All right, great. It's my pleasure to be kicking off the healthcare conference with UnitedHealth Group. With us today we have Wayne DeVeydt, who's the CFO of the company, we have Ben Eichold, who's the CFO of Optum, and we have Tim Noel, who's the CEO of UnitedHealthcare. I think, do you want me to jump right into Q&A, or do you have anything you want to start off with?
No, look, I'll just make a couple of very, very brief comments. First quarter was a strong quarter for us. High quality metrics, feeling very good about the turnaround and the actions we've been taking. The one thing that we said on the call was that you have to be respectful of trend in this current environment, and it was 2Q of last year when I think the industry really got a lot of surprises. For us, you know, it's important to see how April and May evolves. We'll get a lot of the claims from Q1 actually paid in that window and understand with a little more clarity. I would say that, if the trends we saw in the first quarter were to continue, this will be a very strong year.
Okay, great. Maybe just starting off with kind of a theoretical question, just so I understand the mindset of United, 'cause I think everybody here in the, in the room probably thinks that you're operating well below what your earnings potential is. When we think about the ability to kind of recapture that, is there a, is there a view within the company that it's, you know, the priority to get back to that target margin as quickly as possible? Or is it better to slowly kind of get back to that target and kind of make sure you're, you reinvest every year? And how do you think about managing that return to normal target margin?
The first thing I would say is we still believe in the long-term growth algorithm, which is 13%-16%. Ultimately, you know, that algorithm is in place, you know, whether we're at our starting point or not. Meaning, you know, our effort is to get back to our target margins as quickly as possible to run this business the way we have historically, and really get back to that kind of growth algorithm of 13%-16% on a regular run rate basis. The one thing that's probably a little bit uniquely different is we're in an era of AI. This year we've announced we're investing over $1.5 billion.
I think to the extent that we have continuous outperformance, we'll be able to put more of that to work along the way and make those investments. At the end of the day, I wouldn't view it as, you know, managing to an expectation as much as driving to what the asset is capable of doing.
Yeah, on the UnitedHealthcare side, just to chime in, you know, I think our targeted margins that we have in each of our businesses, reflect points that we believe to be also indicative, kind of rational and responsible pricing in each of those businesses. So those are targeted margin ranges that, you know, we're interested in pacing back into, because of what that represents as well. And you know, it varies a little bit by business. However, our intention is to, you know, get back to those targeted margin range, largely by 2028 in all the UnitedHealthcare businesses.
Okay. That 13%-16% growth algorithm, I think that for, you know, for a decade or so you know, certainly pre-COVID, it was pretty clear how to get there because MA was growing high single, low double, and Optum Health was growing 20%+. What is the driver to 13-16? What's the building blocks that gives you confidence that 13-16 is still the right number?
So if you think about the basic drivers of this growth algorithm, you know, roughly a third is just capital deployment. The idea that, you know, we are deploying both for buybacks, we're doing M&A growth and the synergies that come from that, and obviously we pay a dividend on top of that. When you take the other two-thirds, you know, it's a combination of margin expansion, so returning back to not only historical margins, but where we believe margins can be in the long term around our Optum Insight segment. Of course it's top line growth. It's kind of that, you know, 7% plus that you've got to get back to with top line growth over time.
From our perspective, you know, we see in the current environment, especially with the lower margin profile that we have and our desire to just get back, that the margin component, I would say, has an easier path to it. The top line growth is one that we have a lot of high confidence in. I think the way the algorithm was in the past will look different in the future because you're gonna see us shift a lot more to AI. You're going to see the infrastructure savings of that will come through margin. More importantly, we'll productize that into Optum Insight, and we'll be able to offer services that become really kind of a monthly subscription over time versus the historical of, what I'll say, total contract value, kind of the backlog that was there historically.
The pieces and parts will shift around slightly, but the core basics of it are pretty simple, right. You've got to get high single-digit revenue growth. You've got to expand margins, you know, 20-50 basis points a year, and you've got to basically have capital deployment.
Yeah. I guess when we think about the high single digit growth, like, is that what you think UnitedHealthcare could be doing over time? Like, which businesses are we talking about?
