2023-11-29 UnitedHealth.Investor Day
Andrew Witty CEO & Non-Independent Director
Good morning, everybody, and welcome to New York, and welcome to our Investor Conference for 2023. Sorry, we're starting just a couple of minutes late, but it turns out 1 or 2 folks went to the Sheraton by mistake. So we've now got everybody here, and welcome. Thank you, most importantly, for giving us your time today. And for those who are watching online, thank you also for sparing some time today to listen to our updates for you. It's going to be a busy morning, and I'm looking forward to introducing to you during the next 90 minutes, a couple of hours, many of our executives from across our organization.
Andrew Witty 首席执行官兼非独立董事
大家早上好，欢迎来到纽约，欢迎参加我们2023年的投资者大会。很抱歉我们稍微晚了几分钟开始，原来有一两位嘉宾误去了喜来登酒店。现在大家都到了，欢迎各位。最重要的是感谢你们今天抽出宝贵时间到场。对于在线收看的朋友们，也同样感谢你们今天抽时间收看我们的更新。今天上午安排非常紧凑，在接下来的90分钟到两个小时里，我将为大家介绍我们公司多个部门的高管。
Over the last year, about 3.9 million people have applied to work for UnitedHealth Group. And so far this year, our voluntary attrition has dropped by about 1/3. So people want to stay longer and more and more people want to come and join this company. And the reason for that, I think, is because they're inspired by the mission of the organization. It's a mission, which strives to work every single day, 24/7 to improve the health system that we're all a part of and that one day, we all end up relying on.
过去一年，有大约390万人申请加入联合健康集团。今年到目前为止，我们的自愿离职率下降了约三分之一。人们更愿意留下来，也有越来越多的人希望加入这家公司。我认为，这是因为他们受到我们使命的激励。我们的使命是每天全天候努力改善我们每个人都参与其中、最终也都将依赖的医疗体系。
That mission of improvement is focused on helping one individual, one patient at a time. And it's a mission which faces into a daunting system, $5 trillion system, almost 1/5 of the entire GDP of the country, bigger than the entire economy of Japan, a complex system that's grown over many decades. It's grown interwoven, it's grown in fragments, it's grown locally, and it's grown in a way which has not been planned in any particular form. It's done its best to keep up with innovation, it's done its best to keep up with new ideas and technology. But ultimately, it is complex. It is difficult to navigate. It is difficult to deliver great value for money and great quality outcomes.
这项改善的使命专注于一次帮助一个人、一个病人。它所面对的是一个令人望而生畏的体系——一个价值5万亿美元的体系，几乎占全国GDP的五分之一，比日本整个经济体还要大。这个体系在数十年中不断演化而成，错综复杂、碎片化、本地化，而且缺乏统一的规划。它尽力跟上创新和新技术的步伐，但归根到底，它仍然复杂、难以驾驭，也难以实现物有所值和高质量的成果。
And our mission is to try and improve all of those things. And that's why so many people want to be here. They want to join the 450,000 or so people already in the UnitedHealth Group, who work every day in the benefits businesses or the care delivery businesses to try and advance the objective of making the health system work better for everybody.
我们的使命就是努力改善这一切。这也是为什么这么多人希望加入我们。他们希望成为联合健康集团大约45万名员工中的一员，每天在福利服务或医疗服务部门工作，推动让整个医疗体系为所有人运作得更好这一目标。
As we think about how to work to streamline that great system, how to improve that great system, it's inescapable that you need to have scaled capabilities to tackle that job. The idea that we can make real progress in a kind of mom-and-pop approach, doing things at micro levels and just hoping that naturally, it all solves some great problem, I think is unrealistic and non-achievable.
当我们思考如何精简和改善这一庞大的体系时，显而易见地，我们必须具备规模化的能力来应对这项任务。指望通过“夫妻店”式的小规模操作，在微观层面解决问题，并寄希望于系统自然实现重大突破，这种想法不切实际，根本无法达成目标。
What we bring at United is an idea, an idea of bringing together many different capabilities, capabilities that we work hard to understand how we can align incentives so that system parts start to gear together, not against each other. They align instead of conflict. We start to populate within those business models, those incentive frameworks, parts of the organization, which deliver care, parts of the organization, which help to inform users of care.
联合健康所带来的是一个理念——整合多种不同能力的理念。我们致力于理解如何协调激励机制，使系统的各个部分能够协同运作，而不是相互对立。我们追求的是一致性，而非冲突。我们在业务模型和激励框架中逐步引入公司中不同的组成部分，包括提供医疗服务的团队和为患者提供信息支持的团队。
All of that said, is bringing together a set of scale capabilities, which allow us to make bigger impacts across large parts of the system. We spend our capital relentlessly looking for new ways in which we can supplement and augment those capabilities. But we firmly believe that scale is an important element of this change.
这一切的核心，是将一整套规模化能力整合起来，使我们能在医疗体系的广阔领域中产生更大影响。我们持续不断地投入资本，寻找补充和增强这些能力的新方式。但我们坚信，规模是这一变革中不可或缺的关键因素。
But of course, nobody can do all of this on their own. You have to do it in coalition, which is why we're so committed and we're so proud of the deep relationships we have with so many participants in the U.S. health care system, whether that be federal government, whether that be state, whether that be other payers, whether that be employers, unions, and of course, individuals and their families. We see that as a grand coalition, a coalition that we want to try and continue to stimulate to work with us to think about how we can take good ideas and spread them across the country, how we can truly lift the right piece of innovation, integrate it into a broader value stream and allow it to have the impact it really deserves.
当然，没有人能单靠一己之力完成这一切。这必须通过联盟来实现，这也是我们为何如此重视并引以为傲与美国医疗体系众多参与者之间深厚关系的原因——无论是联邦政府、州政府、其他保险支付方、雇主、工会，还是个人及其家庭。我们将这视为一个宏大的联盟，我们希望持续推动该联盟与我们协作，思考如何将好点子推广到全国各地，如何真正提升有价值的创新成果，将其融入更广泛的价值链中，从而实现应有的影响力。
这是系统性的缺陷。
Last year, I talked a little bit about this paradox of nowhere in health care in the world is there more innovation than in America. And yet somehow it hasn't led us to a simple, more efficient system. And the reason for that is because we haven't been able to properly integrate those points of innovation into the value streams, which allow impact to be delivered for many. That coalition across government, across state, employers, unions, individuals, their families and United is a coalition that we are deeply invested in continuing to prove can work. We want to make sure people understand the value we can bring and in many times how we can be the catalyst to help other parts of the system work better. You'll see many examples of that this morning.
去年我谈到一个悖论：全球范围内，没有哪个国家的医疗体系比美国更具创新性，但这些创新并未转化为一个更简单、更高效的系统。原因在于，我们尚未能将这些创新点有效整合进价值链，从而为更多人带来实际影响。这个由政府、州政府、雇主、工会、个人及其家庭，以及联合健康组成的联盟，是我们投入大量心力、致力于验证其可行性的合作体。我们希望人们理解我们所能带来的价值，以及在许多情况下我们如何成为推动系统其他部分改善的催化剂。今天上午你将看到许多这样的例子。
In addition to dealing with the challenge of how can we improve the system, how can we start to think through incentive models and the like, we also, like all companies have to be agile and adaptable. Those are not always terms that are associated with companies the size of this one. But it is a characteristic of UnitedHealth Group. We are agile, we are adaptable, and we strive to be nimble. We work hard to make sure that where we start new ideas, we complete them. But if they don't work, we shut them down, we course correct, we move on. Where we're in environments where things suddenly change, we are focused on not simply wringing our hands but dealing with it.
