Specialist background
- Over 24 years’ experience in the healthcare industry, handling senior-level roles across several healthcare services organisations
- Was responsible for working with and evaluating data exchange solutions from multiple vendors at UnitedHealth Group
- Thorough knowledge of the Medicare Advantage market, with detailed views on the key PPO (preferred provider organisation) products
- In-depth understanding of the Medicare Advantage market’s competitive landscape, including its key players such as Humana, Aetna and UnitedHealth
Questions
1.
From our data and analysis, and this is, mostly, on a national level, it looks like, over the last few years, Humana, in particular, so focusing on Humana first and then moving, broadly, out to the market after that, held market share among HMO products, generally, nationally. Then, however, lost pretty significant market share in the last few years, particularly 2020, '21, '22, in and around and little bit post-COVID, in the PPO product side. Would love to just get your thoughts, do you think that is correct? Did you observe that or have you seen that? If so, do you have any thoughts as to why that was the case?
2.
How would you expect that to develop going forward? It sounded like Humana was, probably, not as aggressive as they needed to be to counteract United's benefit offering, they came back and responded in '23. You have a little bit of a different environment here, going into 2024-25, the rate is not going to be as favourable, risk coding is a little bit more challenging, etc. How do you think that's likely to develop from here? We're also seeing stronger utilisation, United is claiming they priced that into some of their bids, which would mean they have less benefits, etc. Any thoughts on how that develops in '24 and '25?
3.
The question, really, is, you mentioned United was doing a lot of these things, not just the reducing benefits but all the narrow networks, etc. Do you think Humana is doing those as well? Are they successful at it, if they're trying?
4.
How about just the broader market itself? United and Humana are doing what they're doing, are you seeing any pull-back from other people, who may not have the stars ratings or may just not have been as profitable or if there is a big portion of the market, that in '21 and '22 (audio cuts out), are they pulling back to try to protect margins at all, more materially than at United and Humana? Are you seeing any signs of the markets easing or not?
5.
Will Humana and United gain MA market share over the next 2-3 years and why?
6.
If we take a step back and think about United, what are (audio cuts out) competitive advantages as a business, in your mind? What are the reasons they've been successful and continue to be successful, in both MA, commercial, Optum, everything? What are their competitive advantages?
7.
How about management? Quality of the management running United, in terms of integrity of leadership, hard-working, intelligent, really focused on driving shareholder value. How would you think about the management team running United?
8.
With healthcare, broadly, I always wonder or question about whether or not management teams or for-profit healthcare could be too aggressive. You could, literally, say no to every prior authorisation, which would make no sense. You could risk code too aggressively, you could steer too aggressively. There are a lot of things that can go over the line, if you will. How do you think United is with that? I'm just curious your thoughts on the level of how often they're stepping into the grey area vs steering very, very clear from it, that kind of stuff.
9.
There have been rumours or conversations about, "United is just significantly more aggressive about risk coding and that's part of the strategy." Never been said publicly but people, privately, say, "Things work better for United on the Optum side because the coding is just a little bit more aggressive." Is that the case or are they just more accurate at risk coding? Same thing with steering, where the doc has to steer, not the payer, so are they steering the right way or are they being too aggressive about it and going a little bit too far over the line?