Yeah. I, you know, if you break it down into a couple components, one, we certainly need to return back to our targeted margins, which as I just talked about, we have a path to that in all of the businesses. As you also, you know, think about maintaining those margin ranges with a revenue growth outside even of the volume component, that drives a portion of the overall growth towards those high single digits. Lastly, we do continue to see opportunities for growth in Medicare Advantage, and also on the totality of the commercial business. You know, it's really an imperative of ours to maintain cost competitiveness.
Leaning into AI is gonna be an increasing focus there on the way in which we generate affordability, probably pivoting more towards administrative opportunities, because we see greater opportunities there with how we're deploying AI. And, you know, being competitive in the marketplace will allow us to see some of the volume growth that'll supplement, you know, getting back to the margin areas that we wanna be and just some of the overall, you know, revenue growth that occurs on a unit basis as we will, you know, price to maintain those margins and targeted margins into the future.
I mean, I think that United is such a big, complex company. Is there a way to kind of focus us in on 2 or 3 businesses where you say, like, if these 2 or 3 businesses catch the way we think we're going to, then 13 to 16's, you know, pretty well set up?
Look, I would summarize that the two businesses you need to spend a lot of focus on prospectively are going to be Optum Health. Value-based care is even more critical today in the environment that we are in as a country and in where the government wants to take things. Today we serve around 20 million members in Optum Health on a kind of fully vertically integrated VBC model. I think you will see a fair amount of growth within that asset, both margin recovery happening fairly quickly, and then you'll see the top-line growth really move from there.
I think the other one is Optum Insight, you know, being in this industry for 30-plus years, this is the first time we really do have the tools, meaning AI, to kinda revolutionize the business and remove a lot of friction points that exist there. Because we have the ability to understand how the providers think and the needs that they have, because we serve in that space as well as the payer, we really have a unique opportunity for AI to create the connectivity that others cannot do. You have to actually have all pieces of this puzzle to make AI work in a, in what I would call a high functioning way. We also have the cash flow to be able to make those investments in AI.
By doing that, we create products internally that we know our providers and our payer businesses want, and then ultimately we monetize those through selling those back out into the broader market. I think what you're gonna see is it's gonna be a little bit of a longer window 'cause we are decommissioning all the historical non-AI products right now, and we are reinvesting in those, but we are getting sales pipeline already, and those are growing already. I think you'll really start to see that, you know, kind of extend more into 2027, but back half of 2027 into 2028, that will really be differentiated. I think in the near term, we said Optum Health was a multiyear journey to getting our margins back.
We are ahead of schedule on that, still expect to be there by 2028 to the low end of our ranges. I do think you'll start to see the top-line growth from that happening as well. Those two I would put a lot of specific focus on. Candidly, with Tim and UnitedHealthcare, it's a very mature business. It's one that, you know, has been built over, you know, 40-plus years and one that really matured over the last 20-plus years. You can see how quickly that area can be resolved within a year, right? You benefit design products, et cetera.
You know, this year we've already said that, you know, we'll be within our target margin range and, you know, biased towards the upper half, and we expect to be in the upper half for next year relative to those target margins. I think that will recover quickly, and the focus needs to be on health and insight.
Okay. Then what kind of growth can Optum Health deliver longer term? Like, you know, can we get back to 20% now that you've you know, redone the value-based care repositioning, or is it still kind of TBD as to what growth we should be expecting there?
I don't know that I would call it TBD. I'll ask Ben to go into a little more detail. I would say that late last year, this year is all about just refocusing.
Back to basics, getting back to the core of what we did, removing distractions from the business that were not part of the core value-based care model, which meant pruning certain assets. We are substantially through that pruning process. The businesses are refocusing back on where they were at before. There's another party involved in this, which is our third-party payers that we work with for value-based care. We're having probably some of the best dialogue we've had with them in a long time around benefit designs, the new world we're entering, target margins for them. You know, I don't wanna say that next year will be that top-line growth year because, again, I need to see how this open period with payers works through. We're encouraged, I don't know, Ben, if you wanna add as well.
We recently did some five-year planning as well, so maybe you can highlight a little bit of our views.
Yeah. Yeah. As Wayne DeVeydt said, you know, we're serving over 20 million patients throughout Optum Health right now, and that's across an entire integrated value-based care system. Primary care, specialty care, home health, hospice, surgery, behavioral, labs, imaging, and that's really how we're focusing on managing the business. You know, if you don't look at the full 20 million, you're missing the opportunity of what Optum Health has the potential to do. You know, I think as we also come to market, as Wayne DeVeydt talked about with our payers, you know, there's a lot of different risk appetites for payers. Also on our side, it needs to be the right benefit design, it needs to be the right footprint, the right network, and the right rates.