除了应对如何改善医疗体系、如何思考激励模型等挑战外，我们也必须像其他所有公司一样，具备敏捷性和适应力。这些词通常不会用来形容我们这样规模的公司，但它们确实是联合健康集团的特质。我们敏捷，我们适应力强，并始终努力保持灵活。我们认真推进每一个新想法，确保将其落地；但如果某个项目无效，我们会及时终止，及时修正，继续前进。当外部环境突然变化时，我们不会坐以待毙，而是专注于实际应对。
A good example this year, the rate notice or Medicare Advantage earlier this year, a significant change in the funding outlook for the future from Medicare Advantage. That rate notice has a material impact in terms of revenues associated with our Medicare Advantage portfolio. And as you can see, that ripples through the metrics of the organization as revenues, essentially a price cut for Medicare Advantage occurs, you see that pattern flow through the business.
一个很好的例子是今年早些时候的Medicare Advantage付款通知（rate notice），这标志着未来联邦医保优势计划资金预期发生重大变化。这一通知对我们Medicare Advantage产品组合的收入造成了实质性影响。正如你所看到的，这种影响在公司各项运营指标中逐步体现出来——实质上，这相当于对Medicare Advantage计划进行了一次降价，其连锁反应在业务中全面展开。
And yet here we are today standing up and saying, despite that change, despite that impact, we are committed to the kind of earnings growth rate over the next 12 months that you would expect from us even if there hadn't been a rate notice cut. And the reason for that is we spent the last 6 months, reconfiguring our plans for the next year and 2 and 3 and 5 years in response to the change in circumstance. We focused on how we can protect members and their benefits. We focused on how we can take more cost and efficiency into our organization, and we focused on how we can double down on eliminating waste and unnecessary care in the health system more generally.
然而，今天我们依然能够站在这里坚定地表示，尽管面临这些变化和影响，我们仍承诺将在未来12个月实现你们对我们预期的盈利增长速度——即使没有降价通知，我们也会实现这一目标。这背后的原因在于，过去6个月里，我们对未来1年、2年、3年乃至5年的计划进行了重构，以应对新形势。我们专注于如何保护会员及其福利，专注于如何进一步提升组织效率、降低成本，也专注于如何加倍努力减少整个医疗体系中的浪费和不必要的医疗服务。
We've used that adverse event in terms of the rate notice change as a stimulus, as a catalyst, as a way to make us rethink and redouble our energies around the things we've always believed, that we'll put our members first, that we will strive to be the most efficient health care delivery organization in the country and that we will focus on delivering true value-based care.
我们将这一降价通知的不利事件视作一个激励因素，一个催化剂，一个促使我们重新审视自身并加倍投入于始终坚信之事的契机——我们将会员放在首位，致力于成为全美最高效的医疗服务机构，专注于提供真正基于价值的医疗服务。
Meaning that the care you need is great, but you don't get care, you don't need. Meaning that if you do a great job delivering care, we will pay what you deserve, but we will not pay where the work that's delivered is not necessary or is not high quality. Those are the characteristics which have led us to be able to say, okay, revenues change, various parts of our metrics change, we respond in other ways.
也就是说，你需要的医疗服务必须是高质量的，但你不需要的服务我们不会提供；如果某项服务提供得好，我们会支付应得的费用，但对于无必要或质量不高的服务，我们不会支付。这些原则使我们即使在收入和各项指标发生变化时，也能找到其他方式做出积极响应。
We've also taken the opportunity to respond not just for 2024. The rate notice effect is a 3-year effect. Anybody who responds for 1 year against a 3-year effect is going to be in trouble. We have taken a very clear and sober view about how we do everything I've just described, not just for 12 months, but for 36 and for multiple years afterwards. The stimulus of that rate notice has been an incredibly positive and healthy event for UnitedHealth Group. Not because it gave us more money, it didn't, but because it gave us the stimulus to rechallenge ourselves on how we do things even better, even more effectively going forward.
我们也借此机会制定了不只针对2024年的应对策略。此次付款通知的影响将持续3年，若只针对1年进行调整，将面临巨大风险。我们以非常清晰、理性的视角来规划刚才提到的所有措施，不仅针对未来12个月，更延伸到36个月乃至更长远的未来。对于联合健康集团而言，这次降价通知反而成为一个极具积极意义和健康推动力的事件——并不是因为它给了我们更多资金，而是因为它促使我们重新审视并挑战自我，以实现更高效、更优质的运营。
Our confidence in our ability to deliver that growth that we've committed to you this morning is built on the 5 growth pillars that we've been talking to you about over the last several years. And you're going to hear a lot about those growth pillars and the progress we've made over the last 2 or 3 years against all of them, how we've taken the elements of those pillars and increasingly woven them together, how we've taken ideas that have worked in one state and replicated across the country, how we've taken ways in which we might perform in, for example, the pharmacy platform and figured out ways to leverage it alongside our health platform.
我们今天早上向你们承诺的增长目标之所以让我们充满信心，是因为它建立在过去几年我们一直提到的五大增长支柱之上。接下来你们将听到很多关于这些增长支柱的内容，以及我们在过去两三年中取得的各项进展；我们如何将各支柱的要素不断整合交织；如何将某个州成功的实践复制到全国；又如何在比如药房平台上的表现，与我们的健康平台协同利用并放大其价值。
Those are all examples of the progress you're going to hear in the rest of the morning. But you're going to hear those 5 growth pillars really brought together through 2 absolutely driving outputs of the organization, value-based care and empowering the health care consumer. Those will be the lenses through which you'll see all of the activity of the 5 growth pillars of the company.
这些都是你们在今天上午接下来将听到的进展实例。但更重要的是，这五大增长支柱最终都将通过两个关键成果统一呈现：基于价值的医疗服务（value-based care）和赋能医疗消费者。这两个视角将成为你们理解公司五大增长支柱所有活动的核心切入点。
Put another way, the core objective of UnitedHealth Group over the next several years is to continue to drive the implementation of value-based care at speed, to continue to extend its quality, continue to extend its worth far beyond the initial senior marketplaces, and at the same time, to fundamentally transform the way consumers and families think about health care from being something which is so complicated, I don't want to talk about it, to something where I feel like, yes, I can just look at my phone and get what I need.
换句话说，联合健康集团未来几年的核心目标，是持续快速推进基于价值的医疗服务的实施，不断提升其质量和价值，并将其应用范围从最初的老年人市场拓展至更广泛人群；与此同时，彻底改变消费者和家庭对医疗保健的看法——从“太复杂，不想谈”变成“我可以随时拿起手机，获取所需信息和服务”。
Those 2 lenses, value-based care, empowering the U.S. health care consumer are the key ways in which we are driving and aligning all of the outputs of our growth pillars. So think about those pillars as being core organizing engines of the company. They drive their own agendas, but they look for ways in which they can support the value-based care and the consumerization agenda of the company. That's where everything starts to come together.
这两个视角——基于价值的医疗服务和赋能美国医疗消费者——是我们驱动并统一所有增长支柱成果的关键路径。可以将这五大增长支柱视为公司的核心组织引擎：它们各自推动独立议程，同时又致力于支撑公司“价值导向”和“消费导向”这两个总体战略目标。这就是所有工作融合之处。
And we believe over the next decade, the next 2 decades, to aspire to what we aspire to be, we need to demonstrate those 2 things. That we have indeed figured out a way in which we can pull together the various elements of the system into a new way of care delivery, value-based care, which works, better care outcomes, better experience, higher quality, better cost. And we can wrap around that an engagement model, a way of connecting to real people that they really get.
我们相信，在未来10年、20年中，要实现我们所追求的目标，必须在两个方面取得成果：一是我们真正找到了方法，能将体系中各个要素整合为一种全新的医疗服务模式——基于价值的医疗服务，它能带来更好的健康结果、更佳的服务体验、更高的质量和更优的成本控制；二是我们能够围绕这一体系建立起与真实用户的连接模式，让他们真正理解并参与进来。
That's what we are aiming to build over the next 10 or 20 years. And we believe that's going to be very differentiated. It's not unique. Not every piece of that story is full of new ideas. In fact, you'll look at things today and say, isn't that like an old idea? The difference is that we're figuring out ways to take ideas people have talked about for many years and actually bring them to life and actually bring them to a scale, which makes an impact on people. And crucially, we're trying to do that regardless of what your ZIP code is or what your income level is. We're trying to drive forward a way of improvement, which is truly available to all who need it. That's what we're striving to do.
