UnitedHealth Group (NYSE:UNH) Q3 2026 Earnings Call

0:00 Hello, everyone, and thank you for joining today's webinar, Patience Instead of Paperwork. My name is Brittany Turman with Optum, and I will be your host today. Before we begin, please note the following housekeeping items. At the bottom of your audience console are multiple application widgets that you can use to customize your viewing experience. If you have any questions during the webcast, you can click on the Q&A widget at the bottom of your screen to submit a question. We do capture all questions and will be providing follow-up to questions as appropriate. If you experience any technical difficulty, please click on the help widget. It covers common technical issues. You can expand your slide area by clicking on the maximize icon on the top right of the slide window or by dragging the bottom right corner of the slide window. We have several opportunities for you to engage with today's content. To the right of the slide deck, you'll see related content for you, which allows you to download a quick read regarding our multi-model approach.

0:50 Below that related content widget, you'll find our call to action, where you have the opportunity to be one of the first to download the new e-book, supporting providers with the holistic approach. If you'd like follow up on today's webinar, please feel free to utilize the contact us widget located below the call to action. In addition to our multiple engagement opportunities today, there is a survey widget that you may use located below the slide deck with the check mark icon to provide us with feedback on today's presentation. Additionally, this presentation does use streaming audio. You may listen to the audio through your computer speakers or headphones.

1:22 To ensure the best possible system performance, please be sure to shut down any VPN connections and connect directly to the internet. Presenting today will be Amanda Melchi, healthcare advocate and Ari Samaneh, sorry, vice president of growth and strategy at Optum. Now I'm going to hand the presentation over to Ari. Thank you, Brittany. Appreciate it. I've heard much, much worse, so excited to be here. That was pretty good and a great course correction. As Brittany mentioned, my name is Arya Samaney, and I... Thank you so much for having me. primarily in a variety of roles touching on clinical, analytical, financial, business and program development. I live in Minnesota near headquarters with my wife and three children. We've got two girls and a baby boy.

2:28 My wife is an RN at Children's Hospital up here in Minneapolis, St. Paul. And so our children are growing up with a super healthy understanding of the U.S. healthcare system and for Thank you for joining us. Hi everyone, my name is Amanda Malkai. I'm a senior healthcare advocate and I'm here in Columbus, Ohio. I've been in the healthcare field for 15 years or probably more. I'm also an RN and I began working in a primary care office as a chronic care manager working with patients with chronic disease management and this definitely, this experience has helped My husband and I both went to Ohio State.

3:49 So right now, the heart of football season, I'd say that was something just to add about me is go Buckeyes. And that's it. So I'll turn it back over to Aria. I'm excited to talk today and we'll get going. Thanks, Amanda. Appreciate it. And yeah, today we're going to hone in on really kind of two key segments. So I'm going to cover the first, which will be looking at the typical barriers and challenges that we've seen in the risk and quality space. We're going to mostly look at it from a care delivery or health system lens, but recognizing just the dynamic between payer and health systems and what we've done, the work we've done, or observations we've had, both from what the Thank you for joining us.

4:51 Thank you so much for joining us. So we will populate those and then give you about 30 seconds to respond to them. They will just kind of help us as we go guide the conversation and make sure that we are touching on the pieces that this audience here finds most relevant. So with that, let's jump in a little bit to the barriers and challenges. So as I mentioned, you know, I've been in the space of program development for risk and quality and have held a variety of roles from being kind of the primary client liaison for some of the largest health plans across the country.

5:46 And then to kind of business development role, consulting role, workflow coordination role on care delivery side as well. It's most recently really focusing a lot of my efforts around holistic workflow integration. And, you know, we used to, those of you who are familiar with Optum and specifically our segment of business and products and services,

6:07 we used to really kind of bifurcate them into two categories. One, you know, retrospective and the other prospective. And when we would say that, what we meant is by retro is, you basically that chart capture, that backend clinical data acquisition, copying charts, uploading them to portals, things like that to be able to kind of scrub them and derive the data elements we need to close gaps. And then prospective, which was really all about at least kind of the older methodology or older way of thinking about enabling the point of care, whether that be through coding and education, whether that be through suspect gaps, things like that. What we've learned over the past 10 years or so has really been that this iterative type of holistic approach is where we start to see, and it's kind of no surprise, the real power of data and analytics, embedded resources, people, education, really come to fruition in ways that not only help health systems or care delivery organizations and health plans advance their participation in our program, But also, you know, the many other programs or initiatives that they have. And so one of the big ahas that I've had in kind of going to market and developing products and services is just how complex this space is.