We're coming to market with approach with providers, where we might do fully accountable, we might do a professional cap, we might do a shared savings, or in some places we might do fee-for-service. We're going to have that optionality within Optum Health, as we think about the future and focus of value-based care. As we sit here today, Kevin, there are some of those services that are performing well above our 6%-8% target range, and we will obviously continue to lean into those. There are some that will and are performing below that target range, and that's where we have our highest and most intense, you know, turnaround plans, operating discipline. Those places are also key feeders into the rest of that integrated value-based care system.
I think it's too early to say, you know, exactly what that long-term growth rate looks like, but we do feel confident in the 6%-8% target margin and see a lot of growth potential within Optum Health.
Okay, great. I guess one of the things that just came up recently, you guys announced last, I guess yesterday, the new Optum Rx model. Can you talk a little bit about that model? It seems like every company has announced something in the last, you know, year or two. Like, how is this different than what else is out there? Should we be expecting any changes, any investments to get to that model or any impact to margins on the PBM side when you get to the other end of this model?
Yeah. I'll answer your last question first. We don't expect any big upfront investments to get to the model, and we do expect OptumRx to continue to operate in the 3%-5% margin range. You know, as far as the transformation goes, you know, we have been out there and proactive in anticipating the transportation or, excuse me, transformation that needs to happen for the PBM and have also been leading the industry in transparency. I mean, we're right now passing through 98% of our rebates to consumers, expect to be at 100% over the course of the next year. This is something that was kinda the next evolution of how we make the PBM more transparent and provide that visibility to our stakeholders.
Really what it means for them is more visibility, more predictability, more affordability in how they contract with the Optum Rx PBM. We're really excited about it. You know, it's not mandatory right away. There will be an option of do you want to, you know, enroll in this model for new, existing, and retained members as we go through that cycle. But it will be something that brings, you know, a lot of visibility, transparency to any GPO fees that are in there, any rebates paid from pharma. That information will be shared. Then we will be paid based on the value of the services that we're delivering to our constituents. They'll have full visibility into that. We're also bringing affordability and transparency to the consumer at the point of picking up the prescription.
We'll have Shop MyScript, which is when a prescription is written, you'll be able to go in and see where can I pick it up. Is it mail? Is it retail? Which is the cheapest? What's the best option for me? Also Price Wise, which is a cash option. It gives you the exact cash option plus a small transaction fee that will all be completely visible to the consumer. You know, the organization that's partnering with Optum Rx gets the transparency and visibility and predictability of the fee. The consumer gets that point of sale affordability options with Shop MyScript and Price Wise.
Okay. Just to be clear, we talk about the no impact on margins. You're talking about within the PBM business itself, 'cause Optum Rx is a big business.
Yep
and specialties there.
Yep
You're saying within the PBM business, you don't expect a margin impact.
Yeah, we expect this to be relatively margin neutral. I mean, you know, 3%-5% is Optum Rx overall. Within the PBM business, we don't expect that to change.
I guess there's always a little bit of skepticism, just because PBMs are hard to understand from the outside looking in. Like you said you're starting to offer this. Do you have any contracts that are at similar margins now that you as a proof point to that? Or is that still kinda TBD?
Maybe, to put a finer point on all of this, we as an organization have come to the decision that we have an obligation to be transformative in this new window. You know, I think it's fair to say that regulators wanna see our business model be performed differently, both state and federal. I think it's fair to say that the American public wants to see a different mechanism that removes friction from the system. On the PBM side, one thing that was very evident, both from regulators and our customer base and others, was they wanted full transparency, full transparency.
Even though we had already passed on a hundred percent of rebates, even though we thought we were being transparent, we realized that full transparency truly meant that they could see every aspect of your cost of goods sold and what's happening, and then we should get paid for the value of that transaction. We decided to pilot this with a few new customers to see how that would actually work in the market. These were customers that were with some of our larger competitors. We were able to go to market, provide full transparency on the GPO, show them their options if they wanted a GPO, if they wanted full rebates, if they wanted a fee-based approach, but allowing them to have those components. We were successful.
