Good morning, and welcome to the 2021 UnitedHealth Group Investor Conference. Delighted to welcome all of you who've been able to join us here in New York in person, and of course, to everybody who's joining us online. It really is a pleasure to have the chance to see many of you together again, and we really appreciate your effort to join us. During the next few hours, you're gonna have the chance to meet with and hear from around 50 of my colleagues from across UnitedHealth Group, both within the room and virtually, some videoing in. I'm also delighted to let you know that our board of directors is here today and will be here throughout the morning. As we go through the morning, there'll be an opportunity to hear from the stage. There'll be a Q&A session. We'll have seminars, and there'll also be chances to chat with our executives across the lunch tables as we break here in the New York meeting rooms. I hope very much that you'll have a really great opportunity to get to know us, and most importantly, to get to understand what we're focused on as we look at the next eras of growth for UnitedHealth Group. This organization is really all about its people and what those people can do for us. The people you're gonna see here represent 340,000 other colleagues across the whole organization. Doctors, nurses, pharmacists, technicians, engineers, finance experts, marketing experts, customer experts, people who answer phones, people who run spreadsheets, people who give injections, people who replace hips. It's an extraordinary panoply of skills of passionate people. People who every single day wake up in the morning inspired by the mission of UnitedHealth Group. That mission doesn't just inspire the people who are here today and the people who work inside this organization. It inspires people on the outside. You know, the last few months, you've heard that label, the great resignation. Interestingly enough, in the same period at UnitedHealth Group, we've received 827,000 applications for people to work for us in the United States. Worldwide, it's over 1 million people. Interestingly enough, we have about 400,000 or 500,000 people apply more than once. They're super inspired by what it is we're trying to do. Within our leadership today that you're gonna meet, you'll also meet people who've come from all sorts of different places. You'll meet people who've been here just a couple of months, and you'll meet people who've been here for 25 years. You'll meet people who have built their entire career at UnitedHealth Group, and you'll meet people who have recently joined from other advanced careers. You'll meet people who used to work in government, people who used to work for our competitors, people who come from the blues, people who come from companies like Target. You also might find the occasional refugee from Big Pharma. This is a great organization of talented people focused on making sure that this company can truly transform health care. We do that based on our two platform businesses, Optum and UnitedHealthcare. We're focused on trying to make the experience for individuals and families simpler, more affordable, more accessible, so that they can live a healthier life, so that they can really face their health care challenges with less anxiety and less worry about how to navigate a complex system. It is a great paradox when you think about U.S. healthcare. Much money invested in innovation, so many people, so many smart people, medics, innovators, Silicon Valley, Boston, every hospital system trying to figure out better and new ways to do it. Yet somehow, despite all of that effort, all of that innovation, all of that investment, all of that talent, it remains too expensive, it remains too complex, and it creates too much anxiety for the people who rely on it. One of the reasons for that, I would argue, is that for all of that innovation, the system remains hugely fragmented. It's point solutions, but what we've learned, I think, over the last 10 or 20 years is no matter how clever an individual point solution might be, it's just a point solution. In some ways, clever point solutions can just add more and more complexity to an already complex system. For us at UnitedHealth Group, we're more and more focused on how can we take those areas of innovation? How can we think about it in a more systemic way? How can we integrate rather than fragment? How can we bring smart innovation combined with the right kind of incentives aligned with what individuals need to make sure that we can develop really significant services and product offerings that can truly make a difference, not just add to the weight of healthcare activity? That really has been the foundation stone laying process that's been going on over many years at UnitedHealth Group in both UnitedHealthcare and of course in Optum. By the way, you might notice today a slightly updated version of the Optum brand, which you'll begin to see reflected. I'll come back to that later in my comments. As we think about how we might integrate and we look forward, it takes us to a very exciting space around how we think about growth for this company. One of the things I hope you take away from the next few hours and everything we share with you is a relentless fixation on the growth opportunities that we have at UnitedHealth Group. I would argue they've probably never been greater for this company for two reasons. One, the need outside in the real world is extraordinary and not getting smaller. Two, the skills and the foundations which have been laid have created a fantastic position for us to now be ambitious around new areas of growth and opportunity to better integrate services to give better service to our clients, customers, patients, and their families. Let me pick out just five areas which we're gonna be focused on over the next several years. Some of this is gonna be relatively familiar, some a little newer. These are the five areas that we would really expect to drive the growth of UnitedHealth Group over the next several years. First and foremost, value-based care. The care delivery area, the whole story that you've seen developing here at UnitedHealth Group, as Optum Care works with UnitedHealthcare to ensure that we can develop a highly effective approach at value-based care, making sure that the physicians have the time to do the preventative work, have the focus on the patient, and deliver, in our view, superior experience, superior economic and clinical outcomes. That's what we've been building. You've heard us talk more and more about that. It's a huge part of the growth of this company. It's a big driver of the growth we expect to see next year, as we double again the number of lives that we take under full capitation within Optum Health and Optum Care. It's important as we think forward not just to think about Optum Care or even value-based care as simply a primary care strategy. It's not just a clinic strategy. We see that now much bigger. We see that as a clinic strategy wrapped together with our behavioral care strategy, wrapped together with our ambulatory strategies, our virtual strategies, and others. Think much more about how we can wrap those services all the way around the patients and their families. How we can certainly use the physicians at the center of that network, really as quarterbacks for all of the other capabilities we have. Think about how it might happen in the clinic, but it might just as easily happen in the patient's home. There should be no division between medical focus and behavioral focus. After all, the brain is joined to the body. Making sure that we think about all of these things together is gonna be central to the future growth of the value-based care strategy. That care delivery agenda is a great first example of how we are relentlessly integrating, working together across our organization, focused on collaborating between the strengths of Optum and UnitedHealthcare to build what we believe can be differentiated contribution to patients' lives. Second area, health benefits. UnitedHealthcare platform is an extraordinary platform from which to envision everything else that comes from UnitedHealth Group. It would be almost impossible to build the scale of care delivery and value-based strategy that we have without UnitedHealthcare. The vision that comes from that organization, the teams of people who lead that organization in terms of understanding what's needed by our most needy patients across the U.S., whether they be seniors or complex patients, folks who've been excluded from care, is an enormous opportunity, has been a fantastic foundation stone of this company. We see the potential growth there in many areas. You'll hear a lot more about that in the seminar later today and during some of the further sessions. Health technology. How can we leverage the technology that we have inside of this organization to be a much greater contributor to the modernization and streamlining of the healthcare system? You'll hear a lot about this in the way we're working with hospital systems. We're often painted as not necessarily the friend of the hospital system. As you'll hear later today, we're increasingly becoming the ally of our hospital partners. That's where we want to be. We know through our technology capabilities, we can truly help our partners in the hospital sector release enormous value and transform their own businesses. Just one example of how technology is gonna be a key driver of this organization. Another place where technology will speak to it directly is our fourth area of future growth, health financial services. The entire financing network, the complexity of how people get paid, the number of glitches in that system screams out for modernization. It requires a streamlining of the plumbing, and it requires a re-envisioning of how fintech within the healthcare system can be developed in the 2020s rather than relying on 1990s technologies. That's an area that we believe we're in a great position to influence, and you'll hear again more of that today. I'm delighted that Kurt Adams is here as well today, who leads our financial service organization. He'll be around for you to talk to as well around exciting programs he's running around Care Cash and other off-benefit financial service opportunities that we see being developed. Those areas play incredibly exciting role in the future of the business. Fifth and final area, of course, the most commonly transacted part of healthcare, pharmacy. Pharmacy remains the key touch point across the entire healthcare system, but pharmacy is changing, and we're gonna change with it. The future is not gonna be these enormous scale, high volume PBMs. The future is all about how we can really make sure that we are at the cutting edge of frontier medicines, rare disease, specialty, making sure that we're going where this environment's going. The overwhelming majority of new technology in pharmaceuticals is heading towards the specialty complex space. Our business will evolve accordingly. We see that pharmacy platform as a strong area of growth and, of course, an integrated part of everything else I've just talked about. Hard to imagine value-based care without an integrated pharmacy solution. It's why we're continuing to build up our community pharmacy platform within the behavioral health space, just as one example. Some really important growth areas for the company. All of that comes on top of what you've seen so far. We continue to believe that we can be a relentless multi-payer organization. We are incredibly proud that a huge fraction of the Optum business is servicing non-UHC clients. We expect that to continue to grow. That's a key driver of this company. We do not judge ourselves by how well we like each other. We judge ourselves by how well we deliver for others, how well we innovate compared to our competition. We recognize that we're just a relatively small piece in this giant healthcare ocean, but we do believe that we have a really unusual mix of opportunity. We have that opportunity to combine our innovative juices, stimuli, with the capacity to scale and test quickly. You're gonna see some really good examples of that today. I'm gonna call out Optum Virtual as a really great one. Optum Virtual had almost zero lives at the beginning of 2021. By the end of next year, 14 million people flowing through that network. To go from 0 to 14 million in about 12 months just demonstrates the capacity of the company to take an idea, tune it, develop it, scale it. That's really something of value to the entire healthcare system, because it can help others see the path forward, and that's good for everybody. We want everybody's experience to improve. Let me just lift up the perspective just a little more, and maybe be a little bit more reflective. If I look back over the history of the company, very simplistically, you might say that we've typically met an individual or a family through the UHC insurance platform of the company. Then as Optum has been built, we've gradually introduced those members to various services that UHC has commissioned to provide to the membership from Optum. Essentially, we've met people through the insurance membership, and we've gradually connected them to Optum. That's been great. That has been a fantastic evolution for the 45 million members in the U.S. that UHC look after every day. I think in the future, things are gonna evolve dramatically. In the future, we've got to recognize some really incredibly important changes. Some of it's stimulated by COVID, some of it well established before. Consumers, patients, families, they want more direct engagement, they want more direct relationship, and we are in a fantastic position to build that through Optum. As I look forward, in addition to that mechanism I just described, where we meet people through insurance and then we connect into service, in the future, it's just as likely, in fact, I think it will be more likely, that we will first meet people through Optum. We may meet them as a patient, one of the 30 million or so who roughly come into our clinics. We may meet them through pharmacy. We may meet them any way through Optum. The key is then once we've met them through Optum, making sure they're introduced to all of the other services and opportunities that we can give. Let me give you a very simple, completely made-up example. Imagine somebody comes to us online to Optum Store looking for Advil. Okay, that's great. I'm delighted they've come to us for Advil. Maybe they're coming to us for Advil because they have a sore knee. While they come to us, they realize that we have a clinical network that can help consult maybe virtually on that knee. They go to Optum Virtual. Maybe through that, they find their way to a referral to an SCA center for a knee replacement, because it turns out they really needed a knee. On the way to the knee replacement, they also realize they don't have the money to pay for the knee. Maybe there's a short-term financing need for that patient. Maybe Kurt and Financial Services can help on that. While that's all going on, that 28-year-old invincible actually realizes they're not so invincible after all, and after the surgery, decide actually, they should have had insurance all along, and then they meet UHC. That's really the future of the company. It's really a reversal of the model we've used in the past, and it's an opportunity for us to reach out. It's an opportunity for us to lift our growth ambition from 45 