptumInsight, strong growth will be the result of building next generation integrated tools for health plans, such as comprehensive payment integrity, expanding relationships with state governments to address service and analytic needs, and creating operational performance and scale advantage for health systems through enterprise relationships. Given the volume driven nature of some of the OptumInsight businesses, 2020 performance was impacted by care deferral and a slower business environment. Our 'twenty one outlook incorporates the view that some of these impacts will persist. We have been gratified in current conditions that Optum Insights revenue backlog continued to advance.
We see the relationships built and fortified this year, translating to a 2021 backlog figure upwards of 23,000,000,000, dollars an increase of $10,000,000,000 from just 5 years ago. This expansion demonstrates the significant inroads made by OptumInsight across its businesses that will drive double digit growth into the future. OptumRx earnings growth of 4% to 6% is driven by its rapidly expanding specialty businesses, many of which you saw highlighted this morning. Adjusted scripts are expected to approach 1,350,000,000 in 'twenty one, growth of about 2% over 2020. Script volume in the established pharmacy benefit management business has been affected by care deferral during 2020 and our 'twenty one outlook carries in that impact.
The OptumRx specialty businesses now comprise over 1 third of the earnings base with a 5 year compounded earnings growth rate of about 20% and will contribute strongly to growth in this business for many years. Turning to UnitedHealthcare. We expect medical member growth of upwards of 1,500,000 people in 'twenty one, led by our Medicare Advantage offerings. Customer retention continues to be strong, reflecting how seniors value the comprehensive and stable benefits we offer. But retention and expansion don't come from a list of benefits in a brochure.
They are earned through the relationships and connections we build, from how we are able to take care of people and not just episodically or in traditional settings. We do this by facilitating trusted care in seniors' homes, standing by their side to help them navigate the complexities of the care system, and assisting in potentially difficult transitions for families between sites of care. These are among the valued factors that develop lasting connections and that have allowed us to advance the number of seniors we serve under Medicare Advantage at a 13% compounded annual growth rate over the past 5 years. Within our commercial business, we expect net member growth even as our outlook incorporates continued employment related attrition. The ultimate magnitude of this growth could be impacted by any extension of federal assistance programs to employers.
We see particularly strong growth in our individual products, which are expected to grow double digits again in 'twenty one. Within employer sponsored coverage, our expanding set of new consumer centric benefits, which you heard described earlier, are expected to grow again at a strong double digit pace, this after a more than 50% growth in 2020. Medicaid has grown exceptionally well and we expect that growth to continue. This reflects the intentional work we have discussed with you over the last couple of years to improve the performance of this business. This growth is expected even as our outlook incorporates the probable expiration of the federal health emergency, at which point we expect states will resume the benefit redetermination activity, which was suspended for much of 2020.
That will affect membership, yet our 2021 outlook still is to serve a net additional 200,000 to 300,000 people. All in, UnitedHealthcare revenue of 218,000,000 to 220,000,000,000 shows revenue growth approaching 20,000,000,000 and operating earnings in a range of 11,300,000,000 to 11,800,000,000. It is an expectation grounded in UnitedHealthcare's deeply rooted commitment to connect people with care that offers better outcomes and a better experience at lower cost. Let me now turn to some of the other key elements that are typically of of interest to you. The 2021 medical care ratio at 83% plus or minus 50 basis points is impacted by the repeal of the health insurance tax, business mix as we continue to see strong growth in both Medicare and Medicaid, and the largest impact, the pandemic driven effects incorporated in our initial outlook.
Our focus on affordability extends to our operating costs. In 'twenty one, our operating cost ratio will improve by over 200 basis points, a direct result of ongoing productivity efforts to apply modern technology and data driven efficiencies. The change in our 'twenty one effective tax rate is primarily due to the repeal of the health insurance tax. When you exclude that, our rate is largely consistent with 2020. We continue to have a strong balance sheet and ample capacities with over half of operating cash flow to be generated by the growing services businesses, primarily Optum.
Our capital deployment practices remain consistent. We continue to return capital to our shareholders. The dividend has advanced a strong double digit pace and we expect to repurchase between $4,500,000,000 and $5,500,000,000 of stock during 'twenty one. With significant growth capital available, we will continue to evolve our healthcare platform to serve more people more deeply. Let me leave you with this.