The number one reason we got was, you know, essentially for the first time, I actually understand all the parts and pieces that make up the PBM. What we've come to the conclusion on is, you know, we need to be transparent. We need to kinda demystify this idea that we're not transparent. We need to be easier to work with. You probably saw last week, Tim Noel, rolled out across the entire country a substantial reduction in prior authorization. I think a lot of folks wonder, like, "Well, doesn't that mean that payment integrity is not gonna work as good?" Well, quite the contrary. The tools are available today that you can pin in quickly on where you have a prior auth problem and don't.
Maybe, Tim, just elaborate for a second because I want folks to understand this is a movement, and we have an obligation to lead this movement, and you're gonna see much more transparency around what we are doing in our interactions and more emphasis around removing friction versus defending the old business model.
Yeah, you know, our mission, part of our mission is to help the healthcare system work better for everyone. We're leading the modernization of how that healthcare ecosystem works. You know, there's been some commitments that you've probably heard about prior to the more, more recent one around standardizing prior authorization requirements, which today, or, prior to this, physicians didn't really know what had to be submitted to render a full and complete prior authorization. A lot of that friction and the back and forth was created because of that. We've also made a commitment that by the end of 2027, all of our prior auths will be processed in real time.
Then this most recent initiative that we announced was a 30% reduction in all of our prior auth volumes. It's actually more than that on a code basis, but of the volumes, what patients and providers will experience, there's a 30% decline. We're leading here on eliminating abrasion, eliminating latency, making things predictable, and more real time, and believe that this is a direction that we need to go to differentiate ourselves in becoming a carrier that's easy to work with, that shields patients and providers from some of the abrasion that has historically existed in the system. We know, does this come at a cost? It does.
This is an investment that we're making. There are also many opportunities, as Wayne was alluding to do this differently. We have much better early signaling capabilities to understand where we're seeing hotspots, and we have the ability to treat the sources of those hotspots with the attention needed and where it's not needed to allow some of these transactions to flow abrasion-free. It's also already generating some different conversations with providers as we sit down and talk with them about more exciting topics around, you know, interoperability and how this flow of data and how the automation of these transactions allow for large efficiencies in our operations, but also large efficiencies in the operations of health plans as well.
You know, I think of the investment that we're making as really one that's probably short-term with lots of opportunities to offset the costs of some of these things because you've taken out abrasion, and with the abrasion you're taking out a lot of administrative steps on both the payer and the provider side, and also starting a different conversation with the provider community. That's one that's more partnership based, and, you know, that's both good and bad. In areas where we're seeing challenges, those are resulting in, you know, conversations about what are the drivers of these things, and you know, us getting after those things very real time, and focusing on elements of our network in ways that we probably haven't been able to do before.
Some of the new technologies are allowing us to, you know, get at affordability in different ways. You know, we're not talking about pay and chase here. We're really more talking about partnership models and more in-depth interactions where the sources of hotspots are very quickly as opposed to kind of, you know, having everyone experience the same level of authorization requirements.
All right. Then, I guess, Wayne, at the beginning, you kinda talked about Q1 data points coming in well, is this caution, you know, normal Q2 caution, or is there something about the way Q1 developed that says, you know, in a, even in a normal year, this is a little bit unique for me, whether the storms or the flu in January, you know, kind of lower your visibility or whether it's just normal dynamic? Then I guess it's been a few weeks. Is there any color on what's happened in the last couple weeks?
Maybe first to start with, historical dynamics, that we would see what I would call normal trend and normal patterns have really changed quite a bit in the last several years. You had the Inflation Reduction Act, which created some turmoil in how things would develop around Part D. You had three B, you know, the president's kind of, you know, flagship budget and what that did. One of the things that we are trying to do is, one, be respectful of the fact that historical trends do not necessarily reflect current trends and how things evolve. The second thing is, you know, we're in an active AI environment and, you know, parties are learning how to code differently.
They're learning how to categorize services differently outside of a DRG. We wanna be respectful of the fact that these trends are occurring. You have kinda what I'll call the macro overlay, but then you have the micro overlay of what individuals are doing. That being said, you know, January, February, and March were all very strong months for us. There was not a anomaly month in there. We did have a lower respiratory quarter than normal, but it was not a, you know, huge driver of our performance. Those trends in April have continued. I think getting, you know, kinda one more month under our belt in May would do a couple things.
