Good morning. Welcome to UnitedHealth Group. Thank you so much for joining us here today, and we look forward to spending the next couple of hours with you, taking you through our story here at the company. You know, it's about 45 years since UnitedHealth Group was first incorporated, and as many of you will recognize, it's almost unrecognizable today from what it was back in the late 1970s. It's evolved from being a company initiating to look for coverage for folks, grew through an era figuring out how to develop policies to help influence best care delivery, extended into care delivery itself. Those years of evolution have really been a response to market dynamics, to the needs of the environment, to the needs of consumers, and the needs of payers. The company has responded repeatedly with an agility and an energy to grow and change. Yet, after 45 years, the team you're gonna meet today, our team, stands feeling more optimistic that our greatest potential still sits in front of us. We still feel complete commitment to our long-term adjusted earnings growth rate of 13%-16%. We believe that despite all of the achievements of the last 45 years, the scope for further impact is larger going forward than it has been even behind us. Today, we look forward to sharing the reasons why we believe that, why we think those opportunities are real and within our grasp. We're gonna do that through the lens we laid out last year, the growth strategy of UnitedHealth Group, built on our 5 growth pillars. Those growth pillars are guiding us. They're how we run the company. They're how we keep score within our own organization. You're gonna hear over the next two hours how we feel that's going, the progress we're making, we're gonna share with you some of our scorecard in terms of how we think things are playing out. To recap those five growth pillars really quickly. Value-based care, how we can build an ambulatory value-based care system, comprehensively looking after patients, figuring out a way to deliver more quality at lower cost, better medical outcome. Benefits, how we can continue to develop affordable, high-quality, accessible health coverage for people regardless of their status across our country. Health technology, how we can bring the benefits of health technology to payers and providers across the country to be the greatest supporter of the general development and innovation of the healthcare system. How we can bring to life the opportunity of financial services within healthcare, a key strand which drives much of the system and represents great opportunity for simplification and streamlining. Last but not least, the relentless modernization of the most common touch point in healthcare pharmacy services. How we can develop a pharmacy services platform for the future, and one which can really respond to technology and innovation, which is coming from the pharmaceutical industry. Those are our five core growth pillars for this organization. Each one of those individually represents tremendous scope of opportunity. Each one of the five are already very big businesses within UnitedHealth Group. They all represent engines of this organization. You'll see all five of those represented to you this morning. You'll see the progress they're making and the growth they're achieving. They all exist within large addressable marketplaces, in most cases, we're really now, despite our size, only scratching the surface of the opportunity that lay ahead, and you'll see some of that described to you. In addition, importantly in addition to those significant focused engines, they have something else very special. They all help each other. They all play together in ways which make each one stronger than they could possibly be standing alone. That ability to connect the system, to find ways in which financial services can support value-based care, find ways in which pharmacy can help our benefits business, our benefits business can inspire our delivery business. That's where the true energy of this organization lay. Let me bring that to life a little bit by diving into value-based care. Think about what we're building within Optum Health. Of course, the clinics, the focus on building out clinics. As you look at the way in which that has grown, step back, where did it come from? The inspiration for that entire strategy comes from our benefits business. The benefits business conceived of the notion of how we could develop value-based approach. Optum began to build in response to that. That build begins around clinics. It assembles other capabilities, different types of specialists. About half of our physicians are primary care, about half are specialists. We work with employed and contracted and affiliated clinicians, many different models being deployed. You see the pace at which that business is developing. This year already, we've transferred or grown 1 million more lives looked after within our Optum Care value-based platform. Next year, we're expecting to add at least 750,000 more. That pace of growth is coming through because of that growth of capabilities that's been established. It's not just about the clinics, it's now about home and community. As you think about next year, of the very substantial number of lives which will be looked after by the home and community risk-bearing entity platform, complementary to the clinic platform, about half of those lives looked after by home and community are in geographies where we have no clinics. The home and community platform itself gives us yet another opportunity to extend the notion, the idea that we believe in, that comprehensive value-based care delivers better medical outcome, better quality for patients, a better role for providers, and crucially, better value for money for payers. We think it's a truly sustainable way to modernize the healthcare system for all of the key participants. As you think about that value-based environment, not only was it originated conceptually from the benefits business, not only has it assembled these capabilities, it's powered by our data. It's powered by our understanding of the system. It's helped by the way in which our pharmacy capabilities, home infusion, can complement our clinical capabilities in Optum Health. It's a good example of how all five of the engines start to work together to help that particular engine continue to work strongly. As we work those ideas, the key then is to figure out how to grow them. As you look at value-based care, you'll see two dimensions on which you could easily imagine that continuing to grow substantively. One is already within sight, and we've plowed that furrow well, and we will continue to do so. Geographic expansion. Not just through M&A, not just through organic expansion of our clinics, but for example, through home and community, where we find a new way to bring the good idea to people's homes without necessarily having to wait for the build-out of the clinic strategy. It's a great way for us to accelerate the delivery of what we believe to be a highly effective, extremely sustainable approach to more people more quickly. The second area is to conceptualize the way in which we take a great idea, comprehensive value-based care, which of course has been pioneered within the senior marketplace, and take it to a different part of the marketplace. Commercial. $170 million Americans in the commercial insurance environment. The opportunity to innovate in that space feels right. The timing feels right. The rails that we're building within Optum Health creates a set of capabilities, an instinct, a muscle memory within our health system, which we know works for seniors, and we are confident can be developed and built further for the commercial environment. Those two dimensions, geographic and moving across into different classes of business, represent enormous future potential growth for the organization and are high on our list to move forward. You will hear about all of that in the next couple of hours. What we try and do across the organization is relatively simple, and it repeats and repeats across the company. We try and understand the complex environment, and then we try and translate it and make it simpler for the people who live in it. We want people in America who need healthcare to be able to access it without needing a PhD in healthcare to do it. We need people to feel confident that when they come for care, they're gonna get great care, and they're not gonna be bankrupted in the process. Our job is to translate that complexity and make the extraordinary capacity of the U.S. healthcare environment available for everybody who needs it. We're incredibly focused on making sure that that's true across the spectrum of people in the country. Whether they are poor, whether they're rural, whether they're urban, whether they're veterans, or whether they're conscientious objectors. We want to create a system which works for everybody, and we're working hard to make that happen. We believe that within that agenda, that commitment to the mission, that there is tremendous ongoing growth in this organization. You will see that reflected, and I hope you saw that reflected last night in our confidence for next year. Now, to do all of that, we also need to do two other really important things to bring some high-octane energy to the future growth of the organization. The first is to become and learn how to be a preeminent consumer organization. The future of health care in no scenario is a future where the American consumer has less influence than they have today. In every scenario, the American consumer, the American patient, has more influence in the future than today. We need to build and respond to that. That's why you've seen in the last 12 months enormous steps forward in the company's stance towards the consumer at every level. Our agreements with Walmart, our partnership with Red Ventures Health are both designed to engage us at a level with the American consumer where we've been nowhere close to before. Whether people want to meet us on their shopping visits to Walmart, whether they meet us through Healthgrades or Healthline, those hundreds of millions of people a month who are trafficking through those digital environments or through those stores, those are our customers. They are the customers of the future. Theirs are the voices we have to build and respond to. You will see more and more emphasis in the organization as we lean into that consumer agenda. It's important we do that. Those consumers are, of course, our customers. They either are or they will be our patients. They are or will be the decision-makers on how care evolves. There are scenarios, as you imagine, things like commercial health insurance maybe one day evolving from being a defined benefit to a defined contribution environment where you can anticipate the consumer's role becoming even more critical. Building the capabilities ready for those scenarios are no-regret moves and help future-proof our long-term growth over the next decades. Second area that we need to make sure that we accelerate at pace is technological capabilities. Our ability to bring value from all of the data and the connectivity that we have across the system is crucial for us to make sure that we bring to customers, consumers, patients and providers, and to payers, exquisite right-first-time advice, exquisite understanding of opportunities to take cost out of the system, and figure out where are the no-regret places that we can stop care without necessarily impacting outcome, and where we should increase care because we know it maximizes benefits to the patient. That's a data challenge. How we bring that data to life. Again, we're just scratching the surface. We're at a moment in time where technology and the availability of talent is an extraordinary fertile opportunity for this company to leap forward, both in technology and its application, and in the way in which we drive a consumer orientation in the business. None of that takes away from being a hardcore organization focused on medicine, healthcare and, of course, fiscal thoughtfulness. In addition to all of those things, making sure that we are a strong consumer-led and strongly technologically empowered organization are areas for us to continue to build on. You will hear a lot more about that over the next few hours, and I encourage you to engage in the seminars also as we get into that. To achieve all of that, we really need to have an extraordinary organization of people, and I'm incredibly privileged to stand here representing 380,000 people across the world who support UnitedHealth Group every day. Those people do an incredible job, whether they are answering calls, whether they're going into a senior's home to help understand that person's health needs, whether they're making sure that our financial strength is there for us to make the next move in our strategy, whether they are simply making sure that the machine of the company turns every day the way it needs to. We depend on all of them. The diversity of that skill set is proliferating fantastically well. You have to have that diversity in every sense, because we now need strong consumer capabilities. We now need much more advanced, more modern technology capabilities. We need more physicians, more clinicians, more people who've got empathy with the system. It's an extraordinary statistic, for me, the most extraordinary statistic of today, so far this year, 3.9 million people have applied to join UnitedHealth Group as an employee. That is an extraordinary signal of how people want to be part of this journey. Why do they want to be part of this journey? They can see in this company an ambition to grow, yes. They see in this company a deep commitment to quality, yes. They see in this company an extraordinary commitment to putting the patient first, yes. A culture which values performance, yes. A culture which holds ourselves accountable for doing the right thing every single day, when people are watching and when they're not watching, and delivering performance for all of our stakeholders. You're gonna see over the next couple of hours in the seminars later today, 60 of my colleagues. A third of those 60 have joined us in the last 2 or 3 years from other Fortune 100 companies. There is a mix