million members to 330 million Americans. That's really the growth perspective as an organization we are really focused on. Those five areas I talked to you about, value-based care, health benefits, health technology, fintech in healthcare, and pharmacy are the next five great opportunities for us to build an integrated approach, absolutely deliver that for our insurance membership, and absolutely offer it to consumers who might meet us in any one of those venues I just described. To do all of that, we need to really step forward in our technology platform and capability to ensure that we are a go-to consumer platform or venue. Whether they come to us physically or remotely, we wanna make sure we are best in class, and we're not today. That's an area where we will absolutely be engaged. Three themes really pull through from what I've just talked about that really are necessary for us to be excellent at to deliver those five growth areas. Number one, collaboration between UHC and Optum. Co-innovating, helping, try, fail, scale, succeed. All of that needs to be done together. Fantastic internal collaboration is the key to creating these insights, these integration points. Know which piece of innovation to take, know how to stitch it together, know how to launch an integrated model. Second, technology. Huge need for us to continue to appropriately understand the data we're privileged to hold and make sure that we can connect people more effectively. Thirdly, our consumer skills, making sure that we are truly able to be there personally when an individual needs us in whatever venue they need us. Optum becomes the front door for the company. It becomes a way to democratize access to the technologies and the capabilities we have. We think that can underpin sustainable growth for the future of the company. Sustainability doesn't just extend to the economics of this organization. It extends to our much broader contribution. Today, for the first time, you also have the opportunity to attend an ESG seminar. I'm delighted that Patricia Lewis, our head of human capital, is gonna be leading that session. I hope very much you'll take the opportunity to go listen to Patricia and the team there. There's a lot for them to talk about. This is an area we're really doubling down on, both internally and externally. Our acceleration of our diversity and inclusion commitments and our progress there under Patricia's leadership has been terrific, but it's really just beginning. There's tons more for us to do there, but we are determined to be a leader in that space within the healthcare sector. Our commitments across the board on areas like health equity. You'll hear much more about in the seminar. It's an area we think is completely authentic for us to make our contribution to social environment. It's to our core, it's to our mission, it's what we try and do every day, and by focusing on the health equity agenda, it makes us more restless, more interested in trying to help those who might be excluded. You'll see an example of that later on this morning. Thirdly and finally, of course, the environment. I'm delighted to tell you that today, for the first time, the company is making a commitment to be net zero by 2035. We make that commitment with a joint commitment to say we will achieve that without reliance or minimal reliance on carbon offsets. We're gonna do it authentically and properly. We are determined to make sure that as part of our efforts to streamline and simplify healthcare, we're gonna do that in a way which contributes to carbon reduction. We're involved with the National Academy of Medicine Decarbonization Strategy nationally. UHG co-chairs that alongside the administration and the National Academy of Medicine. It's a great place for us to help the whole sector move forward in this important agenda. There's one other little thing we're gonna try and do. We're gonna try and take our business paperless in the next two or three years. That might sound really minor, but actually when you think about the amount of complexity and the amount of paper which is generated in the system, I don't know how many explanation of benefits letters you all receive. You can imagine if we can start to make progress there, it's a really tangible way of demonstrating simplification. Our commitments are all about growth, are all about pulling together areas of innovation and opportunity, trying to drive integrated service offerings to open up new areas of opportunity for patients, providers, and of course, for ourselves. We aim to do that in a deeply responsible way, as you would expect from this company. We want to do things that are authentic. We want to do things that last. We want to do things that make a difference. We want to do things that make a difference for individuals and their families. We want them to be healthier. We want them to recover more quickly, and we want them not to be anxious about being able to afford their care. We think if we can do those things, we have a remarkably sustainable growth profile going forward, and I hope during the rest of today, you'll have the chance to get to know more and more of that detail. We truly welcome your engagement and your questions as we go through the rest of the sessions. With that, I'd love to invite John and Dirk to come up on stage for us to kick off the rest of the session. Just while they're coming up, you're gonna start to hear us talk about a series of different activities, going deeper into some of the things I was just talking about a little bit earlier on. There's a few common themes, so rather than us repeating it 18 times during the rest of the morning, I thought I might just give you the headlines up front, the kind of thematics that might run through what you're gonna hear. The first, you're gonna hear a lot about data analytics being a kind of underlying capability, clinical expertise of course. Making sure that we're doing a great job of trying new ideas and then bringing them to scale as fast as possible, and how we can drive greater connection across the whole system. All of those four things you're gonna keep hearing time and again, data analytics, clinical expertise, getting to scale, quick try, move, innovate, move this business forward, all really trying to underpin the mission that I described all the way through. I hope you recognize that kind of aspect of our work as we go through the session this morning. Who better to start us off than Dirk? Thanks, Andrew. That's a great place to start. When we talk about value and a value-oriented system of care, we have something specific in mind. For some, it's about risk transference or incentive payments. Those are critical aspects, but we actually take a broader view. Put simply, it's better care at lower cost, where payer, provider, consumer incentives are fully aligned. For care providers, it's about creating greater capacity for patient care, ensuring physicians have the time, tools, insights to care for their patients when they're sick and to keep them well. For payers, it's about making high quality accessible and affordable, keeping chronic conditions in check, and making every healthcare dollar do more. For consumers, it's about simplicity and outcomes, quality care, whenever and wherever they need it. These pursuits are connected. They can't be achieved in isolation. In order to drive growth, we're mobilizing the full capabilities of UnitedHealthcare and Optum to create a better system in three specific areas. Okay, this is the tell 'em what you're gonna tell 'em part of the talk, so everybody pay attention. One, driving value over volume. Two, creating comprehensive home and community care at scale. Three, streamlining and simplifying the healthcare system. That's the focus of what we'll talk about over the next few minutes. With that, I'll turn it over to John. Thanks, Dirk. Driving value over volume at scale can deliver durable improvements for the healthcare system. Evolution of this magnitude is difficult in a system where the fee-for-service roots run deep. It's especially difficult for physicians and health systems trying to balance the daily demands of volume-based business models, all while building the financial and operating capacity to move to fully accountable care. Optum and UnitedHealthcare are helping tens of thousands of physicians move along the value continuum, and we are accelerating these efforts because they help patients live healthier and more independent lives. These more accountable models resonate with physicians. They can spend more time with their patients, provide high-quality care, and have measurable impact on their patients' health and well-being. Ultimately, all the reasons they became doctors in the first place. As we work together, physicians get access to a collaborative network of peers, advanced data for more informed decision-making, and technology that aids clinical approaches, care coordination, and administrative management. We are by their side, helping navigate every step of the transition. The experience on this journey of Dr. Rafael Rodriguez illustrates this well. After I finished my residency program, specializing in internal medicine, I moved to South Texas, the Rio Grande Valley area, and I started my solo practice down there. My population was elderly, underserved, with multiple medical problems. Optum has created an organization that delivered this quality of care, and most of this knowledge and this support and structure has come organically. It's nothing that was created in a war room or people design it. This is something that has come for best practices, brought to the office a sense of that everybody has a role in the care of the patient. I didn't achieve that before the organization came to my office. I was kind of surprised because they said that the quality of care that I was offering was only three-star. I was actually embarrassed because I was considering myself to be an excellent physician and doing everything for my patients. When they told me that, I could not believe that. I realized that at that moment that you cannot manage what you cannot measure. In two years, by 2017, I went from 3-star to 5-star. In the past, I was just getting into the room. I only have, like, 2 or 3 minutes or 5 minutes, and I was just giving them orders and leave. This new model that you can spend time with your patient and offer quality of care instead of volume. At the end of the day, when the patients notice the benefit of when I sit down with them and said, "I have checked for cancer, for your cholesterol is controlled, your blood pressure is controlled, your diabetes is controlled," they actually like that because there was more conversation about their health. When I started, my MA population was about 250 patients. From 2015 to 2020, I grew from 250 patients to 950 patients. I feel very happy about my journey and about the way I was moved from the affiliate to contracted and to employed. I've been complaining about the system for 25 years, and now I have the opportunity to make the changes that I want, that make sense, that is good for my patients, and have an organization that listen to it. We get to hear those stories almost every day, and Dr. Rodriguez is among the 60,000 physicians who care for more than 20 million patients in more than 40 states. Optum Health today delivers value-based care to 4.5 million patients, with more than 2 million in fully accountable arrangements. Our growth continues in many ways, including standing up optimal sites of care, which combines strong outcomes with physician and patient convenience at far lower cost, adding physicians organically, even hiring directly out of residency and providing mentoring and training, and attracting new patients due to our high-quality, comprehensive service offerings. We're expanding in new geographies, such as the Northeast Corridor, where we now serve almost 4.5 million patients, more than twice as many as 4 years ago. We're deepening our presence in long-established markets like Texas, Florida, California, and the Mountain West. We asked some colleagues in Southern California to explain more about their experience. We had a number of organizations that make up our California Care Delivery Organization, and each of them had incredibly unique capabilities, served different parts of the geography. The journey we've been on in the last few years is actually bringing those organizations together into a unified ambulatory-centric integrated delivery system that's now serving five counties in Southern California. The journey has been one about taking the best of the different worlds that each of these groups grew up in and making it a better organization by taking those best practices and unifying them so that our patients and our physician partners experience us as a unified network. UnitedHealthcare has a deep relationship with Optum Care all across the country. From our most sophisticated here in California with products and global risk, to our more emerging markets like Colorado and in the Northeast, where we're working closely together along that value-based care continuum. This partnership is key and critical to our value-based model. We've had really great outcomes here in California across quality, affordability, and growth. From a quality standpoint, our senior patients continue to be able to get the chronic disease management as well as the preventive care that they need. We are oftentimes leading on the star ratings across the board. For affordability, which is a big challenge across the country, we are able to manage the total cost of care through affordability initiatives, including making sure patients get the right access to urgent care instead of emergency rooms, where hospitalizations are done in the best possible way. Most importantly and most significantly, where surgical care is done in ambulatory settings rather than in hospitals where appropriate, where the quality is better and much more convenient for patients. For our physician partners, we're actually offering a value proposition to doctors who wanna be employed, but also doctors who wanna stay independent and who want to be working in independent practices and yet can benefit from the support of the value-based infrastructure we're able to bring, but also the multitude of payer relationships we're able to bring so that they can grow their practices. Value-based care plays such an important part in UnitedHealthcare's growth strategy. The more value-based care arrangements we have with our provider network, the greater predictability we're able to bring to our membership and customers through cost, through experience, through quality, and ultimately in loyalty. Some of the best examples of when you know your strategy is working is when you're able to continue to grow. Whether it's in our commercial population, our Medicaid population, our senior population, we've shown an ability to grow our patient base in all of our markets, but also in a way where patients come to us and they wanna stay with us. Beth and Amar show that UnitedHealthcare and Optum can have a profound impact, both when collaborating directly with each other and when they direct their considerable capabilities toward a common goal of improving experiences for people. UnitedHealthcare has been a leader in provider-oriented value-based care for many years. In fact, to date, most of our UHC Medicare Advantage members are cared for by a provider with some level of value-based