One is it would give us a better feel on what I would call those kind of micro things that are happening in the market, where people are using AI to code differently and manage differently and make sure that our own systems and processes to capture this and understand the trend better are occurring. Right now, 4 months in, we're feeling pretty good. Then I think on the macro, you know, as we look at, you know, the One Big Beautiful Bill Act, and I think we've kinda got the seasonality of that figured out now. A little bit abnormal this year. I think in the future, you know, we'll be in a better spot, but I think 1 more month will be helpful.
Yeah, you know, the pieces that were maybe discreet, one time in nature, lower respiratory season, as well as the storms, those are, those are pretty easy for us to quantify, and we've always felt good about our quantification of that. It's, it's really just around what we have seen in Q1 is that durable and persistent, and every month gives you more confidence in that, and we certainly saw that, in April, which points to not only, you know, what we saw in the first four months of this year, but also how you're seeing, 2025 complete as well, which is certainly part of the conversation.
Pointing to durability and what we talked about in Q1 of, you know, modest favorability in the government programs business, Medicaid, Medicare, we feel like that's, you know, pretty good read on what we're seeing.
Okay. Then, maybe shifting gears to MA, you know, obviously the rate notice, the final rate notice was much better than the proposal, but it was still well below, I think, what you guys were talking about.
Yeah
necessary. How do you think about closing that gap between trend and rate next year? You made a major overhaul this year. Should we be thinking about something more stable into next year, or how are you thinking about dealing with that?
You know, we're going to look at all the same types of things that we looked at for benefit planning for 2026. Close look at our plans, the footprint, the plan configuration, you know, network versus non-network. We're going to look certainly at all the benefit levers inside of those plans. We are in a posture of pricing for some level of margin expansion for 2027. You know, given the dynamics around rate and trend, it would be logical to assume there's going to be some level of benefit trimming that's going to be needed to achieve that. A posture, you know, not a lot different than last year. However, I think there's two things that are different.
One, we, you know, made many decisions in 2026 to make sure that we took care of plans that were, you know, poor performing, that we didn't see having a role in the future. The second area is, you know, we're starting from a really, you know, I would say healthy position in terms of the financial performance of our plans. The corrections we made worked out. We don't have a, you know, a lot of plans that were sitting in a position that require, you know, a significant change as a starting point. We're really just kinda contending with the dislocation of rate and trend. We're not, you know, looking at deferred maintenance from decisions made in the past.
I think we're coming at this from a good starting point. We're, you know, feeling good about our ability to achieve all of those objectives for 2027.
I mean, you guys did exit a lot last year, but it sounds like things are coming in better this year. Is there a chance that you cut too much last year and would be going back?
No, I, you know, there's none of that going on. You know, when we look at the plans that we exited, you know, that we're comfortable that it wasn't within, you know, if you get some level of favorability on your core assumptions, it wouldn't have made us change our posture there. These were plans that, if we, you know, had, we probably would've stuck with those. Things on the margin, because we have opportunity to obviously improve plan performance. You know, these plans were plans that we needed to address, and we did.
Okay.
Kevin, one thing I would add is I really would say in hindsight, you know, we've looked at could we or should we have done things differently, and I think we've concluded that these were really no regret decisions, and that even had we changed our pricing posture even slightly, we still would be down about 1.3 million lives, right? Like you know, what we can't control is competitors and how they respond in the market. What we can control is what we believe the right product design and the right pricing is at an appropriate, durable, sustainable margin. I think we have no regrets for a couple reasons. One is we don't think pricing would've changed the outcome.
That would've simply left margins lower and left the industry, we think, weaker in many ways because there's less sustainability to the product, especially with the forward-looking rate environment that we're seeing. 2 is because of the forward rate environment that we saw from CMS, we feel very fortunate that we took the aggressive moves we took this year because that means next year we've already taken the hard hits, and we can be a little more surgical in how we look at benefit design and markets that we're participating in. It's a really fair question, but one that we've looked at and concluded. We actually think these were the absolute right decisions.