7:28 You know, a stat I love to throw out there in our research, we found that Large health systems or care delivery organizations are navigating an average of 50 payer contracts, individual kind of incentive contracts that they're trying to navigate when it comes to interacting with health plans. And I always just find that staggering. And then when you get in there and you realize, okay, there's different lines of business, there's different workplaces. There's different types of incentive programs. It starts to make a lot of sense. And I think everything, most of the things that I've seen have really been initiated with positive intent. But then, you know, when it's coming from all angles, it's really, really overwhelming and hard to keep up with. And ultimately, I think the non-care delivery side, what we see so much of is some of this burnout from focus on things that feel like from the health system perspective that they're taking away from So that's what we mean when we say kind of that administrative burden.

8:27 Anything that kind of pulls time or could be done more effectively and yields less clinical time with patients and some of that burnout. And so what we've really tried to do and what we'll address a little bit today is taking a deeper look at Thank you so much for joining us. struggles the most. So is it digital challenges, you know, your technology, the way that you're connected? Is it workforce challenges?

9:17 You know, do you not have enough staff? Does maybe the process not live in the right place? Or is it really more on the tactical coding and accuracy kind of challenges part? And recognizing a lot of these, there's a little bit of chicken or the egg here, but if you would, just select the one that is most relevant for your organization. I'll give it a few seconds here to aggregate the polling results, please. We'll give it about 15 more seconds. I can kind of see the aggregation on my end. So it looks like about half of the folks have submitted so far.

10:28 All right, I will keep us moving. I think we've got adequate sample data to move forward. So it looks like most of it is falling under workforce challenges, but a pretty even split amongst the three categories. So again, this I think is in line with around what we would expect and what we're hearing. I think the workforce challenge thing has been particularly relevant as of late between, you know, pandemic response and then, you know, just with getting and retaining talent and getting organized with how do we work in a kind of post pandemic world and how do we go forward with some of this? And so, you know, not not surprising, but really good to see kind of the spread here and then just highlighting that workforce challenges piece.

11:15 So we have a couple Thank you for joining us today. Thank you so much for joining us. and are maybe doing risk and quality off the side of their desk or it's a component of what they're doing or they're not connected to the right places within their organization.

12:12 Say, you know, the person who's over risk and quality may reside in finance and maybe they have a good relationship with the medical director, but they don't necessarily have a clear inroad to getting attached to the workflow. So it's hard for them to affect EHR prompts or back end data capture or whatever it may be. We see a full gambit and a lot of nuance within this space. Obviously, the big one is physician and clinician burnout, shortage of qualified candidates, limited funds. That's obviously a big piece. And then loss of revenue due to these staffing shortages and having to kind of shift where resources are allocated. So these are things that we've aggregated, again, from across the country and a lot of really, really common themes.

13:01 We have a few stories that we'll address again in a moment of things we're doing to address some of that. Amanda will dive into some of the stories that we have and some of the options that we have available. One thing, and you'll hear this throughout too, is we really want to help. Although we're bringing, say, like an in-office assessment program or whatever it may be, we really view our services Thank you for joining us. These two specifically can really be related.