arrangement. However, the scope is quite modest compared to what we believe it can and should be. Looking at the Optum Care practices, those that have been with us the longest consistently deliver top clinical and patient outcomes, including almost 20% fewer hospitalizations, and achieve strong operating performance. In fact, at those longest-standing practices, the number of patients served, number of physicians, and total revenues have grown by multiples, and largely organically. This evolution doesn't happen in just a year or two. It is a multi-year process. As we think about the growth potential, what's striking is that over half of our current practice portfolio is what we would consider still quite early on in their transition. Even among those most advanced practices, we still have considerable opportunity to build out the scope of their service offerings. This is one important reason why we are confident in the long-term double-digit growth outlook for the business. Further, we expect continued growth as we expand our coverage of value-based arrangements to serve more people in the commercial and Medicaid channels, as well as adding more people in Medicare Advantage. Andrew. Thanks, John. As I said before, the opportunities in home care will be massive over the next decade as growing capabilities enable it to become a practical and preferred setting for primary, urgent, and post-acute care. We already know how much cost can be taken out of the system by simply shifting care settings. Moving half of routine joint replacements to ambulatory centers, diagnostic imaging to low-cost centers, and treating people at urgent care instead of emergency departments could save the system almost $400 billion over the next 10 years. There's way more that could be gone after, yet the real opportunity lies in migrating more care out of facilities and into the home. There are many facets to our comprehensive home and community model, and today we'll highlight four: home, virtual, behavioral, and community care. Let's start in the home. High-quality home care is only possible with a value-oriented payment model. It just won't work in the fragmented fee-for-service world, given the time pressure physicians face with high patient volume. Instead of getting paid based on how many patients they see, a value-based model compensates providers on the quality of patient outcomes, which is why home care and the more personalized approach that comes with it are so important. Here's how Dr. Kylander and her team are supporting a couple in Boston. My health conditions are many and varied. Sleep apnea, chronic AFib. I have an aortic aneurysm that's about four centimeters in size. I have COPD with chronic bronchitis and emphysema. I have two leaking heart valves. I have coronary disease, congestive heart failure, type two diabetes, and I have stage four kidney cancer that's metastasized into my lungs and my pancreas. Has it impacted my life? Absolutely. We've been married for almost 50 years. We basically grew up and raised the kids in South Boston. We have 7 children together. Any day, we're gonna have another grandchild, and that will be 10, which is so fabulous. As I sit in the Parkers' home right now, I'm looking at walls of photographs of family members and children. Really just life all around. You see what they see every day, what they wake up to in the morning. Basically, our whole world revolves around the grandchildren now. We get to see the kids all the time. They come down here. It's not a very long jump for us to go up and see them. We like to make memories with them and different things, you know. They're better than medicine. When you have patients who do have multiple chronic health issues, you can't really just solve those issues with one person. We think about their medical issues, but we also have to think about their social issues and also their psychological issues. For the Parkers, we've actually been able to bring a lot of our team members into their care. We're so lucky to have a really deep team. We have nurse case managers who are able to reach out telephonically. We have an ambassador team, which is really community outreach, being able to look into services for our patients, including meals, extra care in the home, even a haircut in the home. We also have geriatric pharmacy, geriatric dieticians, as well as social work and behavioral health nurse practitioners. The visits that we make with Daniel for his COPD exacerbations, his increased breathing problems, are really pivotal in making sure that he's able to stay here. Dr. Kylander and team have Yes. They come in and made it a lot easier for us to maintain our health. They are able to write prescriptions for us right from here, and we don't have to go in and call a PCP or call a specialist. It's made life a lot easier for us. When you're sick at our age, it's very difficult. It's eye-opening, and it's really essential for people who have advanced and chronic health issues to be able to see how they're living in their homes. Prior to Dr. Kylander coming out and seeing us, I would have to trudge all the way into Boston into the emergency room. Or I'd have to make an appointment with my PCP. I was basically in and out of the hospital every three months. A couple of times, I had to call an ambulance to get me out because I couldn't breathe at all. Whereas I can just pick up the phone and make the call, I'm a lot better off. In a setting where you're coming to them, and you're also entering into their home. You're a guest in their life, and you're a guest in their home, and you're showing that you're there for them. It's a tremendous privilege to be able to be in this setting. I'm so happy to be able to do this job. We're planning on going to Rhode Island, and all the grandchildren, my children are all gonna go down and have a little Christmas party. Just, it's more so just for memories for the kids. I'd just like to say thank you to the Parker family for letting us show that, and I hope you will join me in wishing them all the best as they face their health challenges. I'd like also maybe to ask Dr. Wyatt Decker, the head of Optum Health, to comment a little bit from your perspective on what we just saw. Yeah. Thank you, Andrew. What you just saw, that comprehensive care focused in the home for the Parkers is an area of significant investment for us at Optum Health, particularly for seniors. In fact, in 2022, we'll nearly double the number of fully capitated lives we're caring for in our home and community platform. The other comment that I'd share with you is the deep satisfaction that our clinical teams have working in these kinds of environments. Dr. Kylander is triple certified in family medicine, geriatrics, and palliative care. She now does 5 or 6 in-home visits a day instead of 15, 20, or 30 visits in a clinic setting in a fee-for-service practice. She tells me she loves her job, and she really hopes she never goes back to the grind in a fee-for-service practice in the clinic setting. In the home, we often see things and gain insights around social determinants, food insecurity, or even fall risks that we would never do in the clinic. Andrew, this is a very powerful platform for us that will continue to add value as we grow. That's great, Wyatt. Thanks so much. I think as you and I have talked before, you could imagine in the future, primary care being much less office-orientated, and over time, becoming much more home-orientated. As you just heard from Wyatt, that seems to work well for a lot of the physicians, and it clearly works for the families. It's a lot easier to see the challenges and the problems when you're in the home, just as you saw with the Parkers there. Of course, that's just one way where we're meeting people in the home. Another is through house calls. A true collaboration between Optum and UnitedHealthcare, where our clinicians help seniors in Medicare Advantage programs manage their chronic disease, close gaps in care, and stay healthy and out of the hospital. Our teams not only look after our members' medical needs, they help with any number of life challenges, like keeping healthy food in the fridge or finding assistance with a utility bill. Our house call clinicians will make about 2 million home clinical visits in 2021, leading to hundreds of thousands of referrals for much needed care. Nearly 80% of that results in an in-person visit with a physician within 90 days. Now, you can imagine the last 18 months how important this has been for seniors who just didn't wanna leave their homes during the COVID pandemic. Imagine how isolated they would have felt if it wasn't for those visits from our house call teams, and how many gaps in care would not have been spotted, and how much disease would have spiraled further out of control. Helping people safely return home from the hospital is also critically important. This year, we'll manage nearly 500,000 post-acute care transitions, earning member satisfaction scores of more than 90% and reducing costs by nearly 25%. Another critical element of our strategy is virtual care. I mentioned a little bit about this earlier. Virtual visits, yes, offer transactional convenience, but we believe there's more value to patients and physicians when the full range of care services, primary, urgent, behavioral care, are all integrated and available at a moment of need. That's why we built the Optum Virtual Care platform. It lets patients connect with their own care provider, not just any care provider, and is now available 24/7 to more than 7 million UnitedHealthcare members. As I said earlier, in 2022 we'll be able to provide access to double that number, 14 million, across all 50 states. This is an example of how we can quickly bring good ideas to scale through enterprise collaboration, meeting a critical market need while going from zero to national scale in just months. Optum Virtual also provides the backbone to UnitedHealthcare's brand-new virtual-first health product, NavigateNOW. It connects members to a personalized care team, simplifies the experience for patients, and helps reduce premium costs by about 15%. It is currently available to employers in 9 cities, and we plan to add 25 more cities by the end of next year. We intend to offer it to our self-funded customers starting in 2023. Here's how it works. The pandemic really set us up for a catalyst to introduce telehealth in a new way. We took the learnings from last year and used this technology to be able to deliver the care that people needed and the convenience that they wanted, which is in their homes. We first built proprietary technology that connected our assets across the company, and then we stood up Optum Virtual Care, which is a 50-state medical group that is focused on a virtual-first offering. Not virtual only, but virtual first. We now have the technology to connect people to healthcare in their homes and their workplaces. If they need care in person, our technology makes that a seamless, great experience as well. NavigateNOW is more than just telehealth capabilities. It's a comprehensive offering that starts with virtual, where you get an entire care team helping navigate and guide you through your journey, helping you make those decisions about when it's something that you can get that care virtually and when do you need to be in person. It helps you with preventative care, staying well, and can often include incentives for wellness. Also helps those who have chronic diseases manage those chronic diseases with a combination of in-person and virtual visits. The reason Optum Virtual Care, we were able to launch in months and weeks, it was built on a foundation of technology platform that was existing. A technology platform that's rooted on interoperability principles and values, where we're able to bring the multiple breadth of assets of UnitedHealth Group into a common infrastructure and can stitch it together and integrate them in a meaningful way across the continuum of care. UnitedHealthcare has been bringing a suite of virtual care solutions forward over the past many, many months, and our customers and our members are very excited about these opportunities and have been utilizing them. We now have our members accessing virtual primary care for those who don't have a primary care physician relationship, and more recently have introduced this virtual-first offering, where people can literally click a button and be able to connect with their personalized care team. We're really positioning ourselves for the go forward, which is all about experience and coordination and really delivering on the outcomes that we know are possible in a hybrid model of care, where we take advantage of the robust, broad assets that are in Optum, the large provider group, large number of 1,600 clinics across the country, and then couple that with technology to deliver a personalized relationship that is virtual first, but not virtual only. Ask almost any employer or payer, and they'll talk to you about the challenges of meeting the fast-growing demand for behavioral care, not just with point solutions, but with fully integrated and connected care. We're really leaning into this need, as I suggested earlier. So far this year already, we've added 35,000 providers to Optum's behavioral health network, which now totals more than 300,000. Behavioral care should be an intensely person-to-person experience, so it's important to have the capacity to be at the patient's side whenever and wherever they need it. Increasingly, that's done virtually as well. In fact, today, we deliver about half of all of our behavioral services in a virtual setting. We know demand for quality behavioral care is gonna keep growing, so we'll continue to build on our broad capabilities to help people get the compassionate care that they need from those coping with mild levels of anxiety or depression to those with severe complex needs. In the past few years, we've shared with you the work underway in our community pharmacies to address these needs. Over time, we've worked to more tightly integrate our medical behavioral pharmacy care services across all modalities, digital, telephonic, and in-person. Today, we'd like to share more about how we're finding people who really need help and connecting them to the full range of resources they need to stay out of the hospital and lead more independent lives. I'm Jordan, born and raised in Houma, Louisiana. The Comprehensive Medication Management program is a program we identify individuals with complex behavioral and medical needs who could benefit from a clinical pharmacist intervention to optimize their medications. Once an individual is identified for inclusion in the program, our clinical pharmacists work to virtually engage that member. When I got Jordan on the phone, I immediately knew that he needed someone in his corner. Jordan was depressed. Jordan had thoughts of suicide. Jordan had a plan. Jordan just needed help and to get on the right path. I was homeless now and then, and it was. I was sleeping at the Civic Center and, you know, just, you know, basically it was just kinda rough on me. What we were doing was very important to him. It was sensitive to him, and I really wanted to make sure that he knew that I was there to support him. I made sure that we set him up with local care there, so he knew someone was also going to be following up. She called me one day 'cause she had talked to Jordan, and he was living in one of the homeless shelter here in the