of experience there. People who've been here for decades, people who've been here for a much shorter time. People who've come from the biggest tech companies in America to the biggest consumer companies, from pharmaceutical industry and from government. It's that diversity reflected in the 60 folks you're about to meet, reflected down through 380,000 people across this organization, which gives us the confidence to be able to commit to the growth that we're laying out for you today. We believe it's built behind a great mission. We believe it's built on the shoulders of values. It's built on a culture of quality and performance, and it's built on a culture of holding ourselves accountable for delivery. We're gonna take you through that. We're gonna share that with you, and I hope very much you see at the end of the day why we're so confident our potential is stronger in front of us than it even has been already. Final reason why these 60 people are coming to this company, why these 3.9 million people are applying to this company, why the 380,000 people turn up every morning to work hard for this company, is because they know in this company they can make an impact on healthcare. Not just in a sm all pilot example, not just in an experiment, but when their idea works, it can affect millions of people. It can change the lives of millions of families. It's the impact that people are seeking. It's the opportunity they have to do that at this company that brings them to UnitedHealth Group. It's what brought me to this company. It's what brought the 60 you're about to see from this, to this company. I welcome you to this conference today. Please engage. We look forward to sharing everything we have with you. With that, I'm delighted to hand over to Dirk McMahon, our President and Chief Operating Officer. Thanks, Andrew. That's certainly true for me and the reason I've stayed with the company for nearly 20 years. During the next hour, we're going to dig deeper into the growth strategy powering that mission, introducing you to the people bringing it to life, leaders who've grown up in the company and others who've recently joined us. You'll also meet some of our colleagues in the front lines who are carrying out that mission each and every day, one patient, one member, one customer at a time. As you just heard, we're making real progress, staying laser-focused in our execution and always looking for ways to innovate, drive better value, and serve more people. You'll see over the course of the morning how each pillar of our growth strategy is delivering results on their own, as well as how the interconnectivity between them spurs innovation, creating value that extends well beyond our walls. Each one is an enterprise effort where Optum and UnitedHealthcare leaders are operating across individual lines of business and P&L responsibilities to drive enterprise value and to deliver specific performance and financial targets year-over-year, quarter-by-quarter. As the session unfolds, I hope you'll hear a few key themes pulling through. One, durability. We're a company whose model is built to perform, respond, and if I have anything to say about it, relentlessly improve over time. What we're really talking about here is building a consistent, well-balanced growth on the strength of our core market positions. The 46 million Americans enrolled in UnitedHealthcare benefit plans, the 129 million consumers we serve through Optum, our 200 plus payer relationships, 4 out of every 5 in the marketplace, and the more than 1.4 billion adjusted scripts we manage each year. Next theme, innovation. Building and refining new capabilities on top of these market positions and strengthening the connectivity between each of them. You saw from Andrew how we're working to expand the number of people benefiting from value-based care, but we're gonna show you how we're taking that model to a whole new level. For health benefits, you'll see how we're continuing to elevate our value proposition across our commercial businesses and government programs by further integrating our care delivery, technology, financial services, pharmacy, and consumer capabilities in all that we do. How we're moving beyond the traditional PBM model to provide pharmacy services, coordinating care for those with the most complex needs, and how we're continuing to commercialize health technology and health financial services to support other payers, care providers, and consumers across the system. Finally, a laser focus on the consumer. Today, people are more informed and empowered than ever before. Able to get most anything with the touch of a button, the American consumer is in the driver's seat. It's not a leap to think about how those expectations are carried over to healthcare. Better access to their own data, simpler means of transiting a system they once accepted as too complicated to do on their own. There is a recalibration of the expectations people have for healthcare, and today, you'll see how we're working to bring the system in line with those expectations. I promised Andrew and John I'd stay away from the sports metaphors, so I'll take one from my days in the airline industry. Each growth opportunity is at a different level of maturity. Health benefits is the furthest in flight. Health financial services is just getting pushed back from the jet bridge. They all have tremendous potential for future growth. Okay. Throughout the day, I'll come back at the end of each section, and we'll hit on a few important numbers and themes together. With that, I'd like to bring up Dr. Wyatt Decker to take you through our value-based care delivery strategy. Wyatt? Good morning. As a practicing emergency physician, I've seen the best and the worst of the healthcare system. In my 20 years at the Mayo Clinic, I witnessed life-saving interventions by some of the world's best medical teams, I've seen far too many instances where a small gap in care, something as simple as a missed prescription refill, led to a life-threatening condition that could have been easily avoided. That's why UnitedHealth Group's long-held ambition is very inspiring to me. To provide high-quality, comprehensive care through a value-based system to millions more people, connecting every part of a person's health, delivering better outcomes at lower costs. We started this journey well over a decade ago. Today, our physician-led network encompasses more than 2,200 sites of care across 44 states, serving more than 20 million people. As we look to serve even more people more comprehensively, we are further integrating and expanding our capabilities in many ways. First, growing our clinics, reaching more people within the communities we already serve while growing our presence in other regions. Second, continuing to bring other modalities of care, including virtual and behavioral health. We're integrating behavioral and medical benefits and care. Delivering outpatient mental health services in 37 states and offering a growing set of virtual and digital capabilities to patients across the country. We're also expanding our ability to deliver high-quality care in the home, helping more people manage multiple chronic conditions, providing a broader spectrum of clinical services, and supporting more people as they manage to acute transitions. As they manage those transitions into skilled nursing facilities, and we're helping them return home even sooner. As we expand how and where we reach more patients, what sets us apart is the growing connectivity within our capabilities that deliver truly differentiated comprehensive experiences. While there are different models to align incentives, our experience shows us the most impact are fully accountable arrangements. Today, our care teams are managing the complete health of more than 3.2 million individuals through these relationships. That's 1 million more people than last year, and more than double the number of people just three years ago. In 2023, we expect the total number of people we serve in these relationships to grow to 4 million. One of the most compelling reasons for this continued growth is the outcomes we deliver and the quality of care we provide. Primary care providers working in value-based clinics have more touch points with their patients and offer more coordinated care than fee-for-service. Care teams have more time to focus on addressing their patients' complete health needs. Under our value-based care, patients complete annual wellness visits at a 24% higher rate than people in fee-for-service, allowing care teams to address issues earlier. These more frequent touch points and incentives around whole health, paired with advanced clinical technology, show up in the quality of our clinical outcomes. Let me give you four examples of how Optum's Medicare Advantage patients are experiencing better outcomes than people in MA plans receiving care from other providers. Our patients achieve hypertension control 14% and diabetes control 7% more often. Our patients also have comprehensive medication reviews 7% more often. After hospital discharge, medication reconciliation occurs 39% more often, which is an incredibly important step in avoiding adverse drug reactions. Now, I'm gonna turn it over to Caitlin Zulla, who's going to talk about the opportunity we have to drive quality and affordability by optimizing the site of care. Thank you so much, Dr. Decker. The site of care has a powerful impact on both patient outcomes and costs. Our ambulatory surgery centers deliver better patient outcomes at half the cost of hospitals. We know effective home-based medical care can reduce hospital admissions, ER visits, and time spent in skilled nursing facilities by 15%-25%. The ability to guide patients to the right level of care in the right setting and at the right time, and bringing together all the right pieces to offer a comprehensive experience that empowers both the care provider and the patient are critical elements to effective value-based care. For us, this usually starts with a primary care physician. Building our physician-led network over the past decade has been anything but a one-size-fits-all approach. There is a common thread. From large-scale local care delivery organizations to individual physician groups, they all share a desire to elevate patient care and deliver better outcomes in the communities they serve. As we grow our ability to serve more Medicare Advantage patients more effectively, we're continuing to invest in capabilities to expand our value-based care opportunities in new and interesting ways, like exploring other types of strategic partnerships similar to the one we recently formed with Walmart, and further accelerating the adoption of value-based care to the 170 million people who have coverage in the commercial market to serve far more people than we do today. That brings me to Kelsey-Seybold Clinic, who's been serving the Houston area for over 70 years. From pediatrics to senior care, they deliver high-quality, compassionate care in 35 locations, supported by nearly 700 care providers in more than 65 specialties. They're one of only a few organizations in the country with deep experience serving Medicare Advantage and commercial patients through value-based arrangements. Joining me now is Dr. Tony Lin, CEO of Kelsey-Seybold. Tony, thanks so much for joining us. Good morning, Caitlin. Thank you for allowing me to be here. I'm honored to be with all of you today to talk about our future with Optum. Well, thank you for being here. It's amazing to see you. I have so enjoyed going to Houston and getting to learn more about Kelsey-Seybold. I'm sure there's many here who don't know as much. Can you share a little bit about Kelsey? Of course. Caitlin, value-based accountable care is the core to our mission at Kelsey. We introduced our first commercial risk plan in 2008, 15 years later, we're now serving large and small employers, nonprofits, as well as municipalities and school districts. 15 years experience in commercial risk, that is truly unheard of. Can you talk a little bit more about what your experience has been? Yes. Patients in our KelseyCare plan are thriving, and the outcomes are measurably better compared to the fee-for-service patients. Starting at the very top, KelseyCare plan members comply with their preventive care plans at 13 percentage points higher than their counterparts. About 73% of our diabetic patients are compared to their counterparts at much higher percentages, 73% compared to 51% in better control. It's actually very similar stories for hypertension. Wow. Blood pressures are in good control for 73% of those patients compared to a national average of around 49%. All good. Those clinical outcomes are incredible, and I know you care as much about cost. Can you talk a little bit about impact on total cost of care? Yes, we have seen great results on cost as well. Our care coordination on complex patient has allow us to achieve about 15% to 20% lower total medical costs, and that includes 40% fewer bed days and 30% lower emergency room utilization. As the quality goes up, the cost comes down. Kaitlyn, that's our textbook definition of what we've been all searching for in value-based care. I could not agree more. That truly is incredible, and one of the many reasons we're so excited to be part of Optum. Can you talk a little bit about what joining Optum has meant for you and your Kelsey-Seybold team? Definitely. We know Optum is here for the long term, helping us to continue to build on our strong foundation. Optum will help position us to serve even more patients, more seniors, and our diverse communities in our regions. Being part of this organization, Kaitlyn, means that we could start tapping into the full scope of the UnitedHealth Group capabilities that we'll talk about this morning, pharmacy services, advanced technologies. Kaitlyn, I am especially excited to be able to share what we are learning in Houston, especially on the commercial part of the business. Well, I know that we cannot wait to learn alongside you. Thank you so much, Tony. Thank you. Really appreciate you. With that, I will turn it over to Kristy Duffey to explain how we're expanding our in-home capabilities. Thank you, Kaitlyn. Good morning, everyone. As a geriatric nurse practitioner