这正是我们在未来10至20年中致力构建的目标体系。我们认为，这将成为我们的差异化优势。它未必全是独创性的，并不是每个部分都是新想法——你可能会看到某些内容会觉得，“这不就是老概念吗？”但不同之处在于，我们正在真正将这些被谈论多年的想法变为现实，并将其扩大到足以影响众多人的规模。更重要的是，我们希望做到不论你住在哪里、不论你收入多少，这种改善模式都能为你所用。这正是我们全力以赴的方向。
What makes me incredibly confident about our ability to do all of this is the culture of this organization. Those 3.9 million applicants want to come to this place. And when some of them get the chance to come to this place, they'll find an organization which has a culture which I would characterize as being restless, compassionate and accountable.
让我对我们完成这一切充满信心的，是我们组织的文化。那390万名申请者之所以希望加入，是因为他们感受到这里的文化。而当部分人真的加入后，他们会发现这是一家拥有三大文化特质的公司：永不满足、富有同理心、负责任。
It's a culture where every day, you're going to meet and see many of these people. Every day, people wake up despite our size, and say, how do we do this better? Restless. How do we do better? Why didn't we get that right? Every day, they wake up and try and figure out a way to look after somebody better. Compassionate. How do we do a better job of making that member or that patient have a better experience? How do we satisfy more? How do we delight more?
这是一个你每天都能看到许多员工展现这些文化的地方。每天，尽管我们公司庞大，人们依然早早起床思考：“我们怎么能做得更好？”——这就是“永不满足”。“我们为什么这件事没做好？”每天，他们也在思考如何更好地照顾他人——这就是“富有同理心”。“怎样才能让我们的会员或病人拥有更佳体验？如何提升满意度？如何带来惊喜？”
And every day, they wake up feeling the drive and the need to honor the commitment that they made. Whether that commitment was made to a patient or a consumer or a fellow employee or to 1 of the 100 payers who rely on Optum, who are not UnitedHealthcare or whether it's 1 of the 4 in 5 hospitals across America who rely on Optum, all of those people every day wake up and think about how we deliver on our promise.
每天，他们也带着责任感起床，努力兑现承诺——不论这个承诺是对病人、消费者、同事，还是对那100家依赖Optum（非UnitedHealthcare）的付款方，或是全美五分之四依赖Optum服务的医院。他们每天都在思考，我们如何履行我们的承诺。
The accountability running through this organization is second to none. The combination of restlessness, compassion, accountability drives a culture in this organization, which gives me, gives our leadership team real confidence that whatever is thrown at us in terms of change of assumption, we can deal with. And more importantly, we can deal with and not be disturbed from the direction of travel that I've laid out this morning.
贯穿整个组织的责任意识无与伦比。“永不满足”、“富有同理心”和“负责任”这三种特质，共同塑造了公司文化，让我和整个领导团队充满信心——无论面对怎样的假设变化，我们都能应对得当。更重要的是，这些变化不会动摇我们今晨所描绘的前进方向。
That vision of really starting to improve the health care experience for many through real clarity of where we're focused on investing in our growth engines and through real understanding that to achieve that improvement requires a different way of organizing care, value-based care and a way of bringing to life engagement for everybody across the country through a much more empowered consumer relationship. We're looking forward to giving you more detail on all of this, this morning.
我们致力于通过清晰聚焦于增长引擎的投资、深刻理解实现改善所需的护理组织方式——即基于价值的医疗服务模式——来真正提升大众的医疗体验；同时，也致力于通过更加赋权的消费者关系，在全美范围内实现更广泛的用户参与。我们期待在今天上午为您详细介绍这一切。
We're also looking forward to having the chance to talk to you individually in many different formats during the day. I hope you will take the opportunity to ask any question you have, and please feel free to chat to any one of the 60 or so leaders of UnitedHealth Group, who are here this morning in New York.
我们也期待在今天以多种形式与大家一对一交流。希望你们能够把握机会，提出所有感兴趣的问题。同时，也欢迎大家随时与今天在纽约出席会议的60多位联合健康集团领导者中的任何一位交流。
Thank you for joining us. And with that, I'm going to invite our President and Chief Operating Officer, Dirk McMahon, to open the day. Thank you.
感谢各位的到来。接下来，请允许我邀请我们公司的总裁兼首席运营官 Dirk McMahon 为今天的会议揭开序幕。谢谢大家。
Dirk McMahon Former President & COO
So 20 years ago, I got my start at this company, running a UHC team supporting small business. These were businesses born around the kitchen table, people with tireless work ethics, taking chances on good ideas in untapped markets, a perfect place to learn. I saw firsthand how health benefits could punch above its weight when it comes to employee retention, productivity, progress. Companies making tough choices every day on service, on quality, on economics, convenience, and their health care was no exception.
20年前，我在这家公司开启了职业生涯，当时负责一个支持小企业的UHC团队。这些企业多是起步于厨房餐桌的人创立的，靠着勤奋不懈的精神，在未被开发的市场中搏一线机会，是绝佳的学习场所。我亲眼看到，健康福利在员工留任、生产力和企业发展中远超预期地发挥着作用。企业每天都在服务、质量、成本、便利性等方面做艰难抉择，而医疗保健也不例外。
Those early days proved to me, I was in the right place. It showed me that UnitedHealth Group was a business built for people, for both small-town stores and for the global employer, a company focused on execution, a creative and growing set of distinct capabilities. And with the right team of our own, we were able to help people, the chef, the daycare provider, the florist and the partner they can count on.
那段初期经历让我坚信我找对了地方。它让我看见，联合健康集团是一家真正为人而生的企业，既服务小镇商户，也服务全球雇主。公司专注执行，具备一系列独特、不断发展的创新能力。有了我们自己的优秀团队，我们能够切实帮助厨师、托儿所经营者、花店老板，成为他们可以依靠的伙伴。
So every year, we offer you an update on our own kitchen table story, the decisions we made along the way that have shaped our character and evolved our role in the entire system, from the days as a health plan, focused on commercial insurance to the nationwide care delivery organization we are today and how the decisions of the past provide insights into where we go next.
因此每年，我们都会向大家讲述我们自己的“厨房餐桌故事”：一路走来，我们所作的关键决策如何塑造了我们的性格、转变了我们在整个体系中的角色——从最初专注于商业保险的健康计划，到如今成为覆盖全美的医疗服务组织——以及这些过往的决策如何启示我们接下来的方向。
We bring on stage today, a talented team of frontline leaders, innovators from global IT, banking, consumer brands, those who got their start as clinicians, public health educators and United States service members, each one with their own imagination for what health care can be for people, bringing to life their own good ideas and going after new markets every day. That restlessness of our people is what others count on, delivering high-quality care on behalf of everyone in the system through a durable model built to last and always improving over time, with innovation as a fundamental quality that pushes us to unlock better experiences, more value and improve connectivity for the system, all done with the consumer at the very heart of every product road map.