city. My main thing was just getting him housed. He was so excited when Yolanda was able to get him into his own housing. You could just tell in his voice that he felt that he had accomplished something. You know, it all came together, you know, as a puzzle. It all came together, and everything started changing for me. Before I spoke with Jordan, he had mentioned he had been in and out of the hospital several times throughout the year. Once we started talking, we were able to help target certain things to help improve his health that kept him out of the hospital, including his medication adherence and getting him on the right medication regimen. He hasn't been in the hospital since we started care over a year ago, and I'm just so proud of him. You know, they see how I'm doing, making sure I'm taking my medications. Now they got them being shipped to my apartment, my address and everything. They got them shipped. I ain't gotta worry about, like, walking to go to the pharmacy. I get emotional thinking about Jordan. I would spend evenings sitting at home watching TV, thinking about how he was doing because there were days that I didn't know if when I called him the next day, he would be there to answer. I feel more better about myself. I feel more relief. I feel more everything. Jordan is doing really well. I'm so proud of the steps that he's taken to take charge of his own healthcare. I just think, you know, this was a lot of support around me, and I thank God for that, you know, 'cause I don't know what I'd do. I don't know. Again, we'd like very much to thank Jordan for letting us share his story. Actually, he made a phrase in the middle of that conversation, which encapsulates everything. "My life changed when everybody else got their act together around me." That really brings to life this notion of integrating our activities. That's what he was describing. He was struggling to get traction in all of this system with all of the challenges he faces. When everybody else started to work together and integrate, then his life changed. Extraordinary impact. Now, as many of you know, our community pharmacies, which have grown very significantly over the last three or four years, are very often co-located with family health centers, community health centers. Often you'll go, and you'll see lines of folks in similar situations to Jordan lining up outside, waiting to access these sorts of services. The demand is quite extraordinary, and we're incredibly proud of the services that we deliver to these folks. Heather Cianfrocco is with us who's the president of Optum Rx. Heather, you oversee all of this, so maybe, yeah, I'd love to get your reflection. Yeah, I'd be glad to. Thanks, Andrew. You also just witnessed a very heartfelt first in-person visit between Jordan and Allison after over a year of working together virtually. Jordan was first identified by Optum Behavioral Health for the Comprehensive Medication Management program. You could see here that Jordan needed, and Allison helped him with so much more than just medications. That community pharmacy program that Andrew talked about really works to bridge the gaps between behavioral and medical care, medical and pharmacy services by identifying services that a patient's receiving and then identifying those unmet needs. In this case, Allison really helped Jordan with even stable housing. We'll spend a little bit more time this morning in our Optum Rx seminar talking about the community pharmacy program, as well as the continued collaboration between Optum's Behavioral Health and our pharmacy businesses. In the meantime, I just have to give a huge thank you to Allison and Lindsey of the community pharmacy program, as well as Yolanda, our housing partner, for the work that they're doing every day to make what's sometimes a fragmented system more connected for everyone we serve. Great. Thanks, Andrew. Thanks so much, Heather. I'd encourage all of you to spend some time with Heather and her team in the pharmacy breakout session or seminar. In addition to what you've just heard there are a whole series of really exciting updates in terms of the specialty programs that our pharmacy teams are beginning to build and accelerate into the marketplace. Heather, thanks again. People like Jordan who struggle with behavioral challenges often have other medical and social needs. They need whole person care, but they're not always easy to find. Some are without fixed addresses, many without phone numbers. To reach these people, we needed to find better ways to engage and connect others holding the threads of a social safety net, from housing to social services to behavioral health. People who are trusted in their communities and have the credibility with their neighbors, especially those in need. We began working on a new model that we call Catalyst, created to help advance health equity one community at a time. The program combines UnitedHealthcare's data with the perspectives of key local partners, local health centers, public housing authorities, and social service providers to create long-term sustainable interventions to address each community's unique health and social needs, challenges like homelessness, opioid addiction, maternal health. Each local collaborative establishes its own measurable goals, and each partner is accountable for specific results. Let's take a look at how we're bringing this model to life in Ohio. UHC Catalyst has come at a time when we have identified several really significant needs in the Akron community. The Catalyst program is really designed to be one that encourages collaboration with community partners and very actively seeks input from those community partners. What we're trying to do here across the 10 housing authorities that are engaged in the Catalyst initiative is to really study and understand the data that is being shared between UHC and the housing authorities to highlight where there are hotspots, where there are key issues, and where we can really invest strategically in partnerships. There's things like transportation, which seems like it's basic, but when COVID happened, who wants to get on the bus? What we do is take our vehicles, and we'll go to where that person is, whether it's coming to our health center, seeing a psychiatrist, which is also part of our health center, even going grocery shopping, because all of the little things in someone's life can contribute to their health and to their well-being. Well, I think we've made a lot of progress in the last few years on social determinants of health. Five or six years ago, you had to explain it to everybody. You had to convince them that it mattered. Now there's an enormous amount of work in this area. There's a lot of things going on. Really, people get it, but that doesn't mean that it's easygoing. There are a lot of obstacles, a lot of challenges we have to face, too. If we're gonna get different sectors to work together, often that means you've got to get them to change the way, their behavior or how they normally work with each other. I foresee people having the food and the housing and all of the things that they need so that they can just live a happy life and not worry about the basic necessities. Increasingly, action plans for addressing social determinants of health are becoming standard in government RFPs and contracts. Our Catalyst work in our Medicaid proposals has helped us already win contracts in Ohio, Tennessee, and Minnesota. We believe it will continue to distinguish our efforts as we see more opportunities in other markets. In the home, in the community, you can see how we're bringing these pieces together and mobilizing comprehensive solutions, connecting people to the care they need, where and when they need it. Now, Dirk will share how we're working to help streamline and simplify the healthcare system. Dirk. Thanks, Andrew. The drive to make healthcare work better for people's needs needs to happen on two levels. First, the elements that directly touch the consumer and influence how they think and feel about their experiences. Second, the elements that take place at the system level would have a downstream effect on how care is delivered. There are many areas today where our teams provide outstanding service at that individual consumer level. Take our Medicare Advantage programs, which are direct consumer-to-consumer businesses where customer satisfaction is paramount. Today, 95% of UnitedHealthcare MA members and 99% of UnitedHealthcare's MA members served by Optum Care will be in four-star plans or better next year. The reality is, too many healthcare experiences, including some of our own, still don't measure up. We're gonna make that better by focusing on the full end-to-end journey and working to simplify every touch point. Health payments and integrated banking are a perfect place to start. As a financial service company that's in the transactional flow of healthcare, Optum Financial supports more than 8 million consumers with their health bank accounts and has deep relationships with over 2 million care providers. It was because of our unique capabilities that the Department of Health and Human Services asked us to deliver more than $100 billion in CARES Act funding, ensuring providers had essential funds to keep their doors open during the spring and summer of 2020. That was on top of the provider payments we processed during the normal course of business that year. Looking to the future, Optum will continue to build out capabilities to help streamline and simplify payments and eliminate pain points from providers, payers, and consumers alike. For providers, we'll process nearly $260 billion in electronic payments this year, up from $178 billion last year, taking out paper and saving money. We're driving hard to improve their cash flows, applying technology and adaptive multi-payer payment capability to unlock working capital in real time while reducing the stress and administrative burdens also. For consumers, we're helping to make health payments more convenient and affordable, giving them the confidence as they seek care with trusted payment options. One example is Care Cash, a pre-funded debit card for members to use to pay out-of-pocket healthcare expenses with primary care providers and doctors who meet the right standards for providing high quality and cost-efficient care. Another example of it is a first-of-its-kind health banking card with differentiated rewards. We're using our proprietary technology and network of more than 30,000 retailers, from big box to local pharmacies, to ensure consumers get the most value from their benefits and adopt healthy behaviors. In January, we will introduce our members to the UCard. UnitedHealthcare's Steve Warner is here to tell us a little bit more about it. Steve, how's the weather in Minneapolis today? Yeah. Good morning, Dirk. It's another beautiful but chilly morning. The lakes have started to freeze over, but no snow yet this year, so the people who love the snow are getting a little restless. Yeah, they just can't wait to use their snowblowers. I know how they are. It's just the typical Minnesota profile there. Anyway. Hey, tell us a little bit about the UCard and, you know, what we're trying to achieve and what the objectives are. Yeah, sure. Every year, insurers send to millions of Medicare Advantage consumers multiple cards to engage in their plan benefits. These include a member ID card to use at the doctor's office and the pharmacy, an OTC card for the purchase of approved over-the-counter items, a fitness card to access in-network gyms. Many D-SNP plans today now offer a food benefit as well, so you get a food card to support that benefit. On top of all of that, you get rewards cards for completing health-related activities. While each of these cards serves a valuable purpose, the experience of so many cards can often be overwhelming, and it can be confusing. We challenged our teams to do more with less, and we created the UCard to really do three things. First, to combine all of those plan elements onto a single card that's easy to use and that reinforces the UHC brand throughout the plan year. Our members get one card that can be used across settings for everything from benefit verification to plan engagement to payments. The second thing we wanted to accomplish with UCard was to enhance our rewards programs and make them more accessible to consumers. When our members do things like get a flu shot, get a mammogram, or even walk a certain number of steps in the day, financial rewards can be automatically loaded onto the UCard. No extra steps required, no additional cards to mail. It all just happens. Finally, we wanted to give our members more options. The payment technology that's embedded in the UCard allows our members to shop for things like OTC items, food items, or to spend reward dollars at over 30,000 retail locations around the country. Good. That's great. Great explanation. Steve, how big do you think this could be? Well, yeah, as you mentioned, we're gonna launch in 2022. By 2023, we expect to be rolled out nationally to our individual Medicare Advantage population, and we're aggressively working to add even more capabilities to the card as well. Ultimately, though, we think the potential for this technology is much bigger, and we can actually see a future where this capability replaces member ID cards for tens of millions of consumers across product lines, making health insurance a little bit simpler and more satisfying. That's great. Thanks for the great work, Steve. Appreciate all Thanks. Thank you and your team are doing. Let's next shift to pharmacy, the most frequent consumer touch point in healthcare. We've seen several people today who are taking multiple medications. This is an area where we've been innovating to help make it more simple. Dr. Anne Docimo, UnitedHealthcare's Chief Medical Officer, is coming to us today from the city of brotherly love to share more about our multi-dose packaging program and who it's designed to serve. Hi, Anne. Hi, Dirk. Good morning. How's it going there in Philly today? Well, it's great here in Philadelphia, so where it's always sunny. Good. It's a great day. Yeah. Tell us a little bit about the capability. Go right ahead, Anne. Well, we do have a multi-dose packaging system for drugs, but it also includes a comprehensive medication review. The first step is really the pharmacist reviews the entire medication list to look for opportunities to optimize the plan. These opportunities can include things like generic substitution, dose adjustments, which could be for patients with kidney disease or other conditions, and also deprescribing, actually discontinuing medications. This may happen if a patient is on one, two, or more medicines in the same class, like statins to treat high cholesterol. This happens because patients with multiple conditions often see multiple providers. Once this list is finalized, the pharmacist contacts the prescribing physician. They review any recommendations and make any necessary adjustments. In this way, from this comprehensive review, the medications for that member are definitely going to be safe and effective. Once the list is finalized, the medications are put into date and timed packets, and they're easy to use and easy to open. It's a very simple system. Members get everything they need delivered to their home every month. No, I think that's great, Anne. You know, I know the perfect use case. I can remember when my mom was taking