13:56 I think when it comes to coding accuracy challenges, this is really that kind of the bottom line where it comes down to, are we seeing a lot of denials due to coding errors, the revenue loss associated with inaccurate coding, and then just the unnecessary time that is spent to resubmitting denied claims and just the headache that that is. So what are things that we can do or look at to ensure that we're doing things right the first time and really minimizing that rework so that the gaps get closed, that the revenue is able to flow through the way that it's supposed to, and that patients are able to be cared for again in kind of that iterative loop of tying the retrospective back to the prospective and As we capture that clinical data, are we able to then remine it and then resurface it on the front end so that we're able to better inform

14:51 at a pre-visit summary or at a pre-visit meeting or via the data and analytics that's going to go live in maybe with a pop health team or wherever it may be. And so that's kind of that last piece to address is the digital challenges. This is where we hear and we're really working to help enable because what we found is if we can address what we're kind of classifying as digital, it really helps workforce operate more efficiently. And we'll cite a few examples of that. and then it helps obviously kind of that margin of error for the coding accuracy as well as create that cyclical feedback loop of getting the mind coding data and regurgitating it through running suspect logic, things like that where then we're able to plug it in on the front end and enable the care delivery organization to leverage that data and our people resources, embedded resources or Whatever consultative resources that are able to then help leverage that data in a way that really meets health systems where they're at. So that's kind of our goal there.

15:57 And we can touch on that later on. But we've really tried to build solutions that are not just, you know, one size fits all. We certainly try to have our kind of. Thank you so much for joining us. And so when it comes to us embedding our data and our programs and our people in with these health systems, we really, really focus on listening first and then sharing kind of the turnkey solutions that we have. And then especially with really complex or large health care delivery organizations across the country, or then I feel like on the other side, we see it with really small offices too. We are trying to position ourselves and want to be Thank you so much for joining us.

17:23 A few statistics at the bottom there, just to call out with the record high staffing shortages. I think some of these are just, you know, really, we wanted to share them just to kind of create that sense of community and assure everybody and you probably already know this, but you're not alone. And we're trying to really Thank you so much for joining us. to help aggregate and standardize and really with the goal of enabling better patient care in the end. So with that, we'll take a look at some specific stories and best practices. And just a reminder, as you do have questions, please pop them in the chat so you don't forget and we can reference those later.

18:21 But Amanda, I'll go ahead and turn it over to you for some best practices from the field. Okay, perfect. We're going to start off actually with a polling question. So when it comes to the health plan assessment programs, we find that each organization tends to handle them a little differently. and as Aria was talking about, sometimes it's the finance team that's involved, sometimes the medical director, care coordination, nurses, sometimes it's going through the IT department or just a third party or something else. So we want to know in your organization, who oversees the health plan program?

19:07 And I'm going to give you some time to answer this too. I'm going to wait about 15 more seconds just to make sure we're getting enough in. OK. I'm going to go ahead and let the calculations be in.

19:52 Wow. OK. Care Coordinator, Medical Director, Clinician are the first one and then Pop Health and then Finance. Doesn't look like any ITs involved on this call or third party or other. Oh, cool. Well, that basically Not that it was a trick question, but all of those functions actually need to be involved in order to be successful in these programs. So I just kind of wanted to get an idea of where they were at your organization. Okay, so digital challenges can be one of the hardest to overcome because the workflows, the needs and capabilities of each practice, and just completely different and unique ways that are going on in the office.

20:44 So when a vendor or a health plan approaches a group with a one size fits all solution, we know it doesn't work. So if you're thinking about wanting to improve your current digital capabilities or those of you that might still be paper-based, I have some best practices that I would recommend for trying a digital solution. So basically I'd say take a close look at the health plan contract. So many of them do offer complimentary digital upgrades, and this can be an ideal solution if you are resource constrained at your practice. Also, don't accept the one size fits all solution because make sure you're choosing a digital option that works for you. Work with a vendor that meets you where you are and helps you where you're going to need them when you're advancing digitally.

21:34 and lastly whichever option you choose make sure that the vendor you're working with offers in-person support. So we saw the slide that Aria showed us it was common challenges and one area was that their staff don't have the expertise to implement these digital workflows and so make sure you're getting the support from your vendor and having worked in the field for so many years and I've seen many instances where getting the right digital strategy has made a huge impact on the practice. And an example I have to share is with an office about, I would say about an hour from Columbus, a growing population, growing practice with multiple locations They were on a paper program, so they had 1,500 patient assessments in a stack. Trying to go through that and being efficient with that was almost impossible.