in the ER and ICU, I learned quickly if basic needs aren't met, everything else becomes nearly impossible. I saw so many missed opportunities to prevent our most vulnerable patients from ending up in the hospital because they didn't have access to the care that they needed. We are expanding the ways we reach people, caring for them in the comfort of their homes to address their medical, behavioral, and their social needs, which is especially important for the growing number of Medicare Dual and chronic special needs patients who require a far more individualized approach to care, considering the compounding challenges they face in their daily lives. On average, they're managing 9 different chronic conditions. Many are disabled. They lack transportation, and they live in remote areas. They're trying to manage multiple medications. About 40% struggle with mental health issues. That's where our team steps in. Thousands of dedicated Optum clinicians delivering value-based care in their home, bringing together physicians, nurse practitioners, social workers, pharmacists, and other experts. We are bridging home and clinic and coordinating care for the most complex patients. If a patient doesn't have a primary care physician, we connect them with one, and we serve as an extension of that physician, helping to coordinate care. Our clinicians and care teams, they get to know their patients, building relationships and earning their trust. Our home care model is centered around our patients' needs. As their health status changes, we adapt our visits and can spend over an hour with them, depending on the complexity of their needs. We might see a patient several times a week, a few times a month, or multiple times a year. If a patient has an urgent need, we will see that patient the same day. With this level of support, our patients are highly engaged in their care. More than 90% have a primary care physician, and are 8% more likely to visit their doctor each year than patients who are not in our program. This is leading to better outcomes, including a 12% reduction in hospitalizations, high patient faction with an MPS of nearly 80, and 99% of our patients are in a four-star or higher plan. This is only possible because of our access to the broader capabilities of UnitedHealth Group. This past year, we doubled the number of people we serve with this approach to home-based care across both existing and new payer relationships. Dirk? Expanding value-based care requires long-term planning and investments in both people and capabilities in each of our markets. For people, we've added 10,000 more physicians to our team this year. For capabilities, we're putting the right building blocks together and taking the traditional model to a whole new level. Seamless coordination across all sites of care, integrated pharmacy and behavioral care delivered increasingly in the home. In fact, you can expect at-home capabilities you just heard Kristi talk about will generate a significant portion of our value-based care growth next year. Just a couple of numbers to punch this up. In 2022, we added 1 million new patients in these arrangements, 700,000 through organic growth, and we hope to add another 750,000 through organic growth in 2023. As we continue to expand the number of payers we support, there's still a ton of runway ahead. By 2025, 70 million seniors will be eligible for Medicare. Think about what Dr. Lin and the team at Kelsey-Seybold think about the 170 million people who have commercial insurance in America. We're not even scratching the surface in terms of what's possible. With that, let's jump into our health benefits strategy with Brian Thompson. The health benefits business continues to perform at a high level by delivering value to the diverse customers we serve. As Andrew noted, we are preparing for an even more consumer-centric future, fueling innovations that better meet the needs of people, communities, and employers who rely on this marketplace. In Medicare, we're leading the way, focused on addressing the broad health needs of seniors with more value-added benefits at low or no cost to them. In Medicaid, we continue to win and expand into new states with record growth over the past 18 months and an RFP win rate of over 90%. In commercial, we're off to a strong start to 2023, increasing innovation in our consumer offerings while preparing for a future where consumers have more choice in how they get and pay for healthcare. The diversity of our businesses, products, and solutions position us well to succeed in the evolving marketplace, including, in the near term, the redeterminations process. That will require many people to seek new coverage over the next couple of years. We're ready. We've grown our exchange footprint significantly with plans now available to nearly half the U.S. population, and we have significant distribution capabilities. We can help individuals find the UnitedHealthcare plan that's right for them. We're confident our vision will enable us to serve even more people as we focus our work in 3 key areas. First, making care more affordable. The second is simplifying and personalizing the consumer experience. Third, providing quality care in the home virtually and the community. All this work is powered by our ability to bring consumer-centric, tech-forward, Optum-enabled solutions to the market. This year, you've seen us take some steps to lead the industry in novel directions. We're making it easier for customers and consumers to get the most out of their benefits and making it easier for providers to do business with us. From our move to provide access to insulin, and other life-saving drugs at no cost to the member to meaningfully reducing prior authorization requirements so providers can focus on delivering care. We're hungry for change, and we are ready to lead. All right, let's get to it. I'd like to welcome Brandon Cuevas to explain how we're making care more affordable and driving growth across our benefits businesses. Thanks, Brian. Affordability remains the single biggest issue for consumers and customers. We've talked to you in the past about our efforts to bring down total cost of care, and we've made excellent progress improving our network competitiveness over the last few years. It's more than that. We're investing to drive real value for our clients and our members. We're adding new tools and capabilities as well as innovative benefit and network designs like accountable care organization-based health plans, self-funded solutions for small employers, and consumer cost estimators. All these innovations are designed to help people make more informed choices and save money. This is especially important in today's economic environment, where we are helping people maximize their healthcare benefits and get the most for their healthcare dollar. Brian mentioned our move to eliminate out-of-pocket costs for life-saving drugs. We are continuing to explore new ways to offer rewards and incentives that enable people to access care without paying out of their pocket. This type of first-dollar coverage removes consumer costs while improving access to preventive and chronic care. Take our Surest product, which is unlike anything else in the industry. It provides first-dollar coverage by eliminating deductibles. Surest provides cost transparency for consumers, giving them clarity and certainty with a premium designated provider network, allowing to eliminate high deductibles, coinsurance, and other financial barriers to care, leading to high satisfaction for members and reducing costs by up to 46% for members and up to 50% for employers. Customers and their employees are taking notice. In 2021, about 1 in 25 of our national accounts offered Surest. In 2023, 1 in 9 will offer it, making Surest one of the fastest-growing commercial offerings. Affordability is the first thing customers and members consider when picking a plan, but experience is essential. Danielle Tang will discuss how we are making care more personal and easier to use. Thanks, Brandon. After cost, the next biggest pain point for our customers and consumers is how difficult it is to navigate the entire healthcare system, including benefits. Our job is to make it simpler. We're doing this through digital and personal solutions designed to anticipate people's needs and provide next best actions. Using a multi-channel platform, chat, digital, text, and call, we're engaging people at every step of the way. In Medicare, we are engaging seniors even before their benefits take effect, allowing them to start taking advantage of services like scheduling an appointment or earning an incentive. We're also simplifying their experience with innovative products like our integrated card powered by Optum Financial, consolidating separate member benefits and incentives into a single easy-to-use card that can be used at tens of thousands of retail locations to buy groceries and OTC products. This integrated card was available to 180,000 people this year. In 2023, we're bringing it to more than 7 million people. This is a great example of how we can quickly test, scale, and deliver innovation to market. Once members are signed up and have access to their benefits, they can use provider search and online scheduling to see the right doctor, use our cost transparency tools to understand what they will pay, and tap a digital wallet to cover the cost of the visit. For example, NPS scores for members who use our cost estimate tools were 20 points higher than those who haven't. See a huge opportunity to help address fragmentation in the marketplace, addressing the point solutions Andrew referenced earlier, so we can simplify the consumer experience. One way we're doing this is through our programs that advocate for our members. Our advocacy work started by helping members and care providers understand their next best actions. We then developed personalized service solutions for those with special or complex care needs. Our advocacy service solutions help members achieve better health. For example, our solutions led to a 42% increase in closing gaps in care, up to 15% lower ER visits, and an over 10% increase in clinical program enrollment compared to customers who utilize our standard service offerings. Our advocacy service solutions also support the affordability work Brandon discussed. Leveraging data points and signals such as diagnosis codes and claims data, our advocates can help people navigate to higher value options either before they seek care or in real time while they're in the doctor's office, potentially saving hundreds or even thousands of dollars in out-of-pocket costs. For employers, these programs mean better health outcomes, and a more productive workforce, as well as total cost of care savings of up to 4% each year. We're able to provide a single integrated platform to manage the experience and health of their employees versus a portfolio of disconnected third-party point solutions. Through the combination of digitization and a human touch, we are anticipating people's needs, meeting them at the right time, right place, and with the right experiences to guide them on their healthcare journey. With that, Robert Hunter will share how we are meeting customer needs in their homes and communities. Thanks, ChenChen. Convenient access to healthcare, whether it's virtual, digital, or physical, not only improves health but also helps ensure more equitable care for the people we serve. Health equity is built into everything we do, care in the home is no exception. HouseCalls has been the centerpiece of our home care model for government programs for years. We expect to complete 2.2 million HouseCalls this year, bringing personalized care into the home to address both immediate and preventive medical care needs in addition to social needs, including access to healthy food, safe housing, transportation to medical appointments, and more. We have been testing people for underdiagnosed conditions such as diabetes, prediabetes, hep C, and colon cancer. What we found is nearly one out of every four people we screened had a condition they didn't realize they had. The Hepatitis C positivity rates for Dual Special Needs members are nearly double the national average. Based on the program's continued effectiveness, we are expanding HouseCalls to deliver even more clinical services. For example, this year we began providing flu vaccines, and we are adding COVID-19 vaccines and boosters. Additionally, we are committed to identifying even more ways for HouseCalls to make high-quality clinical care more convenient for our members, further solidifying the home as a primary setting for clinical care. While many of our visits represent an opportunity to provide routine care, it's not unusual that we find someone with a dire need. Let's take a look at Margaret's story. It's sometimes hard to go to the doctor, first of all, to get an appointment, but also to be there because I always feel like there's some judgment involved when you go to the doctor, especially if you're overweight like I always was. It didn't feel that way with Aleta. She's very calm and supportive. I visited Margaret twice now. The first time, the health plan recommended that I screen her for an A1C test for diabetes. It was 10.1 at that point, which is very high. I was totally flabbergasted because it was unexpected. I knew it was a pivotal point that I needed to reassure her, and she was afraid. My thoughts were, I've got to make some changes to save my life. There are so many barriers to access to health when you're in your Medicare years, so to speak. We go to the home, and we do a wellness visit, but on top of that, we also have the capabilities to do some diagnostic testing. Anything that can be brought to the home really can improve a member's health before it becomes a big problem. Right now we're testing for pre-diabetes, diabetes, and Hepatitis C. We're continuing to expand that. Something else that we're doing that's really exciting, we're going to be immediately addressing the gaps in care that a member may have. The last set we're adding to help to evolve the program is vaccine administrations. To be able to potentially diagnose a problem and help them get care for that, it's satisfying because we know that a lot of these problems