今天我们请上台的，是一支才华横溢的一线领导者团队，他们来自全球IT、银行、消费品牌领域，也包括从临床医生、公共卫生教育者、美国军人出身的人才。他们每个人都对“医疗可以为人们带来什么”有着自己的构想，每天都在将这些好点子转化为现实，探索新的市场。正是我们团队那份“永不满足”的精神，让外界能够依赖我们——通过一个经久耐用、不断迭代的模式，为整个体系中的每一个人提供高质量护理。创新是我们最根本的驱动力，推动我们不断提升体验、增加价值、优化系统连接——始终以消费者为每一款产品路线图的核心。
And in each of the last 2 years, that story has been told by stepping through 5 strategic areas that are driving long-term sustainable growth for UnitedHealth Group, working to expand the number of people benefiting from value-based care; the many ways we're reimagining health benefits in markets of every shape and size; how we're pushing the boundaries of health technology, facilitating transactions and the flow of information between health plans, providers and consumers; how financial services network is innovating payments and improving the connectivity and exchange of capital in the marketplace; and finally, how we're helping people manage everything from complex specialty medications to getting the right medicine on time for the lowest price.
过去两年，我们始终围绕五大战略领域讲述这个成长故事，这些领域共同驱动联合健康集团实现长期可持续增长：一是扩大享受基于价值医疗服务的人群规模；二是从各类市场的角度重新构想健康福利；三是突破健康科技边界，促进健康计划、医疗服务提供者与消费者之间的交易和信息流动；四是金融服务网络推动支付创新，提升市场中资本的连接与交换效率；五是帮助人们管理从复杂专科药物到以最低价格及时获得合适药物的全过程。
And in the year since, we've nearly doubled the number of people we care for in fully accountable arrangements to more than 4 million. We've grown the number of people in our MA plans by more than 25% to $9.3 million. We'll have processed nearly 3 billion adjusted scripts and over $1 trillion in health payments. Together, these strategies have helped us grow the number of people we serve to more than $152 million across Optum UnitedHealthcare.
过去一年，我们在全责任型医疗安排下照护的人数几乎翻倍，已超400万；我们的联邦医保优势计划（MA）参保人数增长超过25%，达到930万人；我们处理的处方总数接近30亿张，健康支付金额超过1万亿美元。这些战略共同助力我们将服务人数扩大到超过1.52亿人，覆盖Optum与UnitedHealthcare两个平台。
Now I like to say you're only as good as your last at bat. So today, we're going to give you a deeper look at how all this works and what comes next. We'll spend our time this morning talking through two key stories. First, we'll show you how our approach to value-based care is resonating with patients, clinicians, health system leaders, from the Hudson Valley where I grew up and where our Optum practices are taking care of my mom; to Southern California, the birthplace of our pharmacy benefit management's capability, the first company that I ran at Optum; to the Nevada desert, where Brian Thompson and I were part of a team that brought some of our first care delivery capabilities to the company, foundational building blocks that would become the earliest pieces of our value-based care strategy.
我常说，一家公司只能靠最近一场“出击”来定义自己。所以今天我们将为你深入讲解这一切是如何运作的，以及接下来将走向何方。今天上午我们将围绕两个核心故事展开。首先，我们将展示我们推进基于价值医疗服务的方式，如何在患者、医生和医疗体系领导者中产生共鸣——从我成长的哈德逊河谷地区，我们Optum团队正在照护我母亲；到南加州，我们药品福利管理业务的发源地，那是我在Optum任职时经营的第一家公司；再到内华达沙漠，Brian Thompson和我曾在那儿参与团队，首次将护理服务引入公司，这些都构成了我们价值导向医疗战略的早期基石。
Then we'll show you how we're orienting our businesses and designing our new products to hold up against the ever-evolving preferences of the American consumer, whose voice will get only louder, demanding more value for their dollar, more transparency and improved quality at every turn.
接着我们将展示，我们是如何调整业务方向并设计新产品，以应对美国消费者不断变化的偏好——他们的声音将越来越响亮，他们会要求用每一美元换来更多价值，要求更高透明度和更优质量。
Okay. With that, BT, I'll let you take it from here. Value-based care, where are we going and how are we getting there?
好了，接下来交给你了，BT。关于基于价值的医疗服务，我们将如何走下去，又将如何实现目标？
Brian Thompson Former CEO of UnitedHealthcare
Thanks, Dirk. In the simplest sense, we're helping to accelerate the transition from volume to value, moving beyond a transaction-based health system, where physicians are incented only to engage people in a single episode of care to a model designed to be proactive and to help keep people healthy over the course of a lifetime, one that rewards high-quality care, delivers better outcomes and drive lower costs.
谢谢你，Dirk。简单来说，我们正在加速推动医疗体系从以量取胜转向以价值为导向的转型——从那种基于交易、医生只在单次就诊中介入患者的体系，转向一个主动、长期关注患者健康的模式。这个新模式奖励高质量护理，带来更佳治疗效果，并降低整体成本。
In a value-based system, physicians are supported by a care team. They have more time to get to know their patients, develop personalized care plans. And they use real-time data and evidence-based clinical insights to anticipate what their patients might need. Today, value-based care is the centerpiece of our growth strategy. And from my vantage point leading UnitedHealthcare, it is by far the greatest opportunity we have to deliver superior outcomes and lower costs.
在基于价值的体系中，医生由一支护理团队支持，他们有更多时间了解患者、制定个性化的护理计划。他们运用实时数据和循证临床洞察，预测患者可能的需求。如今，基于价值的医疗服务已成为我们增长战略的核心。从我领导UnitedHealthcare的角度来看，这是我们实现更优治疗结果和更低成本的最大机会。
With primary care as the foundation, we've brought on additional capabilities over time, specialty care, outpatient surgical centers, post-acute support, behavioral health and pharmacy services. We've created the capacity to move beyond the walls of a traditional clinic to care for people virtually and now more than ever in the comfort of their own homes.
以初级保健为基础，我们逐步拓展了专科服务、门诊手术中心、急性后期护理、行为健康和药房服务等能力。我们已经构建起超越传统诊所墙壁的服务能力，能够通过虚拟方式，甚至在患者家中，为他们提供前所未有的舒适护理体验。
At UnitedHealth Group, our deepest and most impactful relationships are with the more than 4 million people we serve in fully accountable arrangements. And as Dirk said, that number has nearly doubled since 2021. And you should expect us to continue to grow this number substantially each year, as our long-term ambition is to transition as many people as possible into value-based care.
在联合健康集团，我们最深远、最具影响力的关系，是与我们在全责任制安排下服务的400多万人建立的。正如Dirk所说，这一数字自2021年以来几乎翻倍。你们可以预期我们每年将大幅增加这一数字，因为我们的长期愿景是让尽可能多的人转向基于价值的医疗服务。
We pioneered senior focused to value-based care with Optum more than a decade ago, driving a real focus on quality outcomes. At that time, the percentage of our seniors and 4-star plans was only in the high single digits. Today, 9 out of every 10 people we serve are participating in a star plan of 4 or more. That's a tenfold increase.
十多年前，我们就通过Optum率先在老年人群体中推行基于价值的医疗服务，真正聚焦于质量结果。当时，参与4星及以上计划的老年人占比还只是个位数偏高。而今天，我们服务的每10位客户中有9位在4星或以上的计划中，提升了10倍。
Clinically, we see many other benefits. When you compare it to fee-for-service, people in our fully accountable MA arrangements with Optum experience better complex care management. Their Medicare Advantage patients were 44% less likely to be admitted into a hospital for COPD or asthma and had a 10% lower rate of admission for stroke or heart attack. They also had 14% fewer avoidable emergency department visits. They also had lower admissions. Their patients were 18% less likely to have an inpatient admission and 9% fewer readmissions to the hospital within 30 days. And they had better engagement with their health, over 31% higher rates of annual wellness visits.
在临床上，我们看到了许多其他好处。与按服务付费模式相比，Optum的全责任Medicare Advantage安排下的患者在复杂疾病管理方面效果更好：他们因慢阻肺或哮喘住院的几率低44%，因中风或心脏病住院的概率低10%；可避免的急诊就诊次数减少14%；住院率降低18%；30天内再入院率减少9%；而且他们在健康管理方面参与度更高，年度健康体检的完成率高出31%以上。
Now beyond clinical quality improvements, our value-based care arrangements with Optum are driving important innovation in health, like better products that provide increasing benefit engagement, such as our integrated benefits card and our improved transportation model, both of which you'll hear more about today.