A long time ago and in a far different setting, Benjamin Franklin wrote that people are like the separate filaments of flax before the thread is formed, without strength because without connection. We are better and stronger as individuals when we are connected with each other. This foundation is equally critical, as I hope you have seen today, in healthcare broadly. That's why it remains at the heart of what we do as an evolving healthcare platform, helping people live healthier lives and making the system work better for all. So I thank you for staying connected with us this past year and look forward to doing so throughout the coming year, whether virtually or we hope more often in person as the year progresses or if need be, just try me on the walkie talkie.
And now we'll move to our Q and A session. Dave, Dirk, Andrew and I will be joined virtually by many of our senior leaders, most of whom you've seen this morning.
Hello again. I hope this morning's program deepened your understanding of the distinctive and important ways we serve people in society today and the tremendous growth opportunities that are in front of us. Now we're excited to bring you into the conversation. Joining me in person today are John Rex, who you just heard from and UnitedHealthcare CEO, Dirk McMann. And also joining us once again from his office in the U.
K. Is Andrew Witty. And joining us live and virtually are more than 30 leaders across every part of our diverse enterprise. While you likely know some of these leaders, we're excited to introduce you to the many new faces from this morning's presentations as well. How are you all doing?
Give us thumbs up. All right. You ready to go?
Yes.
Alrighty. Sounds good. So let's get started. I know you've all received instructions on how to ask questions. And to start us off, we have Matthew Borsch.
Matt, how are you?
Good. Can you hear me?
I sure can. Thank you.
Okay, fantastic. My question is regarding how much of your at risk medical spending is currently being provided by your own providers under Optum. What it is today? What percentage it is today? And where do you see that going by, say, 2025?
Okay. Well, I
think we'll start with Wyatt Decker. As is the case, Matthew, we're advancing both our UnitedHealthcare risk business as well as 3rd party risk business as well. And they are advancing at nice paces, each of them. Doctor. Decker, can you answer Matthew's question?
Yes. Thank you, Matthew. If I understood the question because it got a little fuzzy, you were asking about what portion of our patients are in risk based arrangements. Is that correct?
No, not quite. I was thinking about your annual at risk medical spending or if you like just all the medical spending that flows through UnitedHealth Group. How much of that is provided by Optum Providers?
Yes. Okay. And we're
going to
see that going in next 5 years.
So let
me just frame this for you a little bit. At OptumCare, we serve about 20,000,000 patients annually. And of those, they are in 80 different approximately 80 plus different health plans. So we are fiercely multi payer, as you may have heard me or others say before, and actually work closely with UnitedHealthcare as you would expect, but also work closely with another 80 payers. And so for us, we have 53,000 physicians who are affiliated and employed, about 11,000 of whom are primary care physicians, all of whom are focused on delivering outstanding care with over 3,600,000 patients in value based care arrangements, including fully delegated and capitated arrangements like Medicare Advantage.
Thank you.
And Doctor. Decker, if you don't mind, I'm going to ask Dirk McMann to add on to that answer Matthew's question more directly.
Yes, Matt, I can give it to you this way. Roughly 14% of our Medicare Advantage and D STEP members are OptumCare members. I think that's probably the best quantification we can do.
Thanks, Matt. Our next question comes from Justin Lake. Justin? Justin, could you please remember to turn your camera on and unmute yourself as well?
If I could figure out how to turn the camera on, I would. I don't see it popping up here, but can you guys hear me okay, Elyse?
We sure can. Thank you, Justin.
Sorry about that. So wanted to ask a question about cost and obviously there's a spike in COVID going on right now, a lot of focus on what's going on in cost trend. So the MLR guidance for 2020 to 2021 of 83% is up about 50 basis points versus where you are in 2019, which is the last 5th year. Given most of that could be explained by mix change, I'm just curious if you could give us some color in terms of what you're seeing for thinking for trend next year. It seems to imply that you priced for a lot of this COVID because you're not implying in the Larko is up much.
And what is that 2021 trend that you're thinking versus the typical 6%?
Thanks. Great question, Justin. Appreciate it. We'll have John Rex respond.