care of my dad, you know, there was a big yellow pad, and on the top were all the medications, and on the side were the dates and the, you know, AM, PM and the like. She would go through, and she'd check off when she gave him the medication. This capability clearly eliminates that sort of problem that she had. Right. Your father's that story is not unusual. Members with multiple chronic conditions can be having 10, 15, even more different medicines every day. Managing that can be really challenging, especially if you're trying to do it on yourself, by yourself. This simple system has worked really well. Members can be compliant with their care plan, and in some cases, it actually helps them to remain independent living at home. Thanks, Anne. Great work. Appreciate everything you and your team are doing. See ya, Anne. Okay. This approach, the technical process and innovation is really cool. Here's what counts. People are taking their medicine. Adherence rates are in the 90s, very similar to our community pharmacies, and much higher rates than people using traditional models. These are just a couple of ways we're working to improve the consumer experience, care that's more accessible, more convenient, and more effective. We'll continue to build out our suite of direct-to-consumer offerings and connect cross-channel experiences. As Andrew said earlier, this is how we'll reach people in the future with Optum as the front door. As we work to make experiences better for people, we're also focused on system-level change. Health systems play critical roles across the country but face growing financial and operational challenges. With our broad capabilities, scale, and experience, we are uniquely able to help tackle the most pressing issues. When Optum works with a health system, we start with revenue cycle management, but ultimately, we draw on the full strength and breadth of Optum, operations, analytics, technology, and care coordination. Drawing on combinations of these building blocks, each partnership is structured to meet the health system's unique circumstances and needs. Our success is tied to theirs, as agreements are structured with totally aligned incentives. Our goal is to provide local systems with the capacity they need to focus on their patients and ensure long-term financial stability. Over the last couple of years, we've established partnerships with a growing number of health systems from coast to coast, each structured to meet the system's unique circumstances and needs. These include, most recently, John Muir Health in the San Francisco Bay Area, where we're focused on improving the consumer experience across the system's clinical and administrative touchpoints. Boulder Community Health in Colorado, where we're working to create a management model that connects its ambulatory and acute settings. New York State's FaST Health Network, where we're trying to solve patient access challenges given the system's large rural geography. Our newest relationship, SSM Health, a broad-reaching partnership aimed at accelerating value-based care and digital engagement across their Midwestern markets. Two of our valued partners can give you a better sense. Our mission calls us to ensure all people have access to high-quality, affordable care. Creating this new ecosystem of care requires bringing together the best and the brightest to collaborate for the common good. At Optum, we know each provider system has its own unique needs. We tailor our partnerships to bring the right capabilities to achieve each provider system's goals and help them grow in their local markets. We were not gonna be able to succeed on our own, and we started to see that there were many areas where you really could bring expertise and support, particularly in an area where you know, we can't be great at everything. What we're really excited about is what we call ESS or you know, the services that you brought around data and analytics and project management, and to take that and then invest it in other efficiencies and growth and innovation so that we can better serve our community and ideally translate that into better clinical care as well. We continually look for like-minded partners who bring additional expertise, tools, and technology that will help us move faster. We found that in UnitedHealth Group and Optum. Our partnerships with local health systems provide access to a suite of capabilities across operations and administration, advanced analytics and technology, revenue cycle management, population health, and care coordination. By helping each system deliver value and predictable outcomes at scale, their clinicians can focus on providing the best care for the patient. The ability of Optum to step in and provide guidance, support, and data around managing and navigating through the COVID crisis was one of many really key things to give us. What I thought was, all things considered, about a successful outcome as you could hope for, at least caring for our community. There isn't any company, any organization on the planet that has the capabilities to do everything, and that includes SSM Health. In looking at UnitedHealth Group and Optum, we found some really complementary strengths. With aligned incentives and long-term support, our partners have shown less administrative burden, improved claims process, and patient experiences. This is just the beginning. We will be stronger together. We'll be able to provide enhanced care and service at a lower cost for the patients and communities we serve. Ultimately, the partnership should accelerate our ability to achieve our vision of transforming healthcare in America and address the health equity gap for the most vulnerable in our society. You know, as you listen to Robert and Laura speak, one of the things that I think about is our teams and, when they actually partner with health systems, the attitude is we kinda show up and help. The local health system has the things that they're good at, we have some things that we can help with, and ultimately, it's one of these things where, you know, the parts are actually greater than the whole, and it's a really good thing to have these partnerships. Anyway, while we're beginning our work with Laura and the SSM team, our partners at Boulder and John Muir are achieving strong results from revenue management to care efficiencies. At Boulder, there have been measurable improvements in patient experience with better outreach for transitions from ambulatory to ambulatory care management. We continue to see a robust pipeline of opportunities as we deepen our existing partnerships and engage with more local health systems. Our local health system partnerships are one of many ways we're bringing together technologies and both operational and clinical expertise together to make healthcare run more efficiently. We believe our combination with Change Healthcare will actually accelerate this work, helping clinicians by simplifying their access to evidence-based guidance tools in real time as they interact with patients, cutting down on friction in the transactions between clinicians and payers by removing waste and barriers and to make the healthcare process simpler and more transparent, improving patient health outcomes and lowering costs by closing gaps in care more quickly. Making it easier for the consumer to manage their health finances and payments, and helping providers get paid more quickly and accurately. We're energized by the value in this combination and what it will actually bring to the health system and everyone we serve, and we look forward to completing this transaction in the first part of 2022. Now, this is the tell 'em what you told 'em part of the talk. We hope you see in all of this a determination to create a higher performing, truly value-oriented system. One, that delivers value over volume. Two, that creates comprehensive home and community care at scale, and three, streamlines and simplifies the health system. Why? To ensure better experiences, better outcomes, and lower costs for everyone. With that, I'll turn it over to John, who can take you through the financials today. Thank you, Dirk. First of all, thank you again for joining us here today, here in person and online. I just feel I have to take a moment here and just stare out and gaze at the room because it's so incredible to have people gathered back together again, and we appreciate you taking the time to join us here for the day. And the same familiar room, right? I say familiar, yet I know that after all these years of coming to this same venue, I still get lost on my way to that maze of rooms in the seminar level of this hotel every time. I've always wondered, how can it possibly still be so confusing after I've been coming here that long? In fact, as we were preparing for this conference, I realized it was exactly 10 years and one day ago that I attended my last conference as an audience member. November 29, 2011. I was sitting right over there, I think about where you are today, Lisa. It was freezing in here back then too. Recalling that conference got me curious to look back and see what the UnitedHealth Group of 2011 had to say about its ambitions. Two things stand out at this distance. First, that the growth projected by UnitedHealth Group of 2011 was based on a number of initiatives whose roots went back many years. Second, that many of the efforts that were in their earliest stages in 2011 are now some of our most substantive and growing businesses. I raise these points and will spend a couple of minutes on them because they reveal a vital characteristic of UnitedHealth Group. Think big, start small, learn fast, and scale successes. The consistent approach of the enterprise has been to see an adjacent need or gap and to try out many new things as we seek to develop high-performing capabilities to drive better health and experiences for the people we serve and durable growth for the enterprise. This is important to understanding our future. I'm gonna give you a couple of quick examples. That conference was the very first at which Optum was discussed. It wasn't positioned as a new company. Instead, the 2011 narrative very deliberately invoked a 15-year history nurturing the foundational businesses. This new yet established business was expected to post $28 billion in revenue and $1.25 billion in operating earnings, about 15% of the enterprise total. I recall thinking, "15%. That's nice, but you still get a health insurance multiple. Let's talk when you break 30." A few days prior to that 2011 conference, UnitedHealth announced the acquisition of a company called XLHealth. I remember using my Yahoo search engine to figure out what it was and did. The company gave only a glancing reference to XLHealth over the course of that 8-hour conference. Today, that building block has expanded to become a vital clinical service, serving over 2 million seniors in their homes, improving near and longer-term health outcomes for people with medical, behavioral, and social needs. About three months prior, the new Optum Health made its largest affiliation to that point. Care delivery barely got a mention at that conference, and as you know now, it was just a start. That year, 2011, was also viewed as one of great uncertainty in U.S. healthcare, with the implementation of the Affordable Care Act still very fresh. As an analyst, I was assessing what challenges it might pose for insurers. UnitedHealth Group, on the other hand, was assessing how much opportunity there would be amid change for UnitedHealthcare and its new old Optum business. Every year has its share of uncertainties, and this enterprise was built to thrive in ever-changing landscapes, as it remains today. Take commercial benefits, which back in 2011 comprised nearly half of UnitedHealthcare revenue. Since then, even as the commercial business will have grown over 40%, it now comprises about 25% of revenue as other markets, such as Medicare Advantage and Medicaid, have grown more rapidly with more growth to come. That 15% Optum earnings contribution, now it's over 50 and looks to continue in that trend. I'm reminded of all of this that healthcare, for the most part, changes gradually and continually, arguably as it should, since it's about people's lives, and each part is affected in large and subtle ways by changes in others. While a look back can be instructive, we know it's the forward view that's critical to you. It helps to realize that the seeds of the next generation of healthcare are being planted every day at this enterprise, and that many may not fully emerge for 3, 5, or even 10 years. The question, of course, is which new capabilities and investments being planned today might grow and develop as we look at the decade ahead? Given our breadth, many come to mind. Let me touch on a few of these forward themes, all of which align within the strategic growth framework Andrew described. Virtual services could be one area. Already, our comprehensive services have become the foundation for a multimodal care system, one which integrates medical, behavioral, and social needs with an emphasis on care team continuity and coordinates coordination across virtual, in-person, and purely digital channels. Yet the reach, consumer usefulness, and technological sophistication have room to evolve greatly. If meta channels ever evolve, we will be there as well. Another, serving people with complex conditions. That 10% of the population that requires 65% of the nation's healthcare resources. At this stage, after years of building out capabilities, we're serving a portion of that population, surrounding them with coordinated services they so urgently need and increasingly in their homes. This is difficult, complicated work each day, but an area we think still has untapped potential for improving quality of life and scaling meaningful services. Another, as a result of our long-standing focus on building out primary care delivery, which is perhaps the most intimate relationship one can ever have with a consumer, we are building a deeper understanding of what it means to be consumer first and of the road and cultural shift it will take to get there. We see that future as one with the modern tech channels and experiences that are largely missing from today's health landscape, broadening how and where we can serve consumers and driving new levels of loyalty and retention. One last forward-leaning idea might be health financial services. We have steadily built a strong platform for consumer health banking and payment connectivity. What it could be, though, includes advanced and modernized financial clinical intersections, supporting billions of dollars of health-related payments across the system, greatly informing and simplifying the experience among physicians, patients, and payers, helping providers better manage their working capital needs, and connecting important health-related financial factors for people such as food, housing, and transportation. The evolution of this enterprise has been about more than a shift in member or business mix. How strategic collaboration contributes to our long-term 13%-16% earnings growth rate. It has been about continuous evolution in the way we see markets and reach and serve people to have even greater impact on their health, and to provide strong returns for you, our shareholders. It's why we maintain a bifurcated view at our company. A sharp focus on executing the here and now, deliberately linked to a longer-term view at where