could lead to hospitalization and bad outcomes. I don't think I would have made the changes if I hadn't had the HouseCalls and have her tell me right there what it was. Without this program, I probably would be diabetic for life and on meds forever. I believe that. Margaret's story is an incredible testament to how we are bringing clinical care right into the home to help manage and even avoid critical health issues. While the HouseCalls program is key to addressing social determinants of health, we are also tackling disparities in the communities where our members live and work in other ways. This year, we expect to screen more than 5 million members for social needs, barriers to wellness, and other risks that significantly impact health and quality of life, with approximately 1 in 4 members wanting help. In addition to member screenings, we are also partnering with Federally Qualified Health Centers and community-based organizations to address needs on a larger scale, targeting our efforts at what matters most in each community. In Kansas City, we've increased behavioral health and dental care visits for expecting mothers, supporting improvement in full-term birth rates. We've also increased postnatal care appointment attendance by 90%, helping moms and babies stay healthy and thrive. Given the success of these programs, we are doubling the number of Federally Qualified Health Centers implementing these interventions and bringing private sector employers to the table to help accelerate these efforts. For example, we are working with the University of Tennessee, local employers, and community organizations to create a health hub where health coaches will provide support for weight loss, blood pressure control, medication adherence, and more. The goal is to provide a holistic approach to improving health outcomes and do it at no cost for neighborhood residents. From the doctor's office to the living room, we are bringing high-quality care to people wherever and whenever they need it, sometimes even before they know they do. Let me turn it back to Dirk to wrap things up. Two things I want to put a button on. First, Medicaid. As Brian mentioned, we've seen a record growth rate in the last 18 months. We're expecting the public health emergency to end next year, but there's no chance we're going to let a whole bunch of people lose coverage regardless of where they get it. The other big one, Medicare Advantage. Seniors love it. Today, nearly half of seniors are making the choice to join the program, more than double what it was in 2007. There is real, tangible value in these offerings, value people experience every day. Seniors who choose Medicare Advantage save 40% on out-of-pocket costs. That's over $2,000 a year on average, which is particularly meaningful when close to half of all Medicare Advantage seniors live on less than $25,000 a year. The program continues to deliver better outcomes than traditional Medicare, with members experiencing a 43% lower rate of avoidable hospitalizations for any condition, 23% fewer inpatient hospital stays for those clinically complex members, nearly 12% in combined savings for the government and seniors. With that, I want to invite Dan Schumacher to talk tech. Dan, you're up. Thank you, Dirk. Every day, millions of people engage with the health system in millions of interactions. Every day, we are working to make those interactions simple, intuitive, and connected. We're bringing together processes, people, and information to eliminate moments of friction and frustration, delivering actionable data to drive insights and create a more connected health system. With the right technology and the best people, we are getting information into the right hands, improving care quality, building trust, and preventing mistakes. Our recent combination with Change Healthcare strongly positions Optum to continue to lead the industry in healthcare technology and services. It means growth in our capabilities, growth in our customer base, and ultimately, growth in our impact in driving administrative efficiency and reducing friction across billing, claims, eligibility to make these transactions seamless, accurate, and automated. It's about our growing ability to make healthcare payments faster and more accurate. It's about expanding our opportunities to give providers critical information at the point of care so they can make better decisions and ultimately improve the health of patients. Now our team is here to share how we're deploying the most advanced technologies in healthcare to drive real improvements across administrative transactions, clinical support, and payment processing. Let's start with Neil deCrescenzo. Neil? Thanks, Dan. As we expand our efforts to make administrative tasks simpler and more efficient, we are making platforms truly interoperable. We're providing a multi-payer, multi-provider experience, which is creating greater alignment and ultimately reducing rework. A new solution we developed enables faster payment of claims by ensuring these claims get submitted correctly, which, of course, is a big source of friction in the system. When we move payer payment rules into the provider's revenue cycle workflow, the volume of rework drastically declines. Our technology incorporates machine learning and offers recommendations to care providers right at the time they're completing the documentation required for billing, and this gives them the opportunity to correct these claims that would wind up stuck in the system and helps them get it right the first time. The results of this innovation are strong. We're tracking to a 25% improvement in accuracy, which is great as it saves time and reduces costs for providers. When modeling these savings at scale, we can impact the hundreds of billions of dollars care providers and payers pay each year. For consumers like all of us, the value of eliminating one of the biggest pain points is enormous, and this is just one example of what we're doing to improve the administrative side of healthcare. Now Todd Walthall will share what we are doing to improve the patient experience through our revenue cycle management solutions. Todd? Thanks, Neil. We rely on technology to maximize the power of our revenue cycle management tools. Today, across all customers, we manage over $120 billion in annual billings and around 4,000 facilities, hospitals, and health plans covering over 180 million members use our solutions today. One of our partners, Boulder Community Health in Colorado, is using our solutions to reimagine how the revenue cycle can raise performance, and they're seeing strong results, including double-digit improvement in cash collection as a% of revenue billed, as well as clinical documentation and coding, which is key to ensuring appropriate reimbursements for services. These tools, technology, and process improvements are also helping reduce employee burnout. Since forming our partnership last year, employee retention has improved significantly. In addition to our work with Boulder Community Health, we're also helping clients improve the patient experience within the revenue cycle. For example, when it comes to digital, consumers expect ease and simplicity. They also want their healthcare digital experiences to work the same way. Combining the revenue cycle capabilities of Optum and Change Healthcare enables us to provide real-time digital cost estimates so patients know what their financial obligation will be for a medical procedure. We can determine eligibility and automate the prior authorization process so there's no delay. Patients can pay online or through an app. We even offer financial assistance tools. All of this simplifies the patient's financial experience and offers them a peace of mind of knowing what to expect. I'm going to turn it over to my colleague, Dr. Dominic King, who's going to show us how we're helping enable physicians achieve better health outcomes. Thanks, Todd, good morning. An important component of our value-based care is making sure that clinicians have access to the right technology and tools they need to deliver best practice care. As a doctor, I've experienced how technology can often frustrate us in trying to deliver great care, and as a technologist leading research and development teams at organizations like DeepMind and Google, I understand how challenging it is to bring innovation into complex healthcare environments. At UnitedHealth Group, we have an unparalleled opportunity to successfully take cutting-edge technology from the lab right into the clinic and helping our patients. An area we're investing heavily in is clinical decision support. These tools are rigorously researched, importantly built hand-in-hand with users, and reliably updated as peer-reviewed evidence emerges. Dr. Casey Jimenez and his colleagues are using Optum's Clinical Decision Support system in Florida to help him deliver better care for patients with chronic conditions like diabetes and high blood pressure. Let's take a look. I got into medicine because I wanted to make people better. I wanted them to have better health. If I'm not doing that, I'm not doing my job. Anything that helps me achieve that is more than welcome. CDS stands for Clinical Decision Support. It's supplementing what I need to do. Medical knowledge, it's growing at an extremely fast pace. No human or no clinician is going to be able to keep up. Changes in regulations, changes in care, new medications, new therapies. This is where the Clinical Decision Support tools help out. It gives me information about what the latest medications and guidelines say that the patient needs. It also gives me information at a glance about what health conditions the patient has, the allergies, risks, and how well the patient's responding to prior interventions in the past. It's an augmentation of my brain. I'm able to see firsthand which prescriptions are covered by this patient's insurance, an estimate of how much the prescription is gonna cost them, and I'm also able to discuss the risk and benefits right there with the patient. Most of our population, they live on a budget. They're retired. They need to know the impact of medication cost to them. We will need to use these tools as healthcare becomes more complex. I see that they work. I see that they're useful. They make my day easier. It is a game changer because I don't waste time with administrative tasks. I can focus straight on what the patient needs, what's available to the patient, and what the patient wants. Today, 40% of Americans are ma aging multiple chronic conditions requiring challenging merging of guidance. As you heard from Dr. Jimenez, this is all about the complexity of healthcare with the goal of making it easier. Clinicians using the tools that you've just seen followed best practice guidance 98% of the time, compared to 72% without access to this support. There was also a nearly 20% reduction in time spent arriving at those decisions. Better decisions leading to better care and better experiences. As we look to the future, we're excited to begin incorporating trusted artificial intelligence insights into our Clinical Decision Support tools, giving the more predictive capabilities and allowing clinicians to make the shift from detecting a problem to preventing it happening in the first place. Take, for example, chronic kidney disease, which affects 1 in 7 adults in the U.S. We're building artificial intelligence models that can identify patients that require more proactive support, aiming to head off the need for intensive and costly future interventions such as dialysis or a kidney transplant. This is just one focus of our applied research programs. Other areas we're exploring include how AI can help to identify those patients at greater risk of a hospital admission. Similar approaches are being taken to help clinicians complete administrative tasks faster and smarter. Dirk. Thanks, team. Getting things right the first time, that's what stuck with me. You heard the team discuss how we're really leaning into three key areas: expanding point-of-care insights aligned to evidence-based standards inside the physician workflow, making healthcare payments faster and more accurate, driving administrative efficiency, and reducing friction. Less rework, faster speed to payment, putting minutes back on the provider's schedule. All signs of a health technology and data strategy that's durable and scalable. A strategy that enables high-quality care for everyone. The best work at Optum's enhanced capabilities will be exciting. This year, we'll execute $10 billion electronic transactions and with Change, we'll do more than $22 billion. Together, we will manage provider billings of more than $120 billion, which is a 30% increase when Change is added. Altogether, faster speed, better accuracy, greater volume will ultimately drive more standardization and simplicity in the system. With that, I'd like to invite Kurt Adams to take you through our financial services strategy. Kurt? Thanks, Dirk. Nearly 20 years ago, we formed a bank to offer a seamless solution to help people better manage their healthcare expenses. It turns out we created a business that generates steady growth and provides healthcare financial services to more than 17 million people and 58,000 employers. We also saw another opportunity, this time to streamline claims payments for care providers. They were growing increasingly frustrated, not only by how long it took to get paid for their services, but the friction created by disparate platforms, and workflow applications required to reconcile and settle these claims payments. These challenges ultimately inspired the development of a highly efficient and robust payment platform and network that today delivers payments digitally into the accounts of more than 2 million providers on behalf of more than 150 payers. Security, accuracy, and scale are cornerstones of our platform and vital to the day-to-day transaction flow of the entire health system. The value of our network was made even more clear at the onset of the pandemic when clinics were closed, cash flows dried up, and thousands of practices were worried they might never reopen again. Given the crisis, Congress authorized the distribution of billions in payments to care providers, but