I'll start with that Justin and then maybe we'll go to Dirk and we can talk about that segment of trend, that 6% trend that we've typically referred to as commercial cost trend over time also. So just maybe a little color on kind of what we're seeing right now to give you a flavor. We've tried to update this every quarter in terms of how we're seeing COVID cost progression and what we're seeing in elements. Certainly there's been a higher level of it in the last few months. I mean if we get certainly November, seeing that continue to ramp.
And so a view of where we're seeing in November, where that's coming very, very much more in line in terms of just offsetting being just offset by the care deferral levels that we're seeing at this point. As we look into the forward year, one of the comments I made in my address was really what we're seeing for full year 2021, we're looking for a COVID cost level that's largely the same as what we have experienced thus far in what we expect to experience really for all of 2020. However, considerably less offset than we experienced in 2020 from care deferral. Of course, there are a lot of other elements going on within that mix. One of the elements I think you referenced in your comments is also the repeal of the health insurance tax in 2021 that has impact also and where that sets fully.
Dirk, maybe I'll turn it to you for some color on commercial cost trend. And just to put in perspective, again, the commercial element is a little less than 20% of our premium book here.
Yes. I think no, I think it hit it well to start, John. You're going to have COVID treatment and testing costs and then you're going to have abatement. But our underlying trend, 6% plus or minus 50 basis points, Justin, I can assure you that our all of what we consider around unit costs as well as our clinical programs, those are going to remain intact. We have in fact priced considering the continuation of those and all of our expenses being well controlled.
So again, treatment and testing as well as abatement around the edges, consider that as well as what I would say the core trend that we manage normally every year. Great.
Thank you, Justin. Nice to have you with us today. Our next question is from A. J. Rice.
A. J, how are you doing?
Hi, Dave. Hi, everyone. Thanks for doing this. I wonder if I might have you drill down a little further in your Medicare Advantage outlook. You've got an assumption that you're going to grow enrollment back to 13% to 14%.
That's a reacceleration over the last 2 years. It is in keeping with what John said was your 5 year trend, I think. But maybe comment on what you've seen so far in the open enrollment in the individual market, your group expectations? And then I think this year your geographic expansion has returned to pretty significant growth. What's driving that?
And what have you seen in the new markets you're entering?
Great. Thanks for the question, A. J. We'll have Tim Noll respond to that. Our team is having a very nice AAP season that follows a strong group Medicare Advantage season, and AAP is covering both individual MA as well as our decent populations.
We're seeing nice growth there too. So Tim?
Yes. Thanks, AJ, for the question. Good morning. Yes, we're off to a really good start in AEP, getting a lot of positive feedback from the marketplace and doing a nice job of adapting to a little bit of a different selling season this year. Seeing a nice continuation of the momentum that we have established across the board, individual MA looking really good.
And then on the group side, we're seeing some nice growth with that selling season largely complete. We've guided to growth in the 750,000 to 800,000 range with about 175,000 to 200,000 of those growth lives coming from the group business. So that's really terrific to see. Regarding expansions, you're right, it was a little bit of a bigger expansion year. We got into some newer geographies this year and also continue to append counties to our existing footprint, which has been a nice way to grow the business for us historically.
Great. Thank you, Tim. Thank you, A. J, for the question. Our next question comes from Sarah James.
Hi, Sarah. How are you?
Hi, good. Thank you. I had a question follow-up on OptumCare. So I've noticed that this is a big focus today. Also, if I think back to last year, there was a lot of talk around this being a key area of capital deployment.
So maybe you could put it all in context for us. How much does OptumCare contribute to UnitedHealth overall today? Where is it going to be in 5 years? And what do you think are the major buckets between capital deployment, taking on more risk or just expansion of your existing programs organically?
Let's start with John. I think you already declared this a couple of years ago, if I remember correctly.
Yes, I did. And indeed, sir, good to see you this morning. And one of the outlooks we provided a few years ago, and we are taking a long term view in terms of where our company would be out. I think it continues from now. We talked about OptumCare being a $100,000,000,000 business for us and our next $100,000,000,000 business.