healthcare is and could be going. is why our confidence in how we will serve, evolve, and perform in the future has its roots in actions, in investments and commitments made in years past, in 2021, and those we expect to make in 2022 and beyond. Over the course of this gathering, from the small dinner, to this morning's presentations, to the Q&A forum, to the management lunch, to the business seminars, we hope you sense from the many leaders gathered here our restless ambition to continue expanding the ways we can serve people in the decade to come. It is a mindset that enables us to deliver the results you have come to expect from us, and you can continue to expect in the future. Now let's turn to those numbers. Our 2021 net earnings per share outlook for $18.75-$18.90 compares to the original $17.75-$18.25 outlook we offered a year ago. Enterprise growth in 2021 has been led by Optum, with operating earnings growth approaching 20%. Within Optum, the Optum Health and Optum Insight businesses stood out as strong drivers of performance. Moving to 2022, our initial outlook for adjusted earnings per share of $21.10-$21.60. Within this, we anticipate continued COVID-19 pressure, although at this point, lower compared to 2021. Revenues will approach $320 billion, growth of over $30 billion, driven by double-digit growth at both Optum and UnitedHealthcare. Taking a closer look at 2022, I'll start with Optum. Optum will comprise over half of consolidated operating earnings. Optum's operating earnings are expected to grow 16%-19% in 2022 to about $14 billion, once again, led by Optum Health. This growth is being driven by the many ways in which Optum engages across the healthcare system, serving benefit plans, physicians, employers, large health systems, and increasingly, consumers. Optum Care is centrally positioned to help the millions of people it serves across more than 100 benefit plans move into more comprehensive value-based arrangements. You heard earlier that Optum has fully accountable or capitated relationships with more than 2 million patients. What does that really mean? First and foremost, these relationships serve people better. There are many ways to measure this. Patients spend 25% more time on average with their physicians, 20% less time in post-acute facilities, and have more than a quarter fewer hospital readmissions. These patients have higher quality healthcare experiences and better outcomes, and their NPS scores bear that out. In 2022, we expect to add 500,000 new patients for whom our physicians are fully accountable, double this year's increase. This will drive revenue per consumer growth of over 25%. This metric is an essential measure inside our company because it helps demonstrate that we are serving people more deeply and more comprehensively. We expect this measure will grow at strong double-digit levels for years to come. Optum Insight is today providing diverse and integrated solutions for health plans, governments, biopharma, med tech, as well as for the health systems you have heard us speak about. These broad health system partnerships make a positive impact on care delivery and the communities they serve. You can expect them to continue to increase in number and scope. This momentum is reflected in the breadth and growth of the Optum Insight revenue backlog, expected to grow in 2022 by $3 billion to more than $25 billion. Deploying advanced, more modern capabilities enables us to increase our long-term operating margin outlook for Optum Insight to a range of 18%-22%. While the broad fields of healthcare data, analytics, and technology have been around for some time, when we consider their potential, we see them as still at very early stage, and you should continue to expect strong advancement of who, how, and where Optum Insight serves in the years to come. Optum Rx's capabilities provide a strong foundation for creating broader and deeper benefits for people and the health system. Our pharmacy services orientation is based more on integrated clinical level care than procurement and distribution. You heard us discuss the Optum Community Pharmacies, which provide access, guidance, and care for underserved populations and drive meaningfully differentiated health outcomes. Optum Rx specialty and community-based services have the potential to expand the number and ways in which we can serve people to have more positive impact on their health. Home infusion services, so vital during the pandemic, have become a best practice and the future of how we will serve people more effectively. These advancing pharmacy services, including community, home delivery, and specialty, now comprise about half of revenue, and Optum Rx will continue to evolve. Turning to UnitedHealthcare, we expect net medical member growth of upwards of 1 million people in 2022, led by our Medicare Advantage offerings, even as we expect modest net attrition in Medicaid due to the resumption of redeterminations by the states. Revenues at UnitedHealthcare will approach $248 billion, growth of about 11% over 2021. We expect another strong year of Medicare Advantage member growth, continuing the momentum of the last several years. Activity throughout this year's annual enrollment period has tracked well with our expectations, underscoring the consistency and attractiveness of our offerings. Thanks to the steady strides made in quality performance, we are excited that we can enroll people in our 5-star plans throughout the entirety of 2022. Making it easy for seniors to engage with us how, when, and where they want is an important element in member satisfaction and retention, and we do continue to advance these efforts. For example, about 1 million of our senior customers now engage with us digitally each month, interactions which further strengthen our connection to them. In Medicaid, our new state awards and renewals demonstrate the growth momentum which has been building over the last several years. In 2021, we were honored to begin serving the people of North Carolina, Kentucky, and Indiana, with other recent awards in Nevada, Hawaii, Tennessee, and Ohio. In 2022, we will begin serving in Minnesota, and we are eager to add new regions as we look ahead. In the employer and individual market, we continue to grow in 2022 and beyond. The strong response to our newer innovative products is a key reason why. Products such as NavigateNOW, featuring consumer convenience and premiums 15% below standard plans that use the Optum Virtual Care as a first option, Bind, which allows greater benefit choice, certainty, and flexibility, Harmony, which aligns with Optum Care to create better experience and value for consumers. These and other newer market responsive offerings will serve nearly 1.2 million consumers and are the base for further innovation. Our growth and diversification continue to provide a strong balance sheet with ample financial capacities. Our capital employment practices remain consistent, and in 2022, we expect to generate cash flow from operations approaching $24 billion, 1.2 times net income. Returning capital to our shareholders remains a priority. The total dividend payout at that 2011 conference of about $650 million is today $5.5 billion, having advanced at a strong double-digit rate each year since. We expect to repurchase between $5 billion and $6 billion of stock next year. With significant available growth capital, we will continue to expand and evolve our healthcare platforms to serve even more people more comprehensively. Like some of those seeds planted a decade ago, many of the elements underway at today's UnitedHealth Group are creating an enterprise that will not be known in full until that investor conference in that year, 2031. Nonetheless, I expect that session will feature some familiar themes. A story of strong, consistent, and diversified growth. Of a company continually building upon its socially relevant capabilities, creating value across the healthcare landscape, driven by a strategically collaborative and highly focused group of people connected by a shared mission to help people live healthier lives and to help the healthcare system work better for everyone. Thanks very much. We will now set up for the Q&A session and be joined by a number of our colleagues, both on stage and in the audience today. Feel free to stand up and stretch your legs, but please do not go far because we're going to resume in just a few minutes. Thank you. We will be back in 30 seconds, ready for Q&A. Thank you. Please take your seats. We are ready to resume. Thank you. Great. Thanks everybody for coming back so quickly. We really appreciate it. For those of you watching online, thanks for your patience. I guess you might have gone out to make a cup of coffee as well. What we're gonna do now is open up the floor to Q&A. I'm delighted to be joined by a number of our leaders from across the company. You'll see all of their names. We thought if we went through all, it would burn up too much time. You'll see their names there. Also, to let you know, we have other colleagues in the audience we may ping questions to if necessary. All I'd ask you to do, if you can raise your hand, then Brett, Zach, Moses will come to you with a mic. If you could wait for that, because then people who are listening remotely will be able to hear the question, and then we'll call you up. Let's go. Okay. We're up, guys. Zach, are you gonna pick? Oh, sure. Zach, go ahead. Sure. I've got Josh Raskin from Nephron. Hey, Josh. Hi. Good morning, Andrew. Thank you. I guess not surprising, my question's on Optum Care, and I was curious, you know, as you think about the importance of the primary care, I'm hearing a lot more than just primary care from you. I'd be curious how you think about that primary care. Is that relationship that you talked about, What other pieces you think you need? More importantly, what's the process? How are you moving your 60,000 physicians now to risk-bearing and sort of help us think about that process. Yeah, great question, Josh. Thanks so much. Before I ask Wyatt to go deeper on it, one thing that I think is often not everybody sees actually is within our 60,000+ physicians, probably nearly half are kind of specialists, right? That's right. Even within our base population of kind of office-based physicians, we've got a very diverse group, even within that. Then as I was talking earlier today, and to your point, we see this whole arena being complemented by a whole suite, you know, whether it's behavioral care, whether it's at-home care, virtual care. Wyatt, why don't you go deeper? Yeah. Agreed. Josh, thanks for the question. When you think about our 60,000 physicians, they are a blend, as Andrew mentioned, of specialty care and primary care. I'd also like to emphasize there's an additional 20 advanced practice clinicians, nurse practitioners, and others that are a critical member of the care delivery team. Increasingly we're thinking about our workforce, not so much as the 60,000 affiliated employed physicians, but the 80,000 APCs and physicians. The specialists are a critical part of our model because as you know, specialists drive an enormous amount of downstream utilization in hospitals or alternatively, as an example, in ambulatory surgical centers. For us, having a network of affiliated and employed specialists who practice evidence-based medicine and are focused on delivering just the right amount of care, not too much and not too little, is quite critical to our value proposition. Just to Josh's second question. Yes. Just reflect a little bit on what you do during the year before we transfer risk into those things. That's right. Just maybe spend a minute on that. Yeah. Because I think that's quite an important piece of it. Yeah. To the question and the point is, we know that it's critical to move from fee-for-service to value, and it's of course a major theme of our conversations today. We do that by bringing doctors on board and educating them in the process of providing value-based care, what's necessary. We also surround them with a team that helps them deliver that care in a differentiated way. We take the deep expertise of markets like Texas, and you heard Dr. Amar Desai speak about Southern California, and now we're bringing that expertise to new markets like the Pacific Northwest or the Northeast Corridor. Great. Thanks so much, Wyatt. Brett? Yeah. Thanks, Andrew. Justin Lake, if you'd like to ask your question. Could you stand up for us, please, Justin? Just wanna show how tall you are relative to. That's not a huge bar, Brett. My question is Optum Care as well. Wyatt, you're probably gonna be pretty popular today. You know, you keep putting up 30% revenue growth. I keep mismodeling it. You keep beating the number. Wanted to try to understand, you know, better how to forecast this business. You know, for instance, you give us a couple of numbers. You know, your patients served in Optum Health, I think is up 1%, but your, you know, your capitated membership's up 25%. Mm-hmm. Maybe you can help us think about the pent-up demand there. Maybe you can give us some numbers along the lines of, for instance, how many Medicare Advantage members do you see that aren't in capitated agreements that could be moved over? Yep You know, over time. You know, is there some way to give us some ability to think about the TAM there? Thanks. Go ahead. Very good. Yeah, appreciate the question. Our growth engine is multimodal. Think of it as growing in our established markets and states, going into new markets and states, and think of it as our deep partnership with our colleagues at UHC, who continue to grow their books and then transfer, particularly Medicare Advantage, to us when it's appropriate and makes sense. We also have 99 other payers that we have deep relationships with. That's another growth engine, other payers, and particularly in the MA and dual special needs groups. You'll see us increasingly growing in commercial and even Medicaid. Often we talk about the 20 million patients we serve today. That's a growth engine, and some of those are commercial, and they'll age in. Some are fee-for-service Medicare, and they'll transition over to Medicare Advantage. As you can sense, we actually have about five ways that we're growing, and that's really how we're hitting that kind of 30% growth for our value-based care. It might be good as well in a sec to ask Brian to comment a little bit from his perspective at UHC. Sure. Because, you know, at the end of the day, there's a tremendous relationship that drives all of this going forward. I just wanna emphasize this point. You know, when you think about it, you've got more physicians every year. You've got more physicians taking more risk levels every year. You've got more other services being supported into that environment, really to Josh's question as we wrap around. All of that just starts to level up, which is why this kind of revenue per consumer served is really a relevant metric to look at, because that's where you start to capture all these different layers that feed in in parallel. Brian- Sure. It'd be good to get your perspective on where you think this goes from your angle. Yeah, it's multidimensional. As Wyatt said, it starts with community MA. Think traditional Medicare Advantage. Our transfer in 2022 will be the biggest we've ever had. Two years ago, we had no Dual Special Needs plans in capitation. Next year, we will have moved several markets in that regard as well. Beyond just what happens