the agency didn't have the connected network or the platform to deliver the payments as fast as they were needed. One Saturday morning in early April of 2020, we got a call, and within days, we began what would become $150 billion of payments, over 440,000 care providers, a large percentage of the health system, but well within our capabilities. This infrastructure, 2 decades in the making, serves as the foundation for our strategy in shaping and transforming the next 2 decades in health financial services. While there are many payments companies with strong network capabilities and many healthcare companies with broad-reaching relationships throughout the system, no one else brings both capability sets together to create value for consumers, payers, and providers quite like we do. My colleague, Takumi, will now share with you some of the areas where we're driving innovation. Thanks, Kurt. I lead innovation at Optum Financial. Prior to Optum, I was a part of successful initiatives at PayPal and Apple Pay, where I helped build and scale solutions that reached millions of merchants and users because the solutions were intuitive and reliable. I learned the importance of building platforms that could integrate with network at scale and build trust. The ability for a simple app like Venmo to connect to bank accounts and debit cards turned that solution into a verb where 83 million people are now Venmo-ing one another for everything from concert tickets to pianos. A trusted alternative to cash. It's how a platform connected to over 40 global payment networks, connected to thousands of card issuers, facilitated the safe and secure provisioning of millions of cards onto millions of iPhones every day. I was drawn to Optum because of the same potential for impact and scale with a unique collection of assets and capabilities. A financial services business moving hundreds of billions of dollars between payers, providers, and consumers. These building blocks are enabling us to bring scalable innovation to healthcare payments and to bring new solutions to market. One example is the card technology my colleagues talked about earlier today. Not only are we creating a more convenient experience for seniors in Medicare Advantage, and Dual Special Needs plans, linking their health plan information, pharmacy benefits, rewards, gym membership to a single ID card. Our payments capabilities allow members to easily pay for items covered by their health benefits, like groceries, over-the-counter medications, and even utility bills without using cash or worrying about saving a receipt to be reimbursed. We can identify qualified items at the SKU or product level and execute payment at the point of service. The integration with our retail network and ability to adjudicate at single item level precision is what makes this possible. By early next year, this technology will be available to almost 12 million people across multiple health plans. Our retail acceptance network already includes 6 of the 10 largest grocers in America, including Walmart and Kroger, as well as leading pharmacies like Walgreens and CVS. Convenience is key, as 92% of Americans live no more than 5 miles from a participating store, and our retail network will only continue to grow. More importantly, what we're uniquely able to do is to offer a service that connects from within the healthcare system. What's different in our approach is not just connecting the consumer to the retailer, but connecting their health plan as well, whomever the payer or plan might be. The capability and potential impact extends well beyond the core transactional functionality of the retail network. It amplifies the utility. When we connect to the care providers in our ACH network that Kurt just talked about, we are similarly creating opportunities to amplify and play a deeper role in payments and financing to deliver on the promise of real-time payments in healthcare. Platforms that connect to networks to deliver better experiences and embedded financial services at scale. Back to you, Kurt. Thanks, Takumi. We are working on a future where retail purchases and medical claims are processed instantly at the point of service, where payments happen with the same ease and convenience consumers have come to expect in so many other aspects of their daily lives. With our growing consumer capabilities enhances our scale and value of our payment networks and provides an opportunity to improve consumer experiences throughout our combined efforts. This is hard work, no doubt. While we are still early in our journey, the addressable market revenue opportunity is well north of $100 billion across the healthcare industry. This type of opportunity isn't available to everyone. We are unique because of our payment platform, network capabilities, and the broad relationships we have embedded within the healthcare industry. We have just the right mix of expertise, innovation, and ambition to deliver the next generation of solutions that are easy to use and take out the unnecessary friction that exists in the market today. Thank you. Thanks, Kurt. Like I mentioned at the top, our financial service capabilities still in the early stages, but the kind of innovation that Kurt and Takumi are talking about is so elemental to our DNA, building products and services for the people that go on to transform the industry. Those seeds we planted nearly 20 years ago blossomed into a significant and growing consumer accounts business. The largest provider payment network, 2 million plus and growing. A nationwide retail network that includes 6 of America's 10 largest grocers, and much of the transactions infrastructure for the health system. Our story wouldn't be complete without a look at our pharmacy services business. I wanna ask Heather Cianfrocco to come up and take us home. 1 million each day. That's how many people we reach through our pharmacy offerings. Helping people manage multiple medications and chronic diseases, helping people access and afford the drugs they need, giving them every assurance they're not on their own in navigating the complexities of the health system. We have more than 12,000 clinicians, pharmacists, and pharmacy technicians connecting the dots of healthcare, and advocating to make it easier for people to access the medical, pharmacy, and behavioral health therapies that they need. We're driving affordability and transparency for our clients, always guiding them towards the lowest net cost approach while remaining grounded in our strong clinical foundation. We're taking a holistic approach to managing specialty drugs and complex cases, we're providing solutions that reduce drug costs for uninsured patients. We're simplifying access to care through direct-to-consumer digital solutions, home delivery, infusion services, and integrated pharmacies and community mental health centers, all while providing full-service, personalized pharmacy care and multi-channel digital engagement. Let's start with the ongoing evolution of our pharmacy benefits capabilities, our PBM, and the more than 61 million people it serves. I'd like Trisha Purdy to share more about how we're expanding on this foundation and going so much further. Our differentiated PBM has long been the engine powering our consistent durable growth, enabling us to innovate and scale to reduce pharmacy costs, whether consumers receive their benefits from UnitedHealthcare or they are the 50% of people we serve who don't. We are building on our cost-based drug pricing model, an alternative to traditional pricing by creating configurability for our clients, allowing even more transparency in how we deliver value and savings to our clients. Our suite of tools gives both people and their doctors real-time information, including if the drug is covered and how best to receive the lowest price. This kind of innovation is leading to client retention of over 98% and material growth. This year, we expect to process more than $1.4 billion adjusted scripts, up 5% year-over-year. As we continue serving more clients and more patients, we are focused on a future where care services capabilities are increasingly integrated with pharmacy, medical, and behavioral health. More than 400,000 new patients this year alone, helping to deliver an increase of 2.5 million more prescriptions than we filled in 2021. As a result of this growth, we've identified other areas where we can expand the model to people who need a higher level of support for specific conditions. Compelling. One of those conditions is HIV. Maybe Tasha, if you could spend a little bit of time just describing how we're evolving the model, tailoring the model to meet the needs of this unique population. Yes, Tricia, I'd love to. There are more than 1 million people living with HIV in the U.S. today. As you know, there's been huge advances in treatment over the years. A person diagnosed with this disease can really enjoy a long and healthy life if they get the treatment and of course, adhere to that treatment plan. About one-third of people living with HIV struggle with their medication regimen, and not following treatment plans leads to increased morbidity, mortality, and risk for HIV transition. Our pharmacists who are clinically trained in providing HIV pharmacy care really take the time to get to know each patient and their unique treatment plan to provide counseling on those complex medications, help work through side effects they may be experiencing, partnering with their doctors to adjust treatment plans, and overall supporting their medication management. Total direct medical cost to the system attributed to rare disease. While these dynamic therapies are transforming patients' lives, they come with a high price tag and with a number of challenges that the healthcare system isn't prepared for. Patients and providers not only need a reliable resource to secure medication, they also need our expertise because most providers will see a rare disease only a few times at most in their entire career. Drug procurement, logistics, dosing selection, insurance navigation, drug administration, lifestyle changes, and overall medication management are only a handful of examples where rare diseases challenge the system. Many of these patients see multiple doctors over years before they get a diagnosis. Once someone with a rare disease finally has a prescription, they need help with the lifestyle changes that sometimes come with a new medicine so that it works optimally. That is why we built our rare disease pharmacy, which specializes in providing access to therapy, education, and support for the whole person. After we opened our doors in 2021, we quickly started winning with pharma, securing access to manage ultra-limited distribution drugs and support the patients who take them. In 2022, we doubled our win rate, including several exclusive agreements, a testament to the trust pharma manufacturers have in our service and our clinical expertise. We provide value to patients, providers, payers, and pharma to support these complex conditions. What's important about this is that we are creating the foundation for our overall specialty model with expert holistic support. That's why pharma is coming to us. Key to our success has been going deep in each therapeutic area, including extensive research, training, and engagement with patient advocacy organizations. This is how we create custom models that give patients one-on-one support on a first-name basis. We are truly experts in that condition and that therapy and see all That they've been to three, four, five, six different specialists over the course of five years, and no one has answers for them. In Marcy's case, through that one-on-one interaction, we were able to find the time to talk about more than just the medicine, talk about the diet. I determined that it was the formula that was actually potentially causing these symptoms in him. Finally, having someone that sessions is our dual focus, our relentless drive for operational excellence, and our long-term vision for what healthcare can be for people. Now and how we are doing it on behalf of everyone in the health system. Now I'll hand the stage over to John. John? Good morning, let me add my thanks to you for joining us today. We know it's a considerable time commitment, and we're grateful you chose to make it. Along with that gratitude, I have to offer an apology at the outset here. A preemptive apology, let's call it, in the event these comments make you feel like you're back in your high school science class. That's because I want to talk about physics for a moment. In particular, two basic concepts: velocity and systems. Speed, if I recall correctly, is the rate at which something covers a distance. Literally, how fast the thing is moving. Velocity, however, is both the rate of change and the direction of change. The velocity with which a baseball travels from a pitcher's hand to the catcher's mitt, for example. It's an important distinction, and you'll see where I'm going with this in a moment. The body can be fast but not go anywhere. Speed alone doesn't say nearly enough. To put it in terms more relevant to today, simply stating health care is changing rapidly doesn't tell us much at all about where we are or where we're going. Contrast that to velocity, which is pace with direction. That's what we think is important. Not simply how fast we are changing, but in what direction of travel we are seeking to shape those changes. We believe there's increasing velocity of opportunity for UnitedHealth Group to create greater value, and that this velocity is accelerating towards systems, and importantly, a certain kind of system. To explain, back we go to high school physics. Isolated systems, you'll recall, are collections of objects that do not exchange matter or energy with their surroundings, but only among the objects. To some extent, that's how healthcare often functions. Point solutions engaging singly with other dedicated point solutions. It's not that they don't accomplish anything at all. It's more that there's a limit to the ultimate benefit for people and the broader healthcare system effects. In contrast, what we're aiming for is a connected system, where matter and energy are exchanged among the pieces and with the more encompassing