And the progress we're seeing continues to support that view that we've had in terms of where OptumCare will be and as we look out in the future. A couple of important elements I'd like to point out and I think you clearly picked up on some of these here. An important element for us is the focus we have on the revenue per consumer serve because that's an element in terms of what we're seeing in terms of the movement to global capitation, more accountable arrangements with physicians, and importantly, the growing acuity that we serve in Optum over the next many years. To give a little more color on OptumCare, I'd put it in if you look at the OptumHealth revenue line, that's roughly in kind of the 2 thirds zone of revenue, a little bit north of that these days. But that would be the general sizing.
And then
maybe go to What about capital allocation?
Capital allocation also. Capital allocation continues to be important focus for us. We are very active in terms of our affiliations with high performing groups and honored to be able to affiliate with high performing groups. Typically, in terms of the size of these transactions, they're not extremely large transactions for us, but it continues to be one of our primary focus areas in terms of where we'd like to deploy capital over the next 5 to 10 years. And we're going to go to Wyatt.
Wyatt, do you have any further
color? Yes. Thanks, Sarah. I think, John, you covered it well in terms of the growth potential. What we're seeing is continued excitement and energy by physician groups around the country who want to be part of OptumCare because of our long term growth perspective, as well as our deep commitment to physician leadership and what we call the quadruple aim, but patient experience, provider experience, lower total cost of care and outstanding outcomes.
And as we generate the data and really deliver on that vision, it has become very compelling for physician groups. So we're seeing groups approaching us, asking if they can be part of our team. And we're also seeing continued organic growth, which is strong. So I think you'll see growth through both organic and acquisitions and a continued focus on value based care and full capitation. Thanks.
Thank you, Sarah. It's nice to have you with us today. Our next question is from Josh Ruskin. Hi, Josh. How are you doing?
Hi, good morning. Thanks.
Can you guys hear me okay? We sure can.
Perfect. I'll apologize upfront for sort of a multi parter here, but really ultimately, trying to figure out what is the goal for OptumHealth? Are you looking to be a leader in the delivery of healthcare in the U. S? Is this just a better way to manage costs for UnitedHealthcare and other insurers, a way to grow membership?
And then I guess the last part would be, based on this aggressive growth, what is that impact on the relationship you're having with your network providers? Do they see you as a competitor at all?
All great questions. I think for the most part, except maybe sans that last piece, Josh, I'd say the answer is yes. The ultimate goal here is to achieve the quadruple aim, which is to improve outcomes and experiences both for doctors and for patients, at the same time lower the total cost of care. And you can see with our most formed relationships, we reduced the cost of care by somewhere around 40% or so. And that is intensely valuable in particular in the Medicare markets where both UnitedHealthcare and the 3rd party payers that are served by OptumCare are being able to reinvest those dollars into competitive benefits into the market.
And so it's an essential way to drive additional value. It's also one of the ways in which fee for service and MA have from a government funding standpoint have been leveled over time as well. So we just continue to expect that progress will continue and in doing so should yield a greater penetration of MA across the Medicare landscape. With respect to relationships, I referred to millions of relationships in my commentary. And those millions of relationships are both with networked physicians, which still constitute a good percentage of the numbers of physicians we have as part of OptumCare.
They're either employed or highly affiliated from that standpoint. And I think Wyatt addressed that nicely just a moment ago. But also then there's the relationships we have with facilities, which are intensely important. And we saw that play out in the earlier part of the year this year, where UnitedHealthcare Optum, UnitedHealth Group and large facilities were having to work very dynamically with one another in order to make sure that COVID patients were served and served well. And part of that was really around the procedural changes that were made on the fly in order to ensure that we were able to treat our patients and the hospitals were able to do everything they could to ensure the lowest level mortality possible.
So it was a that's just an example of the kind of dynamic and relationship that occurs over time. You'd also see these in our transformational partnerships as well. And those continue to grow and advance and they're essential. These are probably what I call the deepest relationship that we have till date with the health system broadly. So thanks, Josh, for your question.
Next question, please. It comes from Robert Jones. Robert, how are you?
Good. Good. Thanks for taking the question. Maybe just one on OptumRx, haven't spent a lot of time there yet in Q and A. You continue to call out specialty as a significant driver.