around that traditional PCP environment, we're also now moving home risk. You've heard a little bit about the community and home model as well. We're doing that in Georgia and the Northeast. As Andrew pointed out, we've now really started to find some receptivity in the commercial market, primarily on the West Coast with our Harmony product. It's really a layer cake, if you will, of opportunity, and I look at 2022 as much more meaningful than 2021 and still in its infancy as I look at its opportunity. Thanks, Brian. Thanks so much for the question. Moses. Our next question is from Kevin Fischbeck with Bank of America. Hey, Kevin. Hey, great. Thanks. I know you guys are trying to avoid talking about COVID, but Dirk would be mad at me if I didn't try to get John to quantify this. So the $80, I guess, when we think about the 12%-15% growth you're looking for this year, that's a little bit below the 13%-16%, even though there's a COVID tailwind to it. Just love to try and have you know, bring us back to that long-term growth rate this year. But then also you mentioned that COVID is still a headwind. Can you just talk about which businesses do you think are impacted still in 2022 and kind of under-earning because of COVID? John? Yeah, sure. On the first point, yes, COVID impact is lower than it was in 2021. Our expectation, at least at this point, as we sit here today in this session, for 2022. You know, I put it in the zone of about half the impact with some ranging around that in terms of what we experienced in 2021. I would say it's even more heavily biased to UnitedHealthcare in terms of where the impact is being felt for 2022 versus what we described last year. Yeah. Thanks, John. Zach? I have Ricky Goldwasser from Morgan Stanley. Hey, Ricky. Hey, good morning. Andrew, a bit of a strategic question for you. UnitedHealth is the largest insurer in the country. Is United also Optum's largest customer? And if not, how do you incentivize employees in the organization internally to think of United as such? In a follow-up to that, if we think about that vision of Optum being the front door to healthcare and to growing revenue per member ultimately over the next decade, how do you balance the sort of the payer agnostic sort of approach with that ultimate goal of having wrapping around that UnitedHealth member with all these Optum services? Right. Two great questions. Just to start with the second. The Optum Front Door, I think, works provided that the services which then are behind the front door are market leading great value-added services. I think, honestly, the only way Brian Thompson buys anything from Optum is if that box is checked. Because in reality, he can't compete, and he can't survive in his world unless he's being serviced at the top of the marketplace. The embedded opportunity to your first question is by being able to work together across the platforms to innovate and iterate the way in which we think we can develop our services. That's really the kind of unique strength of being in the same family. As I tried to lay out, I think it's becoming increasingly clear that being able to pull together multiple strands of what happens around families and patients and systems, actually, is beginning to look like the key to really driving outcome. The way we incent people in the organization, broadly speaking, if you look at our leadership cohorts, they're incented at UHG level. Actually, when you look at the way in which we incentivize the organization, we basically stand and fall together. I think that's a very powerful driver of the way we look to drive greater collaboration in the business. If you look within our growth organizations, they are massively encouraged to go and ensure that we are intensely pluralistic in terms of who we engage with. Whether that's from a payer perspective, who we sell services to, who we work with in the clinic. You just heard 99 payers are working with Optum Care. That's very evident in that part of the organization. As you move up through the organization, the people who are making the big capital decisions, the people who are making the big investment decisions up and down the company, we basically view that as a UHG cohort, and they stand and fall together. I think that works great. You get a real sense of energy across the company. One of the things we've tried to do is really emphasize the value to the patient and the outside world through our internal collaboration. The more we can get that wheel spinning around innovation, the better. Optum Front Door, I think that's an opportunity for us to really change the way in which this company engages with the environment, right? That changes fundamentally the scope of how we can engage, the numbers of people we can connect with, and how we can then introduce them to the services we have, assuming that they are super competitive services, which is what they've got to be. They have got to be top-of-game services. Yeah. Hey, what I would also tell you is that, you know, UnitedHealthcare is by far and away the most demanding customer of Optum. There's no question, right? So I mean, if you think- Oh, that wouldn't happen. Yeah, no, exactly. I was gonna give you some props. Why? I mean, you heard me talk about 9% of the MA members are in Optum Care in four-star plans. Well, guess what? Brian Thompson's happy with that, right? But I would also say it goes deeper, you know. It's like, hey, to the extent to which Optum does a really great job in payment integrity, well, you know what? Those great jobs they do for UnitedHealthcare goes to other payers as well. So there's a real flywheel effect in terms of UnitedHealthcare being demanding on the part of Optum, and Optum frankly delivering for UnitedHealthcare. Thanks so much for the question, Ricky. Brett? Yeah, thanks. Thanks, Andrew. Next question is from Ralph Giacobbe, and he's standing. Thank you. Hey, Ralph. Thanks. Hey, good morning. I guess back to Optum Care. 60,000 physicians, it sounds like half is primary care. Can you give us a little sense of the 30,000, call it, in primary care? How many of those are risk? Are all of them sort of taking risk? That's sort of 1. 2 is, those that are taking risk, can you give us a sense of how many patients they're treating on average? I think in one of your videos, the doctor said he went from 250 MA patients up to, like, 950 over the course of a few year period. Yeah. I guess I'm trying to get at the visibility that you guys have, because a lot of this is just basically sort of handing off those patients. The 30% growth is sort of UHC largely to Optum, right? I'm just trying to understand the capacity or how much more room there is with that. Yeah. The last piece, sorry, is the profitability ramp, right? You know, you understand how you lock in the profits on the UHC side. They come over to Optum Care. What's the ramp to profitability there on obviously a lower overall premium dollar? Thanks. Yeah. Thank you. Kind of breaking down your questions, starting with the value-based care proposition. We actually have considerable operations, particularly in the Northeast, Massachusetts, New York, New Jersey, Connecticut, as well as Washington State and a bit now in Oregon, that are primarily fee-for-service. You'll see us in 2022, as we talk about the 500,000 risk lives that we'll be assuming care for, increasing the number of risk lives in those markets. Today, we actually have a fair blend. Even in our well-established markets, we have fee-for-service in Texas and Southern California and Florida as examples. What we find is that both for the patient experience and the stickiness and the opportunity to really provide the comprehensive set of solutions that we've already been talking about on the stage today, that's really where value-based care is remarkable. The second point is, as we create that value and create that savings and total cost of care, we're able to deliver a portion of that to you, our investors. We'll continue to move. Now, the second question you asked is, what's that investment period like and how long does it take? To be frank, as we move lives, there is investment upfront. We'll invest the year before we do those risk lives substantially in bringing on the teams, the technology and the training to make sure that we really manage a comprehensive solution for those individuals. You'll see us move those risk lives in. In year 1, it's an investment year. In year 2 and 3, we start to see the investments begin to pay off. When you look at us, because we've been in value-based care for over 10 years, you know, we have also mature value-based markets that are generating the kinds of returns that we'd expect. Then the last piece of your question, if I captured it all, is the question around, as you move from a payer like UHC to Optum Health and Optum Care, how do we create that value? I think that the slide that you saw earlier says it all, which is 99% of our Optum Care UHC members, 99% are in 4-star or greater. That means not just 4-star, 4.5, and even 5-star plans. Five-star plans can enroll year-round, as you're probably aware. That's just one example. The other is we're able to, as providers, actually initiate protocols, evidence-based care that's embedded in a physician's workflow that we know decreases low-value care or over-utilization of services. For us, that's where this transformation begins to happen, not only for the patient experience, for the outcomes and for the total cost of care. Thanks, Wyatt. I think that was a super clear explanation. I think really understanding that kind of roughly three-year cycle in terms of kind of investment and getting the practices to move into the new ways of working is really important to recognize. Obviously, as you can see, the sort of huge scale of what we're moving through, that degree of investment, which runs through year minus one, year zero, year plus one, and then starts to move forward, is really material. Now, what I find super encouraging is when you look at the vintages as we measure of clinics which have moved from fee-for-service to value year- by- year by year, what you would hope to see and we do see is improved speed and performance. We're getting better and better at this. Now, that leads to two things. One, we get more and more confidence to transfer more and more people. Second, obviously, the economics start to get into shape much more quickly than they might have done in the past. I think you've heard a great description of what goes on within that part of the business. It's important. You know, where you end up is an economically sustainable model, which for a lot of these doctors, fee-for-service really isn't economically sustainable. Mm-hmm. You end up with a situation where the patients have a much better experience, the payers have a much better experience, and you get there over that period of 2-3 years of investment. Next question, Moses. Yep. Gary Taylor with Cowen. Thank you very much. I first want to compliment Andrew on his shoes. I haven't been able to take my eyes off those since you walked out earlier. So, really like those. As I'm booking my hotel for the 2031 Investor Day, I wanna think about a decade out. There's so much discussion about value-based care, not just here, but other companies around the ecosystem, and so much of that is oriented around MA, which makes a lot of sense because it's a risk-coded population. It's target rich. You can make these incremental investments and be rewarded for it. What do you think it takes to get the commercial population in Medicaid? A decade from now, are we still living off the value-based care growth in Medicare, or is there really gonna be an opportunity to move these more transitory populations such as commercial and Medicaid into value-based care? No, thanks for the question. I'm gonna ask in a second, Brian. I'm gonna ask Brian and Dan, actually, to make a couple of comments on this, in specific response to what you asked for. I think you've gotta step back and say, what we're really trying to learn and, you know, every day we make a mistake, we fix it, we get it better. you know, constantly trying to learn on this. We're trying to learn a way of managing risk, which of course, initially, is in the Medicare Advantage arena, but those skill sets can be applied much more broadly. more and more, I would expect in 2031 to be talking about, how our risk management skills have found their way across the whole space. I don't really see any logic. If I sit back and think about all the conversations I have with people who lead, for example, you know, big employers who are struggling with cost of healthcare. If they could see a model which could deliver for them more reliable cost outcomes, better responses, all the rest of it, why wouldn't they go there? Now, it may not be the same structure, it may not have the same components as the current MA approach, but underpinning it, I think there's a driving logic which takes you in that direction. Maybe ask Brian to pick up on that and then Dan as well. Yeah. I definitely see a lot of receptivity in the market. Let me start with, it's not a lack of a desire between us and Optum Care. It's really finding that market niche with a customer and a consumer in particular. We've seen it on the West Coast for some time, where they're willing to work with a provider-payer relationship in a different way. Normally, it includes bringing a couple of options to the table for that employer group. We see that take shape outside of just California, I think you're gonna see a natural tendency for more commercial groups to take on a value-based arrangement like we have with Optum Care. I think it gets started with things like digital convenience. What other tools and capabilities can drive a differentiated product? Not just looking at perhaps what might feel like a more narrow network. As those networks stay broad, as those capabilities get enhanced with digital, I think you're gonna see a greater customer response to value-based alignment, like what we have with Optum Care in the commercial marketplace. Dan. Sure. I'd just offer that, you know, importantly to Andrew's point around foundations, I think there's important foundations when you look at the variation in the cost of care in commercial. Site of service has a profoundly different impact than it does in Medicare and in Medicaid, as an example. Building out the foundations around our ambulatory footprint, but also, you know, the virtual and digital foundations that really help with the engagement and the steerage and the redirection and the referral patterns that can really be successful in the commercial marketplace. The other thing I'd offer is, you know, as Andrew talked about kind of reversing the polarity and how would we pull, you know, historically insurance through to services and then services back through insurance. You know, that's another area that we see opportunity to look at our Optum Care assets, how they connect through to our home-based assets, and how do we go directly to employers and introduce ourselves in that way as well. A lot of different dimensions and ways to approach it. Obviously, Medicare Advantage, the concentration of complex needs. The 2x cost profile in Medicare, it's a reasonable place to start building foundations towards commercial, for sure. Absolutely. Thanks, guys. Zach. I've got A.J. Rice from Credit Suisse. Hey, A.J. Hi, thanks. When I think about your priorities for inorganic growth, capital deployment, we always