external environment. This is how we believe better outcomes and experiences can result both within and from UnitedHealth Group. It is the clearest path to creating more value for our many partners and customers and the healthcare system as a whole. We set out intentionally with speed in this direction, primarily from a foundation of employer-sponsored benefits. We built upon this foundation, extending and expanding our health benefit capabilities to serve people in Medicare and Medicaid, and then connecting the two to serve those with Dual Special Needs. We brought out our services, pharmacy, for example, and technology and management systems, and we added care delivery, starting first with primary care practices. As we gained experience in each area, we found we could go both deeper within each capability and broader to the adjacent ones. Building systems which became increasingly more connected. No longer isolated points in nature, but helping those within our company and more broadly. Our intention has never been to be the most successful vendor of single-point solutions. The goal has always been to build strong connections across those capabilities because that delivers the better outcomes, experiences, and quality of a high-performing health system. It takes substantial time and substantial capital to assemble some of these capabilities. In some respects, that's the easy part. Only when the pieces are assembled does the hard work begin. Building the system characteristics and the system effects. The connections that make all this work. A prime example, comprehensive value-based care provided by Optum Health. Working with over 100 health plan partners, including UnitedHealthcare, the overall system benefits from the health outcome improvements discussed earlier here. Consider our advances in bringing care to people at home. We started with in-home preventive care assessments for Medicare Advantage patients. We served about 250,000 people that first year. Today, our nurse practitioners engage in an expanding range of highly effective clinical activities such as vaccines and disease screening. In 2022, about 5 million people will benefit from these capabilities. Importantly, what's also different today is that this once isolated point capability complements other capabilities across our organization. What's also different today is that we can use the expertise and capabilities we have developed in home services to see how else we build greater value for people. Compared to a decade ago, when we look at partnering with an organization like home healthcare company LHC, there are many more points across our company to which they can connect. As such, we can expand the impact we can create for patients and for payer customers. Today, when we look at potential strategic partners, it's through a much wider lens than just five or 10 years ago. We look for not just one, but multiple sets of connection points that solve problems, smooth out experiences, and drive better outcomes. It's part of why we are highly energized about both our near and our long-term prospects. It's the connected system concept come to life, the sharing of energy and value, increasing the velocity of opportunity toward achieving the mission of UnitedHealth Group. All right. That's probably enough about science. Let's head on over to math class and see how this translates into the numbers. I'll start with a brief recap of 2022. As we updated with our third quarter earnings report six weeks ago, we expect 2022 adjusted earnings per share to be in the $21.85-$22.05 range. The growth comes from across the enterprise, with particular strengths from Optum Health by serving more people in value-based care arrangements and from UnitedHealthcare by adding more people to its benefit offerings. There's a lot to point to from this year, but we also know it's the end of November, and what you really want to hear about is 2023, so that's where I'll turn. Our initial 2023 adjusted earnings per share outlook is $24.40-$24.90. Again, with balanced growth from across the enterprise. We expect total revenues to approach $360 billion, with double-digit growth at both Optum and UnitedHealthcare. This growth is driven primarily by serving more people and by serving them more comprehensively. Turning to the specific businesses, UnitedHealthcare revenues will approach $276 billion, growth of $27 billion or 11% over 2022. This is driven by ongoing strength from our Medicare Advantage offerings and innovative commercial products, partially offset by the potential that Medicaid members may be affected by eligibility redeterminations. Our Medicaid team is highly engaged in detailed planning for the potential resumption, with a strong focus on assisting our members and others who may be impacted. The growth outlook presented today incorporates a view that redeterminations will begin in the first half of the year. We will be working with our state partners and community organizations to ensure that people have continuous access to benefits. By the time redetermination activities are completed, we expect that between helping people reinstate existing coverage and offering them other options, including commercial and exchange-based, we will serve even more people across coverages than we do today. The proportion of people in the U.S. with health benefits is at the strongest levels we've ever seen. We should not move backwards now. For our Medicare Advantage offerings, the open enrollment season now underway leads us to expect an eighth consecutive year of above-market growth. We do this by listening to seniors, maintaining benefit stability, and introducing product innovations, delivering real value to both customers and taxpayers. As a result, in 2023, we will serve more people in high-quality four and five-star plans than any other company. You heard earlier about our new and innovative commercial products gaining traction among employer customers and their employees. Our aim is to continue to develop new approaches that meet their ever-evolving needs. You should expect to see this lead to increasing growth rates in this important market over the next several years. We're highly energized about the prospects for Optum, both in 2023 and well beyond. Optum's capabilities and connected system orientation make it an invaluable innovator, one that's uniquely positioned at the center of the health system. That's why Optum's revenues will grow upwards of 17% next year. This growth will come from all segments. Optum Health revenues will approach $92 billion, an increase of about $20 billion or 29%, driven by continued growth in the number of patients served under value-based care arrangements. You heard the Optum team describe the 4 million value-based patients we expect to serve in 2023, an increase of more than 2 million over the past 3 years. It's a start, but still early stage when we consider the potential. For example, when we look at just the regions where Optum Care delivers care today, we currently serve only about 10% of the seniors in those area with value-based offerings. That's just seniors. We're also laying the foundations from which we will serve people in commercial and Medicaid plans. Revenue per Optum Health consumer served is expected to grow by more than 25%, driven by the increasing number of people under value-based care arrangements. This growth, though, is also due to the advancing levels of care we offer. For example, in 2022, our ambulatory surgical centers performed 3 times as many complex procedures, such as orthopedic and cardiac, than just three years ago. Moreover, our patients have high-quality clinical outcomes and strong experiences reflected in NPS scores, which consistently run at 90 or higher. Importantly, this is provided at a 50% savings for the health system compared to traditional settings, delivering critical value in a world of scarce health resources. Optum Insight revenues will grow 30%. The revenue backlog will approach $33 billion in 2023, growth of $4 billion. The Optum Insight team is sharply focused on the opportunity with Change Healthcare to improve system performance and experiences for patients and providers. With the combination having been completed only recently, the 23 earnings outlook accommodates a view that we will accelerate integration activities and investments, so we can more quickly expand upon these capabilities, especially in the first half of the year. Optum Rx continues to evolve its business to extend clinical value beyond medications. These newer services build upon the strong foundation of the PBM, whose purpose is to deliver more value for the people we serve. The breadth and value of these offerings lead us to expect Optum Rx revenues for 23 of $106 billion, organic growth of about $6 billion, and with multiple pathways to continue this growth for years to come. These growing businesses support and are supported by substantial financial capacity and a strong balance sheet. Cash flow from operations in 2023 will approach $28 billion or 1.2x net income. Returning capital to you, our shareholders, remains an enduring commitment. In 2022, we will return $13 billion through dividends and share repurchases, about a 25% increase over last year. We will continue to grow the amount of capital we return in 2023 and beyond. Even with this level of activity, our growth capital capacities remain strong. For example, in 2022, we will deploy over $20 billion in growth capital. Our commitment to building long-term value through strategic combinations into the future, further accelerating system velocity remains steadfast as well. One of the areas from physics I did not touch on earlier was the idea of limits. The idea that there are various technical or physical law-imposed limits on what can be done. As it pertains to advanced physics, I'm not the guy to ask. But as it pertains to UnitedHealth Group, given the markets and the people we serve and the expanding nature of their needs, we are a long way from such theoretical limits. From where we sit, we see substantial opportunities to bring even more value to more people and organizations across the healthcare system far into the distance, and to continue delivering growth at our 13%-16% long-term rate as we do so. You have the commitment from all 60 of us gathered with you today and our 380,000 colleagues to deliver that growth to you and to deliver ever-increasing value to the people we are privileged to serve every day. Thank you very much. Now we're going to take a minute to set up the stage for our Q&A session. Please take your seats. We are ready to resume. Thank you. Well, hello again, thank you so much for your attention so far this morning. I'm delighted that we're gonna start the Q&A now. Thank you for listening, and we look forward to your engagement. Let me ask my team to come up here and join me on the stage real quick. We'll get the Q&A underway straight away. We have folks in the room with mics and paddles, so if you do have a question, just raise your hand, one of the team will come to you, and we'll try and get around just as many as we possibly can. In the center there, Zack, I think I see you first. We're gonna start off with Justin Lake from Wolfe Research. Thanks. My question's on the financial services opportunity. Post the acquisition of Change certainly seems like one of the more significant opportunities down the road. Can you flesh that out for us in terms of what are, you know, one, two, three of, you know, the bigger opportunities you see in the near term over the next three to five years to drive growth in that segment? Yeah, it's great. I'll ask John Rex to make a couple of comments, and then Kurt Adams. Can we get mic to Kurt in the audience? You heard from him already. I'd like him to comment on this as well. John, why don't you kick off and then Kurt. Maybe pitch it up, first and foremost, the opportunity to remove friction from the system. Much of the friction in the system today exists between the patient and the provider in that relationship. Much of that friction results from something to do with a payment or a collection. How do we bring those capabilities together to make that seamless, perhaps even instantaneous, to take out that piece where the friction results. The other opportunities that we see also in this, there's an enormous opportunity there. You heard opportunities described about the consumer experience that we've developed and are rolling out quite broadly this year, in terms of integrated card capabilities. Our ability to help providers, expand their practices, make better decisions, quicker decisions, and much more efficiently and economically than they're able today. Maybe let's just pitch over to Kurt Adams, who runs the financial services business for him to expand on that. Yeah. Thank you. And just to add to that, as we were talking about earlier on the stage, platforms connected to networks to deliver experiences. As we think about the platform capabilities now between Optum, and Change Healthcare, they're massive. It brings us to a true multi-payer capability that allows us to connect to our retail and provider care networks to deliver payments more efficiently, more effectively, and drive a lot more value for both providers and consumers in that value chain. For us to really be able to build experiences on top of all this infrastructure that's been established over the course of the past 20 years or so. Finally, the amount of paper in the system that Change brings. We are talking a lot of paper that is still in the system that we have the opportunity to digitize and make a far more efficient process for both payers and providers in the system. Great. Thanks, Kurt. Justin, really appreciate the question. I think if you just boil it into two segments, there's a huge provider set of opportunities in terms of taking friction out, taking paper out, waste, speeding things up, accelerating payments to providers, helping their cash flow situation, that kind of thing. That's, I'd say, kind of super imminent, super close. Slightly longer term, but not much, really project forward what a true consumer healthcare marketplace could look like. As Optum starts to build a multi-payer marketplace environment, a lot of what the work we've been doing this year