22:33 If a patient was coming in, to try to find that right patient every time was just taking so much time, so just paper sorts. So what we ended up doing was going to a digital solution. I mean, they were even taking the paper from office to office, depending on who was working it and where the patient was going to be and which doctor was going to be there. And it just became like a PHI issue, too. So they went on our portal, which is called Practice Assist, and it has become such a successful experience for them. Everyone can get on whenever they want.

23:06 It's not one person at a time because that's where the paper is. They're all able to log in, work the program, work the patient that's in that office at that time. And it's just taken a lot of that burden off them of sorting papers so much. So I would have to say that was a wonderful experience just seeing that happen. Arya, did you have any digital stories to add? You know, I think you covered a nice gambit of kind of what we encounter, but certainly I think it is when these things come together. And again, as we kind of both touched on, it's that listening piece and being able to find the right needs and recognizing, you know, one thing you've seen a lot of in my experience is, you know, Thank you so much for joining us.

24:14 It's really a moving target, and that's where I think taking it down holistically and finding a vendor who's willing to kind of get in and look at that, help standardize as much as they can, but also try to fit in where you currently are and then be a part of those decisions moving forward is really where I've seen the most success come to fruition. So thanks for sharing, Amanda. Yeah, I agree. So the next slide is the virtual and in-person services. We're going to look at workforce challenges. So even before COVID, obviously the healthcare industry was struggling with workforce shortages. And then since the pandemic, it's become worse. Many organizations are just struggling to fill positions, but also because of that, staff and clinical and office staff that they have is facing a lot of stress.

25:11 Organizations that participate in health plan assessment programs, I have a few best practices that can help fill in those staffing gaps. And as we saw on the In the previous slide, many health plans offer complementary services and resources. And these aren't just the digital implementation, but we also offer them for administrative support. Well, Optum does. When you're working directly with a health plan or a third-party vendor like Optum, make sure you're finding out what administrative services are available to you. I don't know about other vendors. I know Optum does. That's what I do, right, when I'm in person. But we also offer virtual support. And in my field, I have firsthand knowledge of helping with administrative support.

26:00 And it's made a big difference. So I'm able to come in and help. Sorting that paper, I'm there. If they need me to be, I'm sorting it.

26:08 But also even just with having remote access. So I've gotten some EHR remote access. and I can go in and flag charts and put a note that that patient has an assessment so the provider knows ahead of time or when they're seeing the patient. I can do things like checking the schedule and organizing assessments based on when patients are coming in, calling patients to come in if they don't have appointments in the system. and then even running reports. So if they want to get patients in for mammograms or colonoscopy

26:40 screenings, I can run reports and say, hey, here's all your patients that are missing these screenings. And then the office has that list and can make outreach calls to those patients. It's just been a lot of help just to have me in there to assist them. and then we're going to move up to coding education and campaign research. Oh wait, I think Aria had something to add to that. Well, I was just going to call out, too, because I know I've seen firsthand many a time just the value of having you and your team embedded with some of these large care delivery organizations. The other thing, too, to just kind of keep in mind from a workforce perspective is not only do we make available clinical experts in this domain who are willing to roll up their sleeves and do whatever is necessary to but also share best practices that they're seeing elsewhere, access all of our training, et cetera.

27:42 But also, you know, we have some IT staff and some folks who are extremely well-versed at configuring various EHRs, working with partners, good at data mining, things like that. So, you know, maybe currently, as we've seen, you know, if I think about it, it looks like a lot of times it's a clinical or a medical director type of role that risk and quality lives in in most of these organizations. and then you know oftentimes when we go to partner with various care delivery organizations we'll see that hey you know they're really kind of strapping this thing together but what they'd love to have you know some better reports or analytics or prevalence scores available to them or something you know that they would love to tap their pop health team for but as we all know you know when we go to our product or There's a roadmap there and we have to get in line and there's different priorities.