除了临床质量的改善，我们与Optum的基于价值医疗安排也在推动重大健康创新，例如提供更强参与度的新型产品——包括我们的一体化福利卡和改进的交通服务模式，今天你们将会听到更多相关介绍。
Finally, we continue to invest deeply in our benefits across our value-based care arrangements with Optum, increasing their value by more than 40% over the last 5 years. Yes. As far as we've come, the percent of dollars in the United States that flow through fully accountable payment models is still in the single digits. We are in the early stages and there is a lot of opportunity ahead.
最后，我们仍在持续大力投资Optum的基于价值医疗服务安排，在过去5年中，这些福利的整体价值提升了40%以上。尽管我们取得了显著进展，但在美国，通过全责任支付模型流转的医疗支出比例仍仅为个位数。我们还处于早期阶段，未来仍有巨大机会。
Health care should be easier for people. We are cognizant of the challenges. But navigating a future through value-based care, unlocks a situation where the fully -- the family doesn't have to make the decisions on their own. It doesn't fully rest in their hands, and they can be supported by value-based care.
医疗保健应该对人们来说更加便捷。我们清楚其中的挑战。但通过基于价值的医疗服务模式引领未来，将使家庭不再孤军奋战、不再独自做决策。他们能够得到体系的支持。
Now Dr. Amar Desai will describe how the OptumHealth team is continuing to build the capacity and scale to bring value-based care to millions more people served by UnitedHealthcare and many millions of others throughout the health system. Amar?
接下来请Amar Desai博士介绍，OptumHealth团队如何持续扩大能力与规模，把基于价值的医疗服务带给UnitedHealthcare服务的数百万人以及整个医疗系统中的更多人。Amar？
Amar Desai CEO of Optum Health
Thanks, BT. Today, Optum helps nearly 90,000 physicians and 40,000 advanced practice clinicians serve tens of millions of people throughout the United States. Some of our patients are Brian's customers, but many more are not as we work with more than 100 health plan partners. Our value-based care journey has been one marked by expansion in the assembling and integration capabilities and in our reach and impact in different regions of the country.
谢谢你，BT。如今，Optum支持着大约9万名医生和4万名高级执业临床人员，为全美数千万人提供医疗服务。我们的一部分患者是Brian所提到的客户，但更多则不是，因为我们与超过100家健康保险计划合作伙伴合作。我们的基于价值的医疗服务之路，是一条不断拓展整合能力、扩大覆盖区域、提升全国各地影响力的旅程。
As you heard from Brian, we serve more than 4 million people in fully accountable arrangements today. By this time next year, we expect to grow to nearly $5 million. We'll do this by deepening our capabilities and in communities and presence where we already have Optum capabilities while continuing to expand in new geographies and further integrating care for patients along every step of their journey, ensuring patients can receive care where and when they prefer.
正如Brian刚才所说，我们目前在全责任安排下服务超过400万人。到明年此时，我们预计将增长至近500万人。我们将通过加深我们在现有Optum布局社区的能力，并继续扩展至新地域，同时在患者的整个治疗旅程中持续整合医疗服务，确保他们能够在所需的时间和地点获得照护。
Let me give you two examples: pharmacy care and behavioral health. In pharmacy care, we can seamlessly connect our patients to services through OptumRx, unlocking access to reliable home delivery, specialty pharmacy and home-based infusion therapies. Great pharmacy care leads to better adherence to medications and higher-quality outcomes.
让我举两个例子：药房服务和行为健康。在药房服务方面，我们通过OptumRx为患者无缝对接服务，提供可靠的居家送药、专科药房以及居家注射治疗等服务。优质的药房服务可显著提升用药依从性，进而带来更高质量的治疗结果。
Our home delivery patients achieve adherence rates above 90%. That's compared to 70% to 80% for patients who are on 30-day scripts at retail pharmacies. We operate nearly 700 community-based pharmacies and infusion sites. Some of them are located within our clinics. These pharmacies are serving some of the most vulnerable individuals, including people who are on Medicaid.
我们的居家送药患者的用药依从率超过90%，而零售药房领取30天药品的患者依从率通常为70%到80%。我们运营着近700家社区药房和注射治疗点，其中部分设于我们的诊所内。这些药房服务的对象包括最弱势的群体，例如Medicaid受益人。
In behavioral health, we added 45,000 therapists, psychiatrists and behavioral health professionals to our national provider network. We have integrated home care delivery with our behavioral health benefits business to improve timely access to behavioral care for our patients through our home care program.
在行为健康方面，我们将4.5万名治疗师、精神科医生及行为健康专业人士纳入全国服务网络。我们已将行为健康福利与居家护理服务整合，为患者通过居家项目提供更加及时的行为健康照护。
As a physician, I'm particularly excited that we are becoming the practice and partner of choice in the marketplace. That is because we are driving quality, standardizing technology and clinical systems and most importantly, strengthening our relationships with patients and our providers.
作为一名医生，我尤其感到振奋的是，我们正逐渐成为市场上首选的医疗实践机构和合作伙伴。这是因为我们在推动质量提升、技术与临床系统标准化方面不断进步，更重要的是，我们持续强化与患者和医疗人员的关系。
Journey, it really is the right word to describe where we've been and where we're headed. In some areas of the country, we're quite far along. And in other areas, we're just taking off. And we've gained a lot of hard-won experience along the way.
“旅程”这个词非常贴切地概括了我们走过的路和即将前往的方向。在一些地区，我们已经走在前列；在另一些地区，我们刚刚起步。在这个过程中，我们积累了许多来之不易的经验。
For 6 years, I led several markets and care delivery organizations that are now part of Optum West. There, we created a unified experience for patients and care teams. We integrated support functions and technology and we empowered local physicians with best practices and the tools they needed to best serve in value-based arrangements.
我曾领导现属Optum West的多个市场和护理服务组织长达6年。在那里，我们为患者和照护团队打造了统一的体验，整合了后勤支持与技术系统，为当地医生提供最佳实践与所需工具，使他们能在基于价值的安排中充分发挥所长。
For example, within the West, California represents one of our larger fully accountable value-based patient populations, where we serve Medicare, Medicaid and commercial health plans, delivering a connected and coordinated care. Taking what we've learned in California as well as in other advanced value-based regions like Texas and Nevada, we'll establish and grow value-based care delivery in more regions across the country.
例如在西部地区，加州是我们最大的一块基于价值的全责任患者群体之一，我们在那里服务Medicare、Medicaid和商业健康计划，实现连接和协同的护理。我们将在全国更多地区建立并扩展基于价值的医疗服务体系，借鉴在加州、德州、内华达等先进地区的经验。
Caitlin Zulla is here to share one example.
接下来，请Caitlin Zulla为大家分享一个具体案例。
Caitlin Zulla
Over the past few years, Optum's presence has been growing in the Northeast. We now serve more than 5.5 million Medicare, commercial and Medicaid patients across Massachusetts, Connecticut, New York and New Jersey.
过去几年，Optum在美国东北部的影响力不断扩大。如今，我们在马萨诸塞州、康涅狄格州、纽约州和新泽西州，为超过550万名Medicare、商业保险和Medicaid患者提供服务。
Before leading the OptumHealth East region, I led Optum's national ambulatory surgery care business. While we were national, our strategy was local and regional. No care system looked the same, and we adapted to local needs. It's the same approach we're taking in the East, but on a much larger, more comprehensive scale.