I believe you said it's about a third of the base of OptumRx at this point. How do you expect that market to develop over time? And how could you further penetrate that market? Or how do you see the further penetration of that market being influenced by biosimilars? And then I guess just the last part of it, given it's been a big focus as of late, any updated thoughts on the regulatory front, specifically I'm thinking about things like most favored nations and how that might affect specialty?
Sure. Sounds good. I'm going to send this to John Prince. And John, as you respond, let's respond not only to specialty, but use this as an opportunity to talk about some of the work that you've done in services as well.
Well, thanks for the question, Robert. And I'm also going to hand it off in a little while to Sumit Dutta, who is our Chief Medical Officer. Overall, we see the specialty market as a huge important market. It's about 2% of the prescriptions, but over 50% of the cost. We're approaching it from 2 perspectives.
One perspective is as a pharmacy benefit manager. So huge need from a plan sponsor to manage this cost, whether the cost is on the medical benefit or the pharmacy benefit. So a key area for us strategically is to manage it holistically. And thinking about that and the strategy is to help promote biosimilars, promote competition in the market. If you listen to our seminar later today, we're going to actually talk about this in-depth.
So, we'll spend some time on there. In the services more broadly, we're trying to create a healthcare system focused on care delivery and the biggest touch point in healthcare. And specialty as part of it, infusion, community pharmacies, multi dose packaging, a whole suite of services that are addressing those complex patients, polychronic with high needs. So, I think there is tremendous opportunity in the market. I'll maybe hand it to Sumit Dutta, who is our Chief Medical Officer, who can talk a little bit more around how we're differentiating ourselves in the market.
Thank you, John, and thank you for the question. I would add, I think there are 2 important things that differentiate us. One is our deep clinical expertise around managing pharmacy benefit. And the second is the wide range of capabilities that we've put together. When you put the expertise across more than a point solution and across infusion, across specialty, across mail and our other capabilities, that's where you truly create differentiation.
I might give one small quick example. If I think about the COVID-nineteen pandemic that we've all talked about, what we did very quickly is we had fast policy change. We had information to our clients. Over 1,000 people at the peak would call in. We changed our scripting to members to drive value and we've monitored the supply chain.
These are all examples of things that we've done to differentiate ourselves.
Great. Thank you, John and Sumit. Thank you, Robert. We're going to next question is from Kevin Fischbeck. Good morning, Kevin.
Good morning. Thank you. So I guess I wanted to drill down a little bit into that $1.80 that you guys mentioned as far as the COVID costs. I'm just trying to understand what you're trying to communicate by speculating that out. Is that are we meant to take that number and add that back when we think about the base for 2022?
Is that the right kind of core number to be thinking about? And then just to clarify that $1.80 it seems like you're saying it's mostly on the health plan business, but just wanted to make sure that that is the way to think about it or if there's any impact on the Optum side of and the house.
Great. We'll have John respond to that. But given that we're just releasing 2021 guidance today, I don't think we're going to flip to 2022 yet, Kevin. So we're not commenting that far ahead at this stage. As you might suspect, there's a lot of dynamics at play right now with respect to the pandemic and the economy and a number of other things.
But John, do you want to talk more fully on the Katy?
Sure. Good to see you, Kevin. Few elements on that and just let me refresh. So kind of core elements as you would expect are the testing and treatment costs that we have embedded in our as we look towards 2021, meaningfully less impact from care deferral and then all the elements of care deferral that could also have impact, in part also the fact, as I mentioned, that many seniors haven't even seen a doctor this year. So impacts their health, impacts our ability to close gaps in care.
And so we take that into account also. And then just some elements, some economic impacts that we'd have come in there. You're absolutely correct, it is mostly UnitedHealthcare. I'd put that in the zone of, call it, a little greater than 2 thirds UnitedHealthcare impact as I look across the entirety of that. So there is some that pulls into Optum also, but a minority of that amount.
Great. Thank you, Kevin. Good question. Nice to have you with us today. Our next question is from Stephen Tanal.
Stephen, how are you? Steve, I do. Good. How are
you guys? Thank you for taking the question. Actually, I thought I'd follow-up there on Kevin's. John, I was trying to think about this too. And really, maybe if you could just comment on sort of what impacts are going to go into the base of the business and likely to be sustained.