is laying the ground for that. Having a sophisticated financial service capability able to run through the back of that, recognizing that one in five dollars spent in the U.S. is spent in healthcare, super important opportunity for us in terms of the consumer agenda as well. Those two areas, I'd say, Justin, and you heard some of the detail beneath that. Okay? Next one. Yeah, please. In the center there, Julie. Yep. We have A.J. Rice from- Yeah, AJ, go ahead. Thanks a lot. Maybe to just flesh out a little more the commercial value-based care opportunity. I know Kelsey is a big part of that, but over time, how will that start to contribute, and does that model look differently than the risk model that you have with MA and how that's developed? A.J., thanks so much. I'm gonna ask Brian Thompson to comment in a second. As I mentioned, you heard two or three times from the stage today, we definitely feel that the skills and the rails we've been developing, particularly in the senior market, has applicability across much broader segments of the marketplace. Clearly, as you think about a clinic in the real world, of course, they see seniors, they see MA seniors, they see Medicaid. Of course, they see commercial lives as well. Once those clinics have developed a way of working, it's not a huge leap to imagine how that can be practically delivered. The question becomes how you start to evolve the incentives and make sure that the system itself sees the benefit from it. Maybe, Brian, you could talk a little bit to how you envision that. Yeah. Thanks for the question, A.J. Having spent so many years in Medicare, I'm perhaps most excited about the opportunity that I do see in commercial. It's not new to us. We've done value-based care in commercial for some time in California, in Nevada in particular. What I think I'm most excited about is what I haven't known in the past and what I've learned from Dr. Lin and others. I think the breadth and scale of what we can do in commercial, we're just scratching at the surface of it. I absolutely believe that this is the future of commercial care, driving the same sort of alignment is the same sort of incentive that we see between providers and payers. That's no different. How do we make sure that we get that excess and inefficiency out of the system that we see in fee for service is probably what we're most excited about in the business. Yeah, I think we're only scratching the surface, and Kelsey-Seybold is certainly helping us understand what perhaps we haven't known in the past. I think, I'd just add to that, A.J., as you think about it, a lot of the progress that's been made so far, honestly, even in the MA sector, as you think about how we make sure the right resources get allocated to the patient, and then we're very focused on things like site of service and increasingly now beginning to address the efficiency of the core medical spend. Dominic King, when he was talking today about making sure everybody's on that best practice, that cutting-edge evidence-based medicine, but that's really just beginning. That opportunity to take savings out of unnecessary care, not site of service, just care that wasn't necessary in the first place, that opportunity exists both in the current value-based space, unmined fundamentally, and is a huge opportunity in commercial. In a sense, both the current value-based platform and the potential opportunity in commercial benefit from that focus on that piece of the space. That's where you're gonna see a lot of attention. That's why the systems, the bringing together of clinical expertise with technical expertise, being able to automate this at a level we haven't really seen before, becomes a key enabler to both of these. How can we do more for seniors in the classic space? How do we unlock the commercial space? Zack, you have Kevin, I think. Yeah. Zack Sopcak from Bank of America. Hey, thanks. You've talked a lot about home and value-based care, a lot more than I guess I'm familiar with you talking about it. You said that that's gonna be a big part of the value-based care growth. Is that in the 750,000 that you're talking about growing this year? If so, can you talk a little bit about the economics? Is that similar to a physician economics where it's 85% are premium, or is it some component of that, and how do we think about margins? Yeah. Great, Kevin. I'm gonna ask Dr. Decker to respond to that, please. Yeah. Thanks for the question. Absolutely. I think what you'll see us building out is our care delivery capabilities in the home, and that is included in fully capitated lives in our 750,000 risk life number. Point 1. Point 2 is where we can really unlock value and create remarkable patient experiences with better outcomes at lower cost, is when we combine the primary care physician in particular, but the physician practices with the home care. Increasingly, you'll see us across Optum Health bringing together our home care capabilities and partnering with both our own primary care physicians as well as community physicians to create a holistic solution for healthcare. That's really where we see unlocking the greatest value and the greatest accelerant for growth. Of course, as you'd expect in that home and community capability, it really speaks very nicely to the D-SNP population. One of the areas you know well is a lot of the D-SNP patients actually need to be managed much more in the home. It's much more. It creates a much more accessible healthcare opportunity for them. You get better outcomes, people get better care. It allows us to strengthen our capability to be effective for those people with the most complex situations who in many cases don't find it so easy to engage with the classic infrastructure of the healthcare system. Thanks for the question. Julie, you got Josh, I think. Yeah. Josh Raskin from Nephron. Hi. Thanks. I think I'll stick on the same topic. I guess just on the value-based care model, one question I would have is, where are you seeing the most success or most effectiveness in terms of actual care management, you know, setting-wise, you know, through the primary care? Is it sort of MSO-based, center-based, et cetera? How do you manage the specialist as part of that? I'm sort of interested in lessons learned. On the commercial, just to go back to that, my understanding is value-based care is most effective for chronic care management. I know that's a portion of the commercial population, but probably not to the same extent as Medicare. How does the care model change, you know, relative to what you're doing for seniors? Maybe I'll ask Brian to address the second part of your question, Josh, and then go back to Wyatt to comment on the first part. Brian. Sure. I'll be brief on the first. I think it's as simple as when you can get engagement and you can get coordination, there's opportunity. Clearly, I think we see that in chronic populations, most notably, but I don't think that limits the opportunity to manage care better when you have that primary care engagement model, where they're accountable for all the downstream care. I see that with similar upside in our commercial market as well. Wyatt. I would say the magic happens, Josh, with the primary care provider and the wraparound solutions, the team and the technology. As you know well, with chronic disease and with many conditions, specialty input is necessary. What you'll see us doing is thoughtfully employing, and Kelsey is a great example of this. It's a multi-specialty practice. Many of our practices, Atrius, Everett, et cetera, are multi-specialty. We thoughtfully employ the right number of specialists who then engage into that value-based specialty consultation, providing just the right expertise, not too much, not too little. In markets like Colorado, where we have largely an affiliated specialty network, we actually work with SCA, again, Caitlin Zulla, to say, "Who are the highest quality orthopedic providers in that market?" We use data and analytics to identify them and preferentially leverage their expertise. If you're practicing high-quality evidence-based medicine, you're gonna get Optum Health's referrals. If you're not, you're gonna see that number dwindle. For us, that's a very powerful motivator for our physician specialty networks who are a critical part of the team. It's, it's fascinating, Josh, when you spend time with the advanced value-based care clinics, what they really start to do is they look at their overall population on a very dynamic rolling basis, so every few days, every week. Really fixate on literally a handful of patients. I mean, so, if you think about 80/20, when you're really thinking about where the value-based opportunities and risks are in a population, it's probably more like 97/3. I mean, it's a very, very small number of folks in a given time period are gonna be the people who you need to really be focused on. Making sure that you have this kind of pooling of expertise, so pivots around the primary care physician, but pools around them and wraps around them all the kind of insights you need to be able to spot people who might be about to go out of control, who maybe just came back from the hospital, you don't want them to ping back again. Maybe is at risk of being a repeat visitor to the ER. All of those things which are gonna really drive bad performance clinically as well as cost-wise. That's really how this comes to life. As you see this, it becomes a team sport. Primary care physician is very much the center of it, but it becomes a team sport, and the more competency you can put in that team, aligned with the right incentive, the best outcome you get. Of course, as we start to power that with more and more data, which I'd say is still early days. You know, the work that Dominic King shared with you today, the progress we're making in terms of being able to deliver evidence-based care advice to physicians in real time, that's beginning. We have a long way to go with that, but the potential there to really raise the standard across the board is phenomenal. When you think about how that team can strengthen, that's where we, that's where we think we can head. Okay. Zach? I have Ann Hynes from the Mizuho. Great, thanks. This is a follow-on to A.J.'s question about commercial opportunity and value-based care. Can you put some numbers around that, maybe timing of goals, how many lives you expect and when? What do you think the biggest barriers to entry to penetration for that is? Secondly, for 2023 guidance, can you just talk about what type of recessionary risk you have in that guidance? That would be great. John, why don't you tackle the second part, and then I'll come back on the first. In terms of the 2023 outlook and the potential for recessionary impacts and such. For a company like ours and such, in terms of different impacts we would consider, certainly what's happening with interest rates broadly. As we've discussed in prior settings here, we are fairly managed in that regard. However, with interest income and interest expense and how we manage that component of our balance sheet, dramatically reducing the volatility that's created by that. Typically in a position where we are modestly biased to being net investment income positively biased, however, in terms of any of those types of situations. The other impacts that we see in recession, in terms of impacts they can have on other businesses, often have to do with business cycles. Not so much in our core health plan businesses, but in other businesses such as Optum Insight, what would we think about business activity all over in broadly in terms of relationships that we're entering into. Now I say that realizing that health systems, particularly as they work with Optum Insight and the many offerings they have in their rev cycle business, as they come into periods which are challenging are often attracted to the ability to do business with a partner like Optum Insight. Taking a view of that and how would that impact elements such as we discussed, what would happen to our revenue backlog growth as we look at that. Considering all those elements is really how we looked at putting together, the business, in terms of the business plan for 2023 and what kind of offsets we might see. Thanks, John. To your first question, so already underway, so pockets of commercial risk capitation already in the business. You heard from Tony Lin and Kelsey, several other areas of Optum Health, we already have that. I think in terms of pacing, I think this is something which we'd see accelerate over the next three, four, five years. It's gonna be very much a kind of geographic employer kind of mix. I think you'll see it pop up in different locations across the country, and one of the things we're working very closely with is how to do that. We're in a very interesting opportunity in that regard. If you think about historically, we tended to meet our patients through the insurance business first, and then we've connected them to care in Optum. I think as you think about this model of moving toward commercial value-based care, the model can work both ways. We can, of course, continue to do that, and we have a high probability of meeting people through Optum and then arranging their financing through the health, through the the insurance business. That creates a super interesting way in which you can bring to this whole concept to life. Being a little bit more plural about the way in which we evolve this model is something you're gonna see. Sometimes it will be very much UHC-led, and in fact, other payers and we're in engagement with other payers around this agenda right now. It can also work the other way. The clinic sits in the city, it's already looking after lots of people in that employer group. Maybe they want to change the way in which it operates. It's actually a conversation which begins with Optum and then becomes backed up by UHC. You'll see all of that start to play out. I'd guide you over 3-5 years in terms of substantive growth. Yeah, Andrew, let me add, there's, you know, Andrew hit on the two things. You asked about the rate limiting factor. Yeah, the first one is markets, right? If you go back even to the original days of PacifiCare, you know, they had a fairly big commercially capitated book of business in Southern