think about the care delivery side of Optum Health, and we think about Optum Insight, which you're obviously in the midst of a deal. You've emphasized, let's put it that way, some new areas today like Optum Financial and other things. When you guys think about capital deployment and where you might go for inorganic growth, is the priorities changed in any way? And then maybe just on a follow-up on that, if John could spend a second on the 13%-16% growth target for the next few years, how much of that is organic in your mind? And how much is capital deployment, either share repurchases or inorganic growth? Thanks, A.J. Great questions. John, why don't you take both? Sure. Take the last one first. About 3-5 points of that growth would be what we'd call inorganic growth. It was consistent with the model we've had over the last number of years. The important part in that, A.J., to consider is we don't expect that to be year one impact. What we're benefiting from are vintages, well, to use the term Andrew used, that were investments we've made over the past number of years, and those that's come into producing assets. So we're often laying down that capital a few years in advance of where we expect that to contribute to that growth. The same profile that we've had for a number of years in terms of the company and the inorganic growth opportunities. In terms of specific areas, yes. All these areas would be areas of interest to us. I would tell you they've been areas already of interest to us. You can expect we've probably already made some investments in some of these areas. I would still expect Optum Health broadly to be a significant focus and care delivery to be a significant focus in terms of capital allocation. These other areas are certainly also in that zone. You know, some of them are small, some of them are large in terms of that configuration. I don't know that it would look so startlingly different from the outside, though, in terms of what you've observed thus far. Thanks, John. Next question. Yeah, over in the back. Yeah, an online question, I think. Yeah. That's right. We have a question online from Michael Wiederhorn with Oppenheimer. Can you discuss the top-line growth of community and state despite the headwinds from redeterminations? Yeah, sure. Brian, do you wanna- Sure. Pick up on that? A couple of things inside that. Keep in mind, we talked about our growth in Medicare Advantage. The vast majority of our dual special needs is actually in our community and state business. A big part of that tailwind in our revenue inside 2022 is related to that, strength of the recovery that we've seen from physician encounters inside 2021, very similar to the dynamic that we see in our Medicare Advantage book. What I don't wanna lose sight of is just a tremendous growth that we've had organically. You heard about the 7 states, 4 that we renewed and expanded in, 3 which were new. It's a combination of 2 factors. The stronger physician engagement in 2021 on our almost 1 million lives and our dual special needs plans, combined with the organic growth and strength. Great. Thanks so much. Brett? Next question from Matt Borsch. Thank you, Matt. Thank you, Brett. I was hoping to maybe understand in a little bit more depth how the global capitation arrangements work. If we take a seasoned capitated Optum Health group of physicians with an MA member, are you meaning UHC giving up any profit as you do the global capitation? Can we think about what a total profit margin might be on that MA member if you were to take both the profit UHC is earning and what you might be getting at the Optum Care level? I know that's maybe not the fair way to look at it, but you know, it's one perspective that you end up with in terms of you know, how much profit is that member in total generating? John Rex. Sure. There's important things, considerations in that. First, the impact that Andrew and others have described, how that membership moves in terms of the vintages of performance. Important metric we provide, we talk about 8%-10% Optum Health operating margins, long-term operating margins. You heard a couple of comments on the stage today. Year one, it's just straight up investment. 500,000 lives moving in for 2022 takes significant investment in 2021 for that to occur. They mature over the next few years. Just to pull a few threads also from some commentary that was part of some comments that I made earlier on the stage. When we look at those vintages also, more than half of our practices, if you will, are what we would call early stage at this point in terms of performance. Then there's a minority that are performing more where we expect them to be. You would expect a margin profile in those practices that's above the 8%-10% level we described in Optum Health. It definitely runs in that zone. Then you get into what else is happening, though, within those practices. Take maybe a couple of our markets where you're the most built out in terms of movement and performance in that kind of block of business that you're talking about right now. There are other elements that are coming into that picture, though. We are probably not built out in terms of the scopes of services that Optum Health offers in that marketplace. I can think of a few of Wyatt's markets were very built out in terms of capabilities of risk assumption and what they're doing for their senior populations. We're not even close to where we should be in terms of the other offerings that Optum Health has, ambulatory surgery centers, the home capabilities, the other elements you'd be wrapping around that. It gets a little more complicated, you know, frankly, Matt, in terms of thinking about it, because there are other elements that come into that picture in terms of the types of services we're trying to build around that. That's kind of the general perspective in terms of the vintage story. Yeah. I think that's very clear. I mean, the other thing I would say is obviously the only way there's any economic interest created at all here is if better care is delivered and waste and inefficiency is taken out. I mean, that's essentially unless that happens, there is no economic opportunity. Then if you think about it, a lot of that benefit preferentially goes back to members, right? In terms of benefits or reduced premium or whatever else that might flow that way, or to doctors, because we're trying to create a sustainable economic model for physicians to allocate the time to go from 15 or 20 patients a day to 5 or 6 or 7. All of that has to happen as well. In terms of the way I think about it is you gotta really feel confident that you've got an approach and a model, which first and foremost, delivering great care and taking waste and inefficiency out. That opens the door then for members to have a beneficial experience, payers, physicians, and of course us ultimately. I think we have time maybe for one last question or two, maybe two more. Moses. With Michael Ha, with Leerink. Hey, thanks. Actually, I have two, maybe three really quick questions. Of the- Oh, that's all the questions. I should know this, but of the 60,000 physicians today that are affiliated or employed, how many are simply affiliated, and how is that bucket of affiliated physicians? Is it a focus of you to try to transition them into an employment status? I'm just kind of curious how important that is for you. Okay. If you look at your most mature vintage groups that have been taking risk, can you share what the MLR is on those groups today? Why? Maybe I'll start with the first question. I'm gonna harken to the video you saw of Dr. Rodriguez, who I met down in our WellMed Texas practice a couple of years ago. When I heard his story, I thought, "You know, he actually captures it pretty well." He was an affiliated physician who we then moved to contracted, which is kind of still independent, but we wrap more services and incentives around a contracted physician from affiliated, and then ultimately employed, still with a number of value-based care incentives. I think key to the 60,000 physicians is many are on a journey of getting to know us, particularly newer, less mature markets. As we do that, we move them into deeper and deeper relationships. Now, some wanna stay independent their whole careers, and we support that. Others say, "No, I wanna I'm all in, I'd like to be employed." We have tuck-in acquisitions that we do in all of our established markets on a regular basis that are when we reach that point or we move somebody into an established clinic. I would say because it's an evolution, we don't tend to wanna break it down into specific buckets and quantify each bucket because we think of them holistically. We know that the performance of outcomes and cost of care is excellent when they're employed. It's also can be very excellent in our independent doctors that have a large percentage of our value-based care patients. In fact, in those environments, it can be equivalent. The MLRs are We're very proud of them, let me put it that way, in our established markets. Again, we don't really tend to wanna break them down into different buckets of our various markets. Absolutely. Yeah. You know, what it helps us, as we look at our whole portfolio, gives us a confidence around where kind of best practice is as of today, and then that gives us a goal really. That's right. in terms of what we might expect from different clinics over time to progress, and obviously then there's work to continually improve. We're going to the last question, Zach, I think. Yeah. With Lisa Gill from J.P. Morgan. Hi. Hi. Thanks very much. I'm gonna break from Optum Care and move to Optum Rx. Andrew, you started your comments, and you talked about changes in pharmacy. You talked about technology and specialty, which all makes sense because that's now 50% of the market. But as I think about pharmacy going forward, how do you really envision those payment models? Today, right, it's really all volume-based. Every part of this discussion today was around value-based. How do you see that progressing and changing on the pharmacy side? Yeah. Well, obviously, in a second, I'm gonna hand this to Heather, who's spending a ton of time working all this through. I think we're gonna see. I think it's inevitable that we're gonna go to more risk sharing within the pharmacy space as well, up and down the value chain. I think pharma companies are gonna get drawn into this over time. Some are more forward leaning on this, honestly, than others, but I think it's an inevitable consequence as they move to an environment where they have higher and higher prices for drugs which are or treatments which are used by fewer and fewer people. Hopefully, they're gonna have. Their goal is to drive very distinct outcomes. You know, obviously, the Holy Grail is a cure. The good thing about these distinct outcomes, it's really measurable whether you achieved it or not. I think that we're gonna see a lot more assertive negotiation advice, sophistication, actually, around how pharmaceutical pricing gets done. Now, I'm not saying that's gonna happen overnight, but I do think it's coming. I think it's an inevitability. I think we can be very central within that, and it's certainly one of the areas we're focused on. It's not the only one, and Heather can extend. Yeah. That's great. No, it's definitely a big focus for us. I'd say a few things. I think, first of all, we're really already in value-based care in many respects. As Andrew said, it's starting in some of those higher costs, but those fundamental cell and gene and biologic therapies that can be, in many cases, incredibly life-changing, but are incredibly expensive. We've already seen incredible interest and engagement from our pharmaceutical manufacturer partners in value-based arrangements. We have several of those today. The critical piece of that is the analytics exchange, the insights, you know, and the information from our clinicians, our prescribers, that help them get to better outcomes and get that right value-based arrangement. I think the other thing I would say is that the investments we're making today, you know, John talked about our investments, in every part of the business, whether that is in the pharmacy benefit business, helping our clients understand what really are the drivers of those value, and to do their part too, disease management, chronic disease management, and preventive care to actually help the product be effective, wrap around them with social services. Then on the pharmacy side, our own specialty distribution, our infusion services, and then tapping into the power of Optum Health's clinicians to advise us. We're building the tools today. We're making the investments. We are always focused on the client and the patient's needs, and we're working closely and more intentionally with our pharmaceutical partners to really drive for value-based care. I think when you do talk to us again in 2031, we're gonna be. That pharmacy component, it might look different. It might be very bifurcated between those maintenance medications and those very high cost but life-changing medications are gonna be an essential part of value-based care for UnitedHealth Group and our industry, I think. Great. Thanks, Heather. I'm afraid we're out of time for the Q&A session. The seminars are calling, so we need to make sure we wind up and give you all a chance to gather. Let me just finish off by first of all thanking my colleagues for joining me up here today. Great to have you here. Obviously, our team are around, and please take advantage of connecting over lunch and other times during the day, and obviously during the seminars. I wanna thank you for taking the time to listen to us, to have an interest in what we're working toward. I hope you take away just a few things. First and foremost, I hope you take away an organization which is relentlessly focused on high quality growth. This is a growth organization. It's an organization where we feel that 13%-16% long-term earnings growth rate that you've heard and that you're familiar with is absolutely the right and appropriate level of ambition for the company going forward. I hope you've taken away from the various conversations today the areas, some of which are newer, some of which are more emphasized, some of which are more established, that we're gonna be focusing on in terms of how we dedicate our talent, our investment, and our capital to try and deliver those growth areas. We think that piece by piece, those elements that we're gonna focus on can help to improve the quality of the healthcare system, that can help to improve the experience of individuals and families. Through that, we can earn the right economic return. We only earn an economic return if we deliver great distinctive value, and that's what we aim to do. I'll finish off where I started, with people. I think it's fair to say, I don't think I'm putting words in the mouths of people here or in the audience or back in any one of our facilities or anybody who's working from home, right now for UnitedHealth Group, people came to this company because they believe that in a small way, that each individually they could help solve a problem that they know exists, that U.S. healthcare can be better. They know that. That's why they came. I think we feel more confident about being able to help in that mission now than we ever have done, and I hope you take away that same confidence as you leave the session this morning. Thank you all very much.