So obviously, the macro impacts and the industry effects, I think about in that bucket. But then really the non recurring stuff, maybe the direct cost of treating in vaccines,
MR. Wondering if you could kind
of parse those out inside of the 180 and help us think about kind of again that like core underlying earnings power of the business?
Okay. John?
Sure. Stephen, good to see you. Yes, let me get a little deeper into that. So when I think about elements that are, if you said, non recurring elements that would potentially that would carry through. So a few things to think about there.
Certainly, I guess at this point, at this distance, we're not sure how long we should think about COVID testing and treatment costs continuing. Certainly, we have a view on 2021, but not moving into 2022 and what elements there might be in that component. Other elements that question of kind of how far do they persist, I'd say largely in lines with the economic elements. So to the extent that, for example, in DIRF's business, as we think about employer sponsored business, and our expectation is that there will be more employees furloughed as we get into 2021. So what does that do to the base as you're stepping out into 2022 also.
There's an element of there also in terms of investment income. Again, I would put all these elements in kind of the more in terms of impact, probably less material than what we're seeing in terms of the impact from testing and treatment and the impact of care deferral. But those are elements that you would also consider as you think about potential pull through into other periods.
Yes. Let me add on that. I think there's a key thing that John talked about there in terms of our membership and what we have from an economic impact perspective. So I think about the Q1 is there's going to be people coming off a furlough. We may have a little bit of a dividend in the Q1 associated with that, but we expect at some point next year, we're going to see unemployment subside.
That's going to help us from a membership perspective. So as we think about next year, that's kind of the flow of how we'll have the membership and the economic impact. But to John's first point, as we go into this year, we have a run rate down from the membership that we lost this year. And maybe one more element, Dirk, in your business also that we discussed in our commentary was we do expect
the states will begin Medicaid redeterminations at some point during 2021. So that does have some impact also in DIRTT's business.
Yes. And so we do. We will expect that at some point the redetermination relief will sort of end. We guide it up with respect to membership and we hope that our organic growth that we have with some of the states we've talked about before will be an offsetting measure on that front.
Great.
Thanks, Stephen. Appreciate you being with us today. Our next question comes from Ricky Goldwasser. Hey, Ricky. How are you?
Hi, there. So when we think about the key theme throughout this morning, it was really provision of care at lower cost sites. So maybe you can help us quantify the impact of these savings that are associated with better aligning side of care on total medical costs. I know before you talked about medical care or medical costs of around kind of like 6% on the commercial side. If we think outpatient last year, you think quantified it closer to 8%.
So how should we think about the opportunity to lower that given the fact that we're seeing really an accelerated pace of move toward more digital care and move to home care and outpatient surgery
centers. Great. Thank you, Ricky. Dirk, you want to start at UnitedHealthcare maybe and then I'd like to flip it to Wyatt, who I think probably has the most offer in this subject.
Yes, I would say, Ricky, you kind of hit on him. I mean, as we think about our outpatient trend, it's 7.5% to 8% and it's about 35 percent of our spend, there's an opportunity there. Clearly, we have had a good focus on moving surgeries and alike, and we've talked about movement to SCA for things like hips and knees and things like that are very important. So, we think about that. We also across the board, we talk about things going to telehealth, for example.
There's many different we've clearly had 22,000,000 plus visits this year in telehealth. Those visits, at some level are inexpensive. Our ability to move the what I'll call the normal, easy pink eye type of incidents to that are important. So I would say movement to surgery centers, movement to telehealth are really two things which we're working to try to drive to better sites of service.
And just Ricky, just as a reminder, UnitedHealthcare has to work with the entirety of the health system. So its site initiatives are broader, go well beyond OptumHealth, OptumCare as well. But Doctor. Decker, would you like to add on?
You bet. Thanks Ricky and thanks Dave. So we are very excited about the opportunity to drive lower total cost of care by effective treatment sites that are alternative from traditional treatment sites. In a moment, I'm going to ask Caitlin Zullo to speak about SCA in our ambulatory surgical centers. But that's one important aspect is where do people get surgical procedures done.