Okay. Then it seems like CMS has obviously had some concerns about risk adjustment.
the potential overpayment within the industry. I think in particular, they've kind of cited that the larger companies have an advantage on this, and they want to kind of narrow that gap. There's been some questions about, you know, the 2% or almost 2% that got pushed out, and whether you guys are impacted more by that or if there's I guess, A, answer that, B, is there anything on the horizon, if CMS does go after home risk assessments or goes after linked chart reviews? Is there something out there where you would feel like it would be disruptive to the business?
Yeah. To answer your first question, in the 2% that was proposed, we don't see a disproportionate impact for us, and I know Ben Eichold has the same perspective. As you think more broadly about, you know, the modernization of Medicare Advantage, we could talk about lots of different zones there. We are engaged actively in dialogue with the administration on ways to modernize the programs, and we have the perspective that this program will modernize, it will move forward, just like everything that's happening in healthcare.
Our posture is to make sure that we have a seat at the table, like a lot of other carriers, and we're coming with ideas that are ideas that make risk adjustment better, that make the Medicare Advantage program better, and are thoughtful about how technology can be used and will be used to change and evolve the program. You know, we believe that many of these elements of the Medicare Advantage program will change, and that's probably a good thing. There's opportunities to make this more efficient, reduce the administrative cost burden on the health plan, as well as on the provider organizations as well. There's, I think the path forward is one where this will modernize, and that's a good thing.
I'll just mention on the risk model for Optum Health, I mean, we absolutely don't see ourselves as disproportionately impacted by the model. There's a lot of different components that go into the model, obviously the HCCs, but there's also the tailwind and normalization. Our book at Optum Health is a very diverse and mature book. There's chronic conditions, obviously Chronic Special Needs, Dual Special Needs, but we also serve community members. Across the Optum Care portfolio, we have a diverse book. It's also a very detailed calculation. There's 7 different risk models that go into how they were proposing this. Institutional disabled versus non-disabled, full dual versus partial dual.
When you looked across some of the most common HCCs in the proposed model, there was some of them, diabetes for full duals as an example, where funding actually went up. You know, you have to look at kind of the entirety of the model, and we do our full evaluation. We don't see Optum Health dislocated from kind of where CMS published at all.
Okay. Maybe just last question here. You brought up AI a number of times. It seems like everybody gets really excited about it. I guess when you think about the opportunity for United, where is the biggest opportunity for AI? Is there anything that people are maybe getting too excited about, you know, getting ahead of their skis on?
No. Look, I would say that the world is not getting too excited about AI. I actually think it is advancing even faster than people can appreciate or understand. Internally, I would say our primary focus has been about speed and agility. We think there's a window here where we can, you know, lead the industry in ways that others cannot. I cannot emphasize this point enough. The power of AI is in data and in knowledge. We have more data in healthcare than any other party in the world does, candidly. We have pharma data, right? We have medical clinical data. We understand the payer and provider and how they work. On the knowledge front, the knowledge is about the ecosystem. AI will clearly disrupt the ecosystem. That's a good thing. It will remove friction.
It'll make the processes easier. Our goal is not to take the current nerve system of healthcare and do a facelift and lay AI on top of it. That would be failure from our perspective. You know, our goal is to actually take this incredibly complex nerve system and turn it into a stick man, because AI should eliminate all those components of friction along the way. For us, we have many things happening simultaneously that you, the investor, will not be able to see initially, but know that we're running towards a three-year playbook of what we want this to look like. You know, we've rolled out ambient listening within our medical clinics. That means the doctors now have more time to see patients. It also means that it's automatically being coded. It means you don't need to do chart reviews.
It means it gets auto-adjudicated real time. Those are things occurring. We announced our Amedisys acquisition. Having a greater access to HSAs is not the playbook. The playbook is to be able to offer white label products to others so that when individuals are going to book a service or book a visit, that we can have it automatically paid from their HSA or automatically paid by credit card if that's their preference. The provider, who today does not collect 60% of co-pays, has the ability to collect that co-pay upfront. It's all about removing the friction points for the consumer, and I think if we do this well and do this right, we will not look like the company we are today.
We will become the ecosystem, kind of the nerve system, if you will, of healthcare, where a member can be agnostic to whether they are a UnitedHealth Group member or candidly a Cigna or Elevance or any other member. We want them to know that we are gonna help you through that journey, and the technology's gonna be the forefront to do that.
All right, great. That's all we have time for. Thank you very much.
Thank you.
Thanks, Kevin.