Specialist
Former SVP at Optum Inc
Agenda
- Underlying drivers of Optum posting its lowest profit margin in a decade
- Optum’s government programmes, analytics services and network development
- Competitive positioning of major players surrounding Optum and defensibility of company’s market share across key segments
- Optum’s acquisition strategy and possible product set expansions
- Outlook for H2 2023 and beyond, highlighting regulatory threats and strategic assessments
Questions
1.
Could you break out the various cogs in the Optum machine and how these synergistically fit into the massive healthcare technology solutions engine that it is today?
2.
Optum has been extremely profitable over the years. However, what are the primary factors you would attribute to the segment posting its lowest profit margin in one decade at United’s Q2 2023 earnings release?
3.
What do you think are the underlying drivers of increased behavioural health utilisation within Optum Health? We saw some margin pressure from the increased patient flow in Q2 2023. What might be the main causes here? What’s your utilisation outlook over the next 6-9 months and why?
4.
What are your thoughts on the appointment of Amar Desai as CEO of Optum Health? Desai previously served as President of Healthcare Delivery at CVS. How might his appointment shift the strategic direction and perhaps even the rate of adoption of value-based arrangements for the segment?
5.
Could you discuss the recent Amedisys acquisition? I appreciate it’s still pending approval. How might Optum plan to combine that with its other home health and hospice asset, LHC Group? How attractive and complementary are those respective entities, perhaps taking into account the relevant referral pathways, geographic synergies and facility footprints?
6.
How differentiated are Optum’s data analytics capabilities and predictive models? What advantages do these give to providers in being able to adopt value-based care and ultimately be successful in risk capitation arrangements?
7.
What has Optum’s approach been to network development and helping healthcare organisations refine and enhance their network strategies?
8.
I wanted to talk about OptumInsight. Could you discuss Optum’s October 2022 acquisition of Change Healthcare and the clearinghouse assets this brings to the company? How costly do you imagine it will be to bring Change seamlessly into the fold or fully integrate it? What pain points might be encountered?
9.
What infrastructure does Optum have in place to collect, streamline and clean disparate data sets into one streamlined, interoperable platform? How ahead of the curve is the company from a data interoperability standpoint?
10.
What are the main considerations for keeping a name such as Change Healthcare payer-agnostic vs United-specific? What are the benefits and drawbacks of going the agnostic route? Do you see longer-term attrition from companies not wanting to send sensitive healthcare data to an entity owned by a competitor such as the UnitedHealth plan arm?
11.
What efficiencies do you think Optum will be able to achieve by utilising AI for prior authorisations and payment integrity operations?
12.
How are you viewing evolving regulatory attitudes within the risk adjustment sphere around miscoding patient RAF [risk adjustment factor] scores? How has this impacted coding operations, and what’s the headwind Optum could incur to remain compliant?
13.
We’ve seen somewhat of a macro shift of retrospective risk adjustment to prospective. What efforts is Optum making to develop its prospective risk adjustment capabilities?
14.
What’s your updated perspective on the competitive landscape in risk adjustment? How does Optum compare against CVS’s Signify division as well as point solutions vendors such as Episource, Matrix, etc? The company clearly enjoys greater scale, but what are some key differences in the degree of automation, patient focus, customer base, etc?
15.
Switching over to the analytics side, how are other healthcare solutions companies such as Cotiviti, Inovalon and Apixio viewing the increasing size and scale of Optum? What strategic adjustments are they making to defend their market positions?
16.
You mentioned potential acquisitions. Where do you think United will look next for inorganic growth on the Optum side and why? How is the company prioritising building on its existing assets vs expanding into new verticals?
17.
What are your thoughts on the recent news that Blue Shield of California is attempting to ditch CVS Caremark as its PBM [pharmacy benefit manager] of choice, replacing it with an assortment of partners that includes Amazon and Mark Cuban Cost Plus Drugs? Do you see any tertiary risk for OptumRx, or are these concerns fairly overblown?
18.
How are you viewing broader antitrust risk for a large conglomerate such as UnitedHealth-Optum over the next 3-5 years? Nearly every time the company makes an acquisition, it’s held up by regulators. What are your thoughts on how a more hawkish FTC [Federal Trade Commission], led by Chair Lina Khan, could impact the company’s market positioning?
19.
Is there anything we have not touched on that you’d like to highlight or reiterate to tie together our discussion around Optum?