在我负责OptumHealth东部地区之前，我曾领导Optum的全国门诊手术业务。虽然我们的业务遍及全美，但我们的策略始终是本地化、区域化的。因为没有两个医疗体系是完全相同的，我们始终根据当地需求进行调整。现在在东部地区我们仍采用这一策略，只是规模更大、覆盖面更广、综合程度更高。
We are rapidly maturing our multi-specialty fully accountable care business, which represents 8% of our Northeast patients today, whether it is our relentless focus on quality in Massachusetts, where Optum practices are consistently ranked in the 90th percentile in HEDIS quality measures to partnering with health systems in Connecticut and growing fully accountable lives in New York and New Jersey through comprehensive connected capabilities like behavioral health, complex kidney care management, in-home and post-acute navigation.
我们正在迅速成熟我们的多专科、全责任制医疗服务业务，目前已覆盖东北部地区8%的患者。无论是在马萨诸塞州持续聚焦高质量护理——Optum诊所的HEDIS质量评分长期处于第90百分位；还是在康涅狄格州与健康系统建立合作关系；又或是在纽约和新泽西通过行为健康、复杂肾病管理、居家和急性后护理等综合互联能力扩大全责任照护人群，我们都在全面推进。
This is all assisted by integrating Optum's care and administrative platforms that drive both operational and clinical excellence, and by leveraging the strengths of our other businesses in OptumHealth, like our ambulatory surgery care expertise to create new opportunities to reduce total cost of care.
这一切都得益于Optum医疗与管理平台的深度整合，这些平台同时推动运营和临床卓越。同时，我们还利用OptumHealth在门诊手术护理方面的专长，创造出新的机会来降低总体医疗成本。
To help bring just one part of our story to life in the Northeast, I am pleased to welcome Dr. Caroline DeFilippo from Mount Kisco, New York. Welcome, Dr. DeFilippo. It's so great to see you again. Tell us a little bit about yourself and your patients.
为了让大家更直观地了解我们在东北部的实践，我很高兴欢迎来自纽约州芒特基斯科的Caroline DeFilippo医生。欢迎你，DeFilippo医生，很高兴再次见到你。请跟大家介绍一下你自己和你的患者群体。
Caroline DeFilippo
Thanks, Caitlin. It's great to see you as well, and I'm excited to be here. I'm the Chair of Primary Care and Population Health for Optum's Hudson Valley area practices. We serve patients across Medicare, Medicaid, commercial and special needs plans. More importantly, I'm also a primary care physician.
谢谢你，Caitlin。我也很高兴见到你，也很荣幸今天在这里。我是Optum哈德逊河谷地区初级保健和群体健康的主席。我们为Medicare、Medicaid、商业保险和特殊需求计划的患者提供服务。更重要的是，我本身也是一名初级保健医生。
Half the week, I have a full panel of patients in both fee-for-service and accountable care models. The other half of the week, I'm helping drive our transition to a more sustainable model of primary care. We're doing that through integrated care coordination technology and wrap-around services like full population health management. In other words, giving primary care providers the ability to quarter back all the plays and coordinate true value-based care.
每周有一半时间，我要负责管理一整批患者，包括传统按服务付费和全责任制照护模式的患者。另一半时间，我则致力于推动我们向更可持续的初级保健模式转型。我们通过整合的照护协调技术和围绕式服务（如群体健康管理）来实现这一目标。换句话说，就是赋予初级保健医生像“四分卫”一样统筹全局的能力，从而协调和推动真正的基于价值的医疗服务。
Caitlin Zulla
That support for PCPs is so critical. Can you tell us more about your progress in moving towards accountable care?
对初级保健医生的支持至关重要。你能再多谈谈你们在迈向全责任医疗服务方面取得的进展吗？
Caroline DeFilippo
Absolutely. We have made a lot of progress in a short period of time. In the past, we've operated a few Medicare ACOs, which introduced some elements of value and risk, but opportunities around fully accountable care weren't possible before Optum. To succeed, you really need a local and regional approach that aligns primary and specialty care with technology and care services.
当然可以。我们在很短时间内取得了大量进展。过去我们运营过一些Medicare ACO（责任医疗组织），引入了一些价值导向和风险控制的元素，但在加入Optum之前，我们还无法真正推进全责任照护。要想成功，必须采取本地化和区域化的方法，将初级和专科护理与技术和医疗服务有效对接。
Being part of Optum gave us the confidence and the ability to move into fully accountable care. The model we built from the ground up here in the Hudson Valley is now serving about 70,000 patients. And in the broader New York and New Jersey area, our fully accountable patient population has grown by more than 60%.
成为Optum的一部分，赋予了我们迈向全责任照护的信心与能力。我们在哈德逊河谷从零开始构建的这一模式，现在已服务约7万名患者。而在更广泛的纽约和新泽西地区，我们的全责任照护患者群体已增长超过60%。
Caitlin Zulla
Can you offer a specific example of where you've seen success in bringing these Optum capabilities to bear in your practice?
能否分享一个具体案例，让我们了解Optum的能力在你们实际操作中带来了怎样的成效？
Caroline DeFilippo
Sure. I'd call out post-acute care navigation. I regularly see patients who have recently been discharged from the hospital. And too often, I have to play detective. Why were they in the hospital? What medications are they taking? Do they have home care in place? What's really going on here?
当然。我想特别提一下急性后护理导航服务。我经常接诊刚出院的患者，过去我常常要像侦探一样追查他们为什么住院、在服用什么药、是否安排了居家护理、到底发生了什么。
With our post-acute care program, I'm now working with a proactive team, coordinating discharge, rehabilitation and then home care. I don't have to play detective and can focus on the reason for a patient's visit. I perform my job better because care teams are tracking medications, support services and clinical data in real time.
而现在，通过我们的急性后护理项目，我与一个积极主动的团队协作，统筹出院、康复和后续居家护理。我不再需要扮演“侦探”角色，可以专注于患者此次就诊的原因。我能更好地开展工作，因为照护团队实时跟踪患者用药、支持服务及临床数据。
只是有了更好的数据共享机制。
Other capabilities Optum brings to bear are home-based and palliative care for some of our most complex patients. I can tell you that this is enhancing the physician relationship with our patients and giving us the time and space to deliver extraordinary care. We're able to layer in the appropriate tools at the right time, which allows us to expand this model and our impact on patients.
Optum还为我们最复杂的患者提供了居家护理和缓和医疗服务。这显著增强了医患之间的关系，并让我们有时间和空间提供卓越的照护。我们可以在合适的时间引入合适的工具，从而扩展这一照护模式并提升对患者的影响力。
Caitlin Zulla
Thank you so much, Caroline. This has been a great view into the work happening in your practice.
非常感谢你，Caroline。你为我们展示了你所在诊所令人印象深刻的工作进展。
Caroline DeFilippo
Thank you.
谢谢你。
Caitlin Zulla
Over time, these integrated capabilities and models of care will be available in all of our markets. It's about unleashing the passion of our care providers like Dr. DeFilippo across the country to truly empower them to practice comprehensive and accountable care, supported by the tools that address a patient's entire needs and social determinants of health, whether in the clinic, virtually or in the home.
随着时间推移，这些整合能力与照护模式将在我们所有市场逐步铺开。我们的目标是激发像DeFilippo医生这样的医疗人员的热情，真正赋能他们去实施全面且负责任的照护服务。无论是在诊所、线上还是在患者家中，都有相应工具来支持他们满足患者的整体需求，包括健康的社会决定因素。
Robert Hunter
UnitedHealth Group has been a leader in home-based medical care for nearly 20 years, serving people across the care continuum from preventive to episodic, chronic, highly complex and palliative care. And while the need for home-based capabilities from consumers, health plans and care providers has never been higher, the market remains deeply fragmented, rooted in fee-for-service models to put the burden of finding and navigating care squarely on the shoulders of the people who need help the most.