Another is when do they need to even leave their home as we've touched on. So we have conducted over a 1,000,000 virtual visits this year in OptumCare and over half of the visits, outpatient visits for Optum Behavioral Health, our behavioral health network are occurring virtually. So there's been a massive shift. And of course, as the pandemic ebbs and flows, you see some fluctuations in how people are digesting or consuming their healthcare. But as you heard during the conversations already today, there is a massive opportunity for us to serve people on their own terms, in their own ways and much more convenient fashions and deliver actually higher quality care in lower cost settings.
So we're very excited about this. And Caitlin, maybe you can provide a little bit of color around SCA's impact in this space.
Sure. Thank you, Wyatt and thank you, Ricky. So surgical related spend is approximately 30% of U. S. Healthcare and the majority of it is still performed in hospitals and hospital outpatient departments, HOPDs, which are reimbursed at 2 times the cost of a surgery center for Medicare and often far higher for commercial.
And so as we think about how do we reduce the total cost of care that site of service migration is so meaningful. When you take 2 of the service lines that John mentioned in his remarks, orthopedics and cardiovascular within UHG alone moving from HOPD to ASCs, there is over $2,000,000,000 side of service savings opportunity. So we are excited by the growth and the opportunity and happy to answer your question. Thank you.
So we could have taken that into any number of zones, whether it be digital at home to a MedExpress or urgent care center to ambulatory surgical capacities to the way in which we're managing care in the acute care setting or in the subacute setting as well, all of which have a pretty significant impact on the total cost of care as well as the impact on experiences and outcomes. So thanks for the question, Ricky. Next question, please. It comes from Lance Wilkes. Hey, Lance, how are you?
Doing great. Great to see you guys today. So my question is on OptumRx and it's really related to kind of the growth in online pharmacy. And if you could just talk a little bit about your efforts in development and the status in online pharmacy, how you're looking at Amazon or others as far as being in network from an online pharmacy standpoint? And then maybe more broadly thinking about your reinventing care delivery, how does online pharmacy or that touch point fit into the your view of what healthcare looks like in the future?
Yes. We'll have John Prince start with that. But obviously, as you probably could tell from the opening remarks as carried out through this morning, it is a it's an integral part of a next generation health system broadly. And we should never lose sight of the fact that you need both the digital and physical realm of healthcare coming together, but also that it is a system. And that system is much more complicated than in any single dimension.
And that's part of what we're trying to bring forward for you today. John Prince, do you want to respond specifically to Lance's question?
Sure. Lance, good to see you. In terms of the consumer trend, we've been at this for several years. We've actually noticed that trend and we see it from several perspectives. First of all is consumer affordability.
Consumer affordability within pharmacy, the biggest touch point has been a big issue, as well as the experience, as well as having a seamless ability to handle the whole needs of a consumer. And so we've been investing in this from several perspectives. First of all, as our tools, We've been investing in how we work with people digitally. We talked to you in the past around PreCheck My Script, My Script Finder, tools that allow an individual to shop more effectively, make better decisions on their own. We've rolled those out.
We've had huge adoption for that. We've also been focused on affordability tools, such as discount cards. We've been in this business for more than a decade. We rolled out our own branded card this year called Optum Perks, which is a 3 steps and you can get your discount. We've added $100,000,000 of value to consumers pockets because of that.
We've been investing in our own e pharmacy. We've been as Dave mentioned earlier today, we've launched Optum Store. We've launched an e pharmacy in addition to our home delivery. So we have a whole bunch of strategies to serve this key need in the market. We've gotten great adoption.
These are businesses that are growing strong double digits. We see a huge market opportunity. And the pandemic has really allowed these businesses to accelerate because it was fit for our market need. Specifically to your last question, we have a variety of different partners in our network. Some of the ones that are coming new to the market, they are part of our network.
We continue to evaluate whether they will be in different networks based on the client and the consumer need, But we continue to see good opportunity. The last piece I'd say we're also excited about is our multi dose packaging. We have a now really strong offering in the market there, which augments our home delivery and e pharmacy. So good opportunity and expect continued strong growth going forward.
And you can get the last year holiday shopping done at the Optum store with free shipping available to everybody. Thank you, Lance. Nice to have you with us today. Our next question comes from Charles Ray. Charles, how are you?
Yes, great. Hey, can you guys hear me?
Yes. Yes, for sure.