28:33 And so could you engage us? Could you engage an opt-in to see if we could help tee up some of that or customize some of what you would like to see to enable your workforce to work more efficiently? I know I've personally seen a couple of really large health systems that had entire staffs like They were returning about, say, 25,000, approximately 25,000 in-office assessments across their care delivery organization. There's one I'm thinking of in particular.

29:02 And they had 10 people, FTEs, that supported this initiative. Most of them were certified professional coders. And when we walked in and said, hey, we have some of these digital modes, at first I could kind of read the room, see a lot of the people in there thought, well, what am I going to do if we automate this whole thing? And then we were able to kind of showcase, hey, by getting this data to them, they were able to really focus on, you know, coding efficacy and accuracy and education within their organization, be a part of the QA instead of just copying charts, you know, and that type of nuanced work. And so the value both that the plan sees that the care delivery organization receives through whether it be a risk or gain share arrangement, you know, Thank you for joining us.

30:06 in conjunction with our embedded resources like you and your team, Amanda. That's just where I've seen this harmonize the best. And so I did just want to call out when we think about how do we enable that, it's not always just from people, but technology and how do we kind of pull all of this together and be a resource for our customers. So I know you've been heavily involved in a lot of that too, Amanda, and I've seen the fruits of that labor for sure. Yeah. Yeah, definitely. If the charts are automatically coming through and they're not having to sit there and click and copy and upload the chart, they can spend so much more time on the actual important things like the coding, closing of the gap, getting the patients in, spending the time on that than just the administrative part of sending the chart. So I agree. And it's a really good example of how, you know, It has a direct impact on improving their operations and efficiency too.

31:04 So thanks. So like I was talking about coding education, and also I wanted to talk about some campaign resources.

31:16 So in my time working with care delivery organizations, there is one place I've come to rely on, which is better knowledge, better care. So you don't need me to tell you this because I know you all know, but accurate coding

31:30 can result in more reimbursement or more access to health plan services for patients, right? We all know this. But the real question is going to be, how can we improve coding accuracy? And in terms of best practices, we've been talking a lot about accessing free services offered through the health plan or a vendor that you've contracted. And another important one is coding and documentation support. And Optum is an example of a vendor with coding specialists on staff, and that would be like me, so I'm a certified risk coder as well, and other coding consultants that work directly with Your organization should improve your coding accuracy.

32:15 I work with a coding consultant that's on my team. And so if a group is needing coding education, like I have someone right there to help out. And how that kind of looks is she can go in and meet with a provider one on one at the provider's convenience.

32:33 I've seen it successful just with her sitting in the lunchroom.

32:37 and people coming in when they have a minute or two or five or 10 just to kind of run something by her, a question they've been having, an actual patient that they wanna talk about, documentation that they've struggled with and she's able to help them as well as doing a virtual meeting. So say it's a large group with 15 locations and they don't all get together, she can virtually get in there and do a coding education that way. with just general topics or specific topics that they're focusing on. Maybe it's a monthly provider meeting that she goes to and she does a topic each month. So this month might be morbid obesity. Next month might be major depression. And she focuses on sometimes just generic examples and sometimes she can get some specific documentation from that group Thank you for joining us today.

33:47 So it's just a great free resource that we provide that has been really helpful in a lot of my groups. Even the groups that have a large hospital system, they like having that one-on-one relationship, as well as the small groups that don't have a big coding

34:02 department. So it's just been a really great experience to have her on my team. Another thing, though, before I wrap up is I wanted to talk about our campaign materials. So we do offer campaign resources, which is, you know, if you're focusing on a theme for the month at your office, like breast cancer awareness or Movember or flu shots or colonoscopies, we have a great way to reach patients. We offer campaign materials. So that's just like a one-pager collateral. We can send it by PDF. Thank you so much for joining us.

35:11 promote when I can because I do enjoy being able to provide that info. So anything that you wanted to add, Ariel? No, I think you did a great job covering me. Yeah, yeah, I think that makes a lot of sense. And yeah, I've seen you do some of those campaigns and it's pretty cool to see the results. So definitely reach out if you're interested.