联合健康集团在居家医疗服务领域已有近20年的领先经验，涵盖从预防护理、短期急症护理、慢性病管理、高度复杂病情到缓和医疗的全方位服务。如今，来自消费者、健康保险计划和医疗提供者对居家医疗能力的需求空前高涨，然而这个市场依然高度碎片化，依旧以按服务计费模式为主，把寻找和协调医疗服务的重担压在最需要帮助的人身上。
To address their unique needs, we've spent the last several years building home care models unlike any other centered around a few foundational capabilities. First, clinical visits delivered in the home and designed to identify medical care needs and help patients with other physical and social needs. Second, care transitions, where we are coordinating care for patients, their families and care providers as members move between the home and other care settings. And lastly, complex care, where we provide individual support for people with the most complex needs and multiple chronic conditions, including the more than 12 million Americans who are duly eligible for both Medicare and Medicaid. These are people who often lack the economic resources and family support to help coordinate care between the home, the doctor's office and other sites of care.
为了应对这些特殊需求，我们在过去几年中构建了一套独特的居家医疗模式，围绕几项基础能力展开：第一，在家进行临床访问，识别患者的医疗需求，并协助解决其身体及社会层面的问题；第二，护理过渡管理，即当成员在家庭与其他护理场所之间转换时，我们为患者、家属和医疗提供者协调照护服务；第三，复杂病患管理，即为患有多种慢性病且需求最为复杂的群体提供个性化支持——其中包括超过1200万同时符合Medicare和Medicaid资格的美国人。他们往往缺乏经济资源和家庭支持，难以协调家中、诊所和其他照护场所之间的医疗服务。
Through our partnership with Optum, we have continually demonstrated the value of bringing these services into the home. This year, we will conduct more than 2.5 million in-home visits through our house calls program, completing approximately 200,000 tests for diabetes and hep C, which are consistently underdiagnosed conditions.
通过与Optum的合作，我们持续证明将这些服务引入居家的价值。今年，我们将通过“上门问诊”（house calls）项目完成超过250万次居家访问，其中包括大约20万次糖尿病和丙型肝炎检测——这两类疾病在临床上长期存在诊断不足的问题。
Within 90 days of these visits, about 75% of seniors will receive additional primary care in a clinic setting. Being in the home also provides the opportunity to identify unmet social determinants of health such as healthy food and transportation. This year, we will screen nearly 3.8 million people, helping connect them to necessary resources with over 40% of those screenings occurring during a house calls visit.
在这些居家访问后的90天内，大约75%的老年人会在诊所获得进一步的初级医疗服务。居家访问也让我们得以识别一些未被满足的健康社会决定因素，例如健康食品获取和交通问题。今年，我们将对近380万人进行筛查，其中超过40%的筛查将在上门问诊期间完成，帮助他们衔接必要的资源。
We also serve hundreds of thousands of people who are homebound through our Medicaid long-term care businesses. Our local care managers assess care needs, develop care plans and then ensure patients get the support they need via community-based providers and our innovative technology delivered in the home enables real-time connections with delegated providers.
此外，我们还通过Medicaid长期照护业务服务数十万居家卧床人士。我们的本地护理经理负责评估照护需求、制定照护计划，并确保患者通过社区服务提供者获得所需支持。同时，我们的创新居家技术可实现与授权服务提供者的实时连接。
可能是大型科技企业的增长点。
Now I'll hand it over to Josh to share how we are advancing our partnership with providers around both skilled and non-skilled care.
接下来我将交给Josh，来分享我们如何在专业护理与非专业照护方面深化与服务提供方的合作。
Joshua Proffitt CEO & President
Thanks, Bobby. Fragmentation and the opportunity to reduce it is particularly apparent for care being provided in the home. I spent 15 years helping to build LHC Group, and now I'm proud that we're part of the Optum team. In fact, one of the reasons our company was founded was to develop deeper, more personal relationships with patients and their families in the home care marketplace. Our ultimate aspiration was to move away from the fee-for-service model and drive better outcomes through value-based care but we knew we didn't have the capabilities to do it on our own. Now that we're part of Optum, we can.
谢谢你，Bobby。在居家医疗领域，碎片化尤为明显，而减少这种碎片化正是我们看到的巨大机会。我在LHC Group工作了15年，并帮助它成长，现在很自豪我们成为了Optum团队的一部分。事实上，我们创立公司的初衷之一，就是为了在居家护理市场中与患者及其家庭建立更深入、更个性化的关系。我们的终极目标是摆脱按服务计费模式，通过基于价值的医疗服务实现更好结果，但我们也知道，单凭我们自身的能力是做不到的。现在加入Optum，我们可以实现这一愿景。
Today, we see tremendous opportunity to not only scale within Optum's value-based strategy, but also connect into the broader capabilities of Optum's comprehensive home care offerings. Anyone who has helped a loved one through a care transition knows it can be scary, it can be confusing experience without the right support. Yet properly coordinated, it can be game-changing.
现在，我们不仅可以在Optum的价值导向战略中扩展规模，还能接入Optum更广泛的综合居家医疗能力。任何协助亲人经历护理过渡的人都知道，这种经历在没有合适支持时可能令人恐惧和迷惘。但如果协调得当，它可以改变一切。
Care coordinators are active partners with patients and their families. They provide actionable information on progress and care needs while patients are in a skilled nursing facility. Our patients value these services, which is why we have more than doubled the number of people Optum's care coordinators serve since 2020.
护理协调员是患者及其家庭的积极合作伙伴。当患者在专业护理机构时，他们会提供有关治疗进展和照护需求的可执行信息。我们的患者非常重视这些服务，这也是为何自2020年以来，Optum护理协调员所服务的人数已翻倍以上。
We know from experience the flexibility and convenience offered by superior home care can be transformative. Fewer readmissions compared to the national average and higher consumer satisfaction. Overall, those who utilize home health services after a hospital admission have a 36% lower 90-day readmission rate than those who did not. In a recent analysis of our diabetes patients, we reduced hospitalization rates by 50%. That translates to a real difference in people's lives.
我们的经验表明，优质居家护理所带来的灵活性与便利性可以产生颠覆性影响。它能显著降低再入院率、提升患者满意度。总体来看，出院后接受居家健康服务的患者，其90天再入院率比未接受该服务的患者低36%。在我们最近对糖尿病患者的分析中，我们将住院率降低了50%。这是真实改善人们生活质量的体现。
Often, we serve people that have been historically marginalized or underserved, people deemed too difficult to reach and engage. But their goals are simple. They want to walk outside, check the mail or pick up and hold their grandchild. And that's why we are building the capacity to help more people reach and regain their independence and be where they want to be, at home. Let's take a closer look.
我们服务的人群中，很多都是长期被边缘化、得不到充分照护的人，被认为难以接触、难以参与。但他们的愿望其实很简单：走出家门、查看邮箱、抱起自己的孙儿。正因如此，我们正在构建能力，帮助更多人实现和重拾独立生活，让他们能待在自己最想待的地方——家中。下面我们一起来深入了解。
[Presentation]
Kristy Duffey
I love the time that I got to spend with Linda. She is just one of the thousands of dedicated and compassionate Optum clinicians who support our patients in their homes every day. When I worked in the ER early in my career, I saw so many elderly patients who were in really bad shape. There were so many missed opportunities to prevent them from ending up in the ER in the first place. Home-based care gives us the ability to seize those opportunities.
我非常珍惜和Linda共度的时光。她是成千上万位Optum敬业而富有同情心的临床医生中的一员，每天在患者家中为他们提供支持。早年我在急诊室工作时，见过太多身体状况非常糟糕的老年人。有太多本可提前干预、避免他们最终来到急诊室的机会被错过了。而居家护理让我们得以抓住这些机会。
For example, in the program you just saw, Linda and her colleagues will help close more than 3 million gaps in care for their patients this year, addressing their medical, their behavioral and their social needs. With this level of personalized and ongoing support, our patients are more engaged and they're healthier. Our patient satisfaction scores are in the 80s. And it is just one element of the comprehensive home care model I have had the privilege to help build over 2 decades.