Thanks for taking my questions and thanks for hosting this event. My question, I want to go back to a lot of the virtual care capabilities that you guys discussed today. And 2 things, I guess, really is you talked about the nerve center and unable to generate about, what, 400,000,000 alerts through the collection information. Trying to understand that when you are providing those devices for patients, is that part of the benefits that they receive so the members get those devices sent to them? And then really more with these alerts, can you talk maybe about how many actions that came out of it where you were able to proactively then intervene with members to maybe avoid unnecessary costs?
And then maybe related to that, you talked about point of care assist as well here, able to I think what the number was, 30% of members we're able to send to a lower cost of care. Is that product being sold to other payers? And maybe talk about how that uptake with payers other than UHC is kind of trending? Thanks.
Charles, great questions. Appreciate it. I'm going to ask Brian Thompson to respond. And part of the reason I'm asking Brian to respond is Brian was really the innovator around the development of the signaling Yes, thanks for that. Actually, I just was grateful to lead a lot of seniors, but
Yes, thanks for that. Actually, I just was grateful to lead a lot of people that had a lot of great ideas. I would say kind of yes to all of those things actually, Charles. It first and foremost starts with identifying folks that we know have conditions. We provide specific devices to them based on their condition.
It's a variety of them from continuous glucose monitors for diabetics to things like weights and scales for fluid retention in areas like CHF to a variety of other items as well and have expanded that here recently, obviously with the COVID pandemic, we reached out directly to our members that we knew were high risk and tried to help enable them stay in their home where they were safe. So, it starts with devices, but those are only interesting and not instructive if we can't act upon it. And that's where really I believe the value comes into play and that's largely our support teams inside Optum and that's where we really make that transition from technology to people. We've invested meaningfully in our navigators and they have their phone number and their name, not just a number on the back of a card that they can call and engage with our members. So the nurse center includes real time monitoring, examples where we've used that to stop an event, low blood sugar as an example, fluid retention is another example, dehydration, we can meet that with actual nurses in the home, we can do it via telemedicine.
We can see the signals coming through the nerve center on the devices in their home. And of course, what I find to be the most valuable is that personal relationship when they feel scared or vulnerable, they're calling their navigator to whom most of our seniors at risk have a name and a phone number. So a variety of different interactions certainly coming to life here during the pandemic and we're certainly pleased with the traction and perhaps even more so with the optimistic view of what we can do with this going forward. Thank you.
And Charles, if we did have those 1,000,000 signals filtered through artificial intelligence, we would just get inundated with kind of noise. And so what happens on the back end of all this is that what our clinicians receive are filtered signals to assist, so that we direct care to the right patient at the right time. Thank you, Charles. Our next question and our last question comes from Whit Mayo. Hey, Whit, how are you?
Good. Thanks, guys. I appreciate the question. Really a 2 part question. Can you maybe give us a sense of what the cadence of the $1.80 looks like in 2021?
And really my real question is following up on Charles with the health at home strategy discussed. As you deployed that nerve center, I think you said 4,000,000 MA members. 1, is that right? And how did you select those markets to deploy the technology in 3, what does your Optum provider network look like within those markets?
Sure. John, you want to start with the first and then I'll come back to Brian Thompson as well.
Good morning, Whit. Maybe the best way I can help with that is think about how we would look at seasonality for 2021 versus historical seasonality. And I would say it's generally in line when you look at first half, second half with historical seasonality we've had in our business that roughly say 48% of our earnings are generated in the first half, a little bit more in the second half. And so that would be the kind of the general move we'd expect. So a similar overall quarterly seasonality within that as you likely expect, there are kind of elements that are differing and playing across the businesses given the assumptions we've built in here, but still a general overall typical seasonality for first half, second half earnings progression.
And Brian?
Yes, I'd say it's all
of our markets. Obviously, we have more than 4,000,000 members enrolled across our book, but all of our markets have this option. And where our touch points are, where folks are most vulnerable. I would say our most innovative partner is certainly where we have aligned physicians like OptumCare, but we have those capabilities in all of our
and participating with us today and answering your questions. And finally, on behalf of John, Dirk, Andrew and myself, thank you for participating in the morning session of our virtual investor conference. We appreciate your time and thank you for your thoughtful questions.