California. Also, as I've sort of been in the national account space, we're hearing more and more are sort of willing to sort of go to Optum Care and say, "Hey, what's going on Optum Care? Can we dedicate part of our population in this zip code to Optum Care?" I think with the... There's a little bit more lean into some of them being willing to accept a little bit of a narrowing of a network. Those type of things are sort of, what I would say you could look at market-wise and employer-wise are two things that you would logically look at as the rate limiting factor. Absolutely. Julie. Hey, Lance. Hey there. You're casting some really strong growth in the employer membership in UHC, in particular in ASO. Just interested in what sort of products are driving that and what particular segments that that's expected to come in? I think Brian's been hoping you would ask that question, so I think I'm gonna just let him answer that. That's on a T. We're really excited about our growth, as you might expect, for 2023, and I'd say it's really balanced. A couple of things that I might point out, our Surest offering is really resonating in the market, both fully insured and in our ASO. Level-funded products continue to be an alternative for small group plans. As I look forward to 2023, I think this is our strongest growth year that we've seen in almost a decade for our national accounts. Our value prop of how we organize across our enterprise with Optum is resonating. You're just seeing strength and balance across the inter-business. Clearly that's also benefiting from the expectation that we see redeterminations start up here again in 2023. Really pleased with that balance, not only at ASO, as you said, but also growth in our fully insured business. Great. Thanks so much. Zack? I've got Lisa Gill from J.P. Morgan. Hey, Lisa. Hi. Thanks very much. I have two questions on the pharmacy side. First, Andrew, I think last year we talked about value-based programs and shift towards value-based care when we think about the pharmacy. I can understand that for UnitedHealthcare, but how do I think about difference in payment mechanisms for non-UnitedHealthcare when I think about your PBM? Would maybe first question. Secondly, when I look at the margin improvement for 2023, is that biosimilars, and how do I think about the biosimilar opportunity? Yeah, no, two great questions, Lisa. Thanks so much. Make comments and I'm gonna ask Heather to go into more detail on both of those. Just on the biosimilar piece, and Heather can describe a little bit more to you on that. From our perspective, we see the PBM as a key mechanism to drive as much cost advantage in the system as possible, so to drive down those prices as fast as possible, driven by the catalyst of the biosimilar. We're passing that through to the payers. The short answer to that question is really no. We, we see this very much as a moment where the PBM demonstrates its effectiveness as a procurement vehicle on behalf of the clients, the beneficiaries of the savings. Give a little more detail on biosimilars, Heather, and then into the first part as well. Yeah, sure. Maybe let me take the biosimilar and how to think about 2023, and then we can do the value-based care. When you think about 2023 and the strength in 2023 is really gonna come from a couple of things. I've said it before, but the PBM is really well positioned, you know, from just a value proposition standpoint and how we're serving clients, and we've seen really strong growth there. That's one element. The other element of it is the breadth of the pharmacy services. You saw we highlighted a few of those today, but you can feel pharmacies that are integrated into communities. They're integrated into care models. They're integrated into patients' lives. We're leading with Pharmacist First 24/7 access, and we've seen material growth year-over-year as a result of that. In fact, we've seen double-digit growth in the pharmacy segment of our business, and a lot of that growth comes from non-UHC sources, a lot of that volume and growth. I think that's the strength you're gonna see in 2023. Biosimilar, to Andrew's point, that's all about the client. This is the event that offers the opportunity to drive affordability, beginning with Adalimumab in specialty drugs for clients. We use the competition, the selection, and I think, you know, when I think about biosimilar, the thing I would take away for what Optum Rx is doing is we're really set on ensuring that we provide affordability with choice. We're not limiting to provide client, patient, and prescriber choice. We wanted to provide both. We're driving affordability with year 1 material savings to our clients while allowing our patients, their prescribers, and our clients to make the choice between continuity or new options. That's how I think about biosimilar. Value-based constructs, so we're not gonna actually impact total cost of care until we get pharmacy into the perimeter. Those models, you'll see us driving 2 really important aspects. 1 is those clinical models, where we're doing more than just dispensing. We're getting closer to the prescriber. We're getting closer to the pharmacist. We're getting closer to those that bear risk, and we're making sure they have the tools and the supports. We're wrapping around them with the clinical models. We're co-locating with them with Optum Care practices. That's how I think when you think about value-based care, think of us as the enabler. We provide the data, the tools on the PBM side. We provide the holistic pharmacy. Then, we'll talk about this a little bit more in the Optum Rx seminar, but we are building capabilities with our pharmaceutical manufacturer partners to give them better tools, better data, so that they can ensure that they're, you know, enabling the value-based care as well. That's how I would think about it going into 2023. No, great. Thanks so much, Heather. I'd just go back to biosimilars just real quick. The work that Heather and her team have done in terms of creating this platform where we believe we get great opportunity to leverage down cost and maintain increased choice so the consumer provider has choice, we're really laying a template down to how we think future biosimilars need to be managed. This is very much pro biosimilar, it's pro competition, it's pro bringing costs down, and it's a model we're gonna apply on future. As you know, there's many more coming after this one. This is an important step and a ton of work's gone on this year to lay the ground, and we're feeling very good about how we sit as we roll into the new year. Julie? Yep. Gary Taylor from Cowen. Thanks. Good morning. I wanna go back to value-based care for a minute, and what I'm thinking about when we look historically at entities that have assembled large groups of physicians, either employed or affiliated, and have quickly ramped the risk-taking, the actuarial risk-taking that those groups have had, so many have struggled or outright failed. All we get to see when you guys acquire something or build something is we see it going into that Optum Health line, and we get to see the O.I. That's kind of all we're getting to see out of it. I was hoping maybe you could talk about two or three things that you're tracking or looking at as CEO to give us comfort that the clinical technology, financial integration is happening, and that the risk-taking and the ramp of risk-taking is prudent and not, you know, getting ahead of yourself, so to speak. No, it's a very fair question. We spend a lot of time focused on this, and as Wyatt Decker will confirm, Solomon, who's here, who's our finance leader for Optum Care, Travis Winky, who's here, who many of you know well. John Rex, Dirk McMahon, and I think monthly sit with the whole team, and we go through how all the vintages of our various clinics are doing. Each year who's joined the organization? Where are they in terms of risk transference? What's the performance of those groups? How are they doing in community MA? How are they doing in D-SNP? Then a whole piece around our alignment and integration. I'd say, you know, I give Wyatt Decker enormous credit for this over the last 3 or 4 years. The transformation in the way in which Optum Health is integrating to a national system, a national approach is completely different to where it was four or five years ago. That's critical because it's given us really clear insight, early warning in terms of where things aren't quite performing the way you'd like them to do. The final, I think, final thing I would say, Gary, is that we're a beneficiary of the portfolio. Because the scale of Optum Health is significant, and because we have multiple vintages of risk transference going through, we learn as we go through, so when things go wrong, we're able to course-correct and avoid it the next time. We're also able to accommodate within the portfolio a mix of performance. We're not exposed to any given trend, typically. If you have one part of the country or one clinic which for whatever reason stubs its toe, you know. has made fantastic investments in technology, in talent, and in all the programs that we're running. To Andrew's point, the opportunity here is immense in trying to make all of this technology, first, more consumer-friendly, frictionless, and there's just infinite opportunity there. Second, make it more connected, as our beloved physics professor taught us today, how a connected system would work much better. Then finally, the data that we collect, we use responsibly to continuously improve those systems so that our consumers get the best of all worlds. I think those three things, consumer-friendly, frictionless, connected and always improving is the big opportunity in front of us. Let me give you two specifics. Thanks, Sandeep. Let me give you two specifics, Gary, on how we manage and measure. You know, one of the key things you have to do is get the systems aligned, right? You have things like utilization management systems, you have patient portals, you have EMRs. We track really explicitly through each of our local care delivery organizations, where they are with respect to end state. What you wanna ultimately do is have a model which is very consistent or is consistent can be systems-wise across. In order to do all the efficient data that we've all talked about today, you gotta be as common as you can with systems-wide. That's one real KPI that we track. The other thing I would say that's a little bit under the covers is there's a big people piece of this too. You know, you have to move. We've moved some real actuarial talent from UnitedHealthcare, now they're working at Optum Care. Network talent from UHN, United Health Networks, we moved them, now they're Optum employees, right? Sort of the talent to be able to take that risk, there's a lot of that talent in our organization, and we deploy it across the enterprise, and that's really benefited us. Yeah. Thanks, Doug. I'm afraid we only have time for one more question. Zach. Steve Valiquette from Barclays. Hey, Steve. Great. Thanks. With the MLR guidance for 2023 expected to be up 60 basis points at the midpoint versus the 2022 estimate, can you just remind us and reiterate what the biggest variables are in your initial assumptions for the MLR to be a little higher year-over-year? How are you thinking about the flu impact on MLR in early 2023? Thanks. Yeah. Great. John, why don't you start there and maybe Brian, maybe add a little bit more depth to it. All right. The outlook for 23 accommodates the view that we've been anticipating for some time now. Do we see people start to present with more acute conditions because of deferred care that occurred during the height of the pandemic? Does that present itself in a way where you just see an average higher acuity level and return to pre-pandemic levels of consumption plus that? That's a key component there. Also accommodating a view that there is a moderately higher flu incidence level than we've had than normal years. Something that we haven't actually experienced yet as we look at current trending in the month of November, but in anticipation that that could occur. Brian, do you wanna add a little? The only thing I would say is really pleased with how we're stepping out for our BCR next year, particularly as you think about continued greater mix in our government programs. Really stepping out at what I consider to be a real sustainable and durable position. On the flu, we probably all experienced it as we gathered for Thanksgiving holidays. certainly seeing it a little bit higher, but that's really resonating in the RX scripts, Tamiflu, physician, not seeing it on our inpatient level. I would suggest less intense but moderately higher than normal and both rest of 2022 and how we thought about 2023 is instructed with what we've seen here early. Oh, thanks. Unfortunately that's, we're pretty much out of time in terms of the questions. Just to introduce, make sure you know three people who are here who you haven't heard speak already today but are gonna be here for the rest of the day. Patricia Lewis, who leads our sustainability effort, Erin McSweeney, who's our Chief People Officer, and Dr. Margaret-Mary Wilson, who's our Chief Medical Officer. All three are gonna be here, obviously. Although questions didn't come up in their topic area, please do take advantage if you're interested in what we're doing in terms of people strategy, what we're doing in terms of our quality patient safety strategies, and what we're doing, of course, in our core ESG strategies, where a ton of progress has been made this year. Please do take advantage in the corridors or in the seminars to catch up with everybody you want to. We've tried to put some time in the day for you to catch up with folks in the corridors. Please do do that. You've seen about half of our team who are here. There are another half ready to go, ready to answer your questions. Please do avail yourself of that. Wanna thank the team, but most importantly, thank you very much for the questions, and thank you for your attention today. The seminars are gonna start after a short break. Please take advantage of all of that. We look forward to spending the rest of the day with you all. We appreciate your attention. Thank you so much. Thank you.