比如，在你刚刚看到的项目中，Linda和她的同事今年将帮助患者弥合超过300万个护理缺口，涵盖其医疗、行为健康以及社会层面的需求。正是这种持续且个性化的支持，让我们的患者更积极参与、更健康。我们的患者满意度评分达到了80多分。而这仅是我20年来有幸参与构建的综合居家护理模式中的一个组成部分。
This year, we will complete more than 10 million home visits and deliver fully accountable care to more than 1 million dual and chronic special needs patients. That is more than twice as many as last year. You should expect strong growth in the years ahead as we continue to invest in and expand our home care capabilities to provide these critical services. And thanks to people like Linda, I have never been more excited about our ability to serve more people in more personal ways.
今年，我们将完成超过1000万次居家访问，并向超过100万名双重资格患者和慢性特殊需求患者提供全责任制照护。这一数字是去年的两倍多。未来几年，随着我们持续投资并扩展居家医疗能力，大家可以预期这一服务将强劲增长。正因有Linda这样的人存在，我从未像现在这样，对我们以更个性化方式服务更多人充满信心与期待。
Timothy Noel CEO of UnitedHealthcare Business
As my colleagues have shared value-based care represents UnitedHealthcare's best opportunity to drive better health outcomes, better quality care and medical cost affordability. Let me share a little bit about the Medicare Advantage program and how we are leaning deeper into senior-focused, value-based care.
正如我的同事们所分享的那样，基于价值的医疗服务是UnitedHealthcare推动更好健康结果、更高质量护理和实现医疗成本可负担性的最佳机会。让我来介绍一下Medicare Advantage（联邦医保优势计划），以及我们是如何更加专注于老年群体的价值导向医疗服务。
This fall more than 32 million seniors, about half of all who are eligible will choose a Medicare Advantage plan. What they are responding to is a value proposition that's hard to beat, high-quality coordinated care and stable benefits. And for those who choose UnitedHealthcare, 0 premium plans, no co-pay for hundreds of the most prescribed drugs and many other features.
今年秋天，将有超过3200万名老年人——也就是大约一半符合资格的人——选择Medicare Advantage计划。吸引他们的，是难以抗拒的价值主张：高质量、协同的照护服务和稳定的福利。对于选择UnitedHealthcare的人来说，我们提供0保费计划、数百种常用处方药零自付等多项优势。
In fact, compared with traditional fee-for-service Medicare, seniors in Medicare Advantage saved 45% on out-of-pocket cost each year, which is especially important to the 52% of participants who live on an annual income of less than $25,000. In total, these savings when paired with those of the government saves the health system more than 12%. Consumers in Medicare Advantage also experienced better health outcomes across a broad range of measures, including more preventative care visits and fewer hospital visits.
事实上，与传统按服务计费的Medicare相比，Medicare Advantage的参保老年人每年可节省45%的自付费用，这对于52%年收入低于2.5万美元的参保人而言尤为重要。总体而言，这些节省再加上政府的节支，使整个医疗体系节省了超过12%的成本。而Medicare Advantage的消费者在多个维度上也获得了更好的健康结果，例如更高的预防性护理就诊率和更少的住院次数。
As you've heard from BT, our partnership with Optum allows us to go even deeper, providing more touch points and more coordinated care than traditional Medicare Fee-for-Service. And that partnership and coordination enables us to serve 9.3 million people in Medicare Advantage plans across UnitedHealthcare.
正如BT所说，与Optum的合作使我们能够走得更深，提供比传统Medicare更丰富的接触点和更有协同效应的护理服务。这种合作与协调，让我们能够为UnitedHealthcare旗下930万Medicare Advantage参保人提供服务。
I can tell you the positive health outcomes we see across our plans are incredibly meaningful to our members and their families. But I think it's important to go a level deeper to hear what those numbers mean from a physician's perspective and to understand the cost and health impact, people incur when diabetes or hypertension goes unchecked or slips out of control.
我可以告诉你，我们在这些计划中看到的健康改善结果，对我们的成员及其家庭而言意义重大。但我认为，更重要的是从医生的视角深入理解这些数据的实际含义，理解当糖尿病或高血压失控时，对个人健康和经济造成的重大影响。
And with that, I'll turn it over to my colleague, Dr. Derek Chao.
接下来，我将把时间交给我的同事，Derek Chao医生。
Derek Chao
Thanks, Tim. You're right. The outcomes are demonstrably better. Let me share more about how we're helping achieve these improvements. In addition to leading OptumHealth West, I'm also a nephrologist. I have treated many patients with diabetes throughout my career. Our care model works because it allows us to deliver evidence-based coordinated care designed for our patients' holistic needs. Everything from managing chronic disease and mental health to reconciling medications to coordinating with specialists to treat very complex conditions. And it all starts with preventive care.
谢谢你，Tim。你说得对，确实可以看到显著更好的治疗结果。让我再介绍一下我们是如何实现这些改善的。除了担任OptumHealth West的负责人，我也是一名肾病专家，在我的职业生涯中治疗了很多糖尿病患者。我们的照护模式之所以有效，是因为它能基于循证医学提供以患者整体需求为中心的协同照护，涵盖从慢性病和心理健康管理、药物协调，到与专科医生合作处理极复杂疾病等方方面面。而这一切，始于预防性护理。
For example, OptumHealth Medicare patients have higher rates of wellness visits and preventive screenings for conditions such as colorectal cancer when compared to patients in Medicare Fee-for-Service. Our patients in value-based arrangement also have better diabetes control than fee-for-service patients. In fact, 1/3 of patients in our Living with Diabetes program improved their A1C by at least 1 percentage point.
例如，与传统Medicare患者相比，OptumHealth的Medicare患者在健康检查和诸如结直肠癌等疾病的预防筛查方面的参与率更高。我们在价值导向安排下的患者，其糖尿病控制水平也优于按服务计费的患者。事实上，我们的“糖尿病生活管理”项目中有三分之一的患者将A1C降低了至少1个百分点。
For most adults, a normal A1C is below 5.7%; 6.5% or higher generally indicates diabetes. So that 1 percentage point improvement is very significant. It can mean the difference between a patient controlling their diabetes or not, which leads to a reduction in the risk for developing debilitating complications such as blindness and kidney failure.
对大多数成年人来说，A1C低于5.7%为正常，6.5%或以上通常表示患有糖尿病。所以将A1C改善1个百分点意义重大。它可能意味着患者能否控制糖尿病，从而降低发生严重并发症（如失明和肾衰竭）的风险。
At Optum, we combine chronic condition management program and technology to identify and alert care providers to gaps in care and high-touch services for those most in need. Let me give you a couple of examples. Our transitional care program helps patients navigate their hospital discharge and next care steps with the goal of preventing readmission. People who underwent the full program had a readmission reduction of 21% compared to control groups.
在Optum，我们结合慢性病管理项目与技术手段，帮助识别照护缺口，并为最需要的人群提供高接触度的服务。我举几个例子：我们的过渡护理项目帮助患者顺利完成出院及后续护理步骤，目标是防止再入院。参与完整项目的患者，其再入院率比对照组降低了21%。
We also help patients form social bonds with one another, creating a sense of community among people with similar backgrounds. This not only combats loneliness and encourages people to embrace healthier living, but does it in a culturally competent way. Patients in these programs are 23% more likely to access preventive care and 15% more likely to undergo a medication review compared to controlled populations. These are just a few of the many ways our care teams are delivering real results for real people through value-based care.
我们还帮助患者之间建立社交联系，在拥有相似背景的人群中营造社群归属感。这不仅能减轻孤独感，鼓励人们更健康地生活，而且是在文化上具有适应性的方式。参与这些项目的患者比对照组在预防性护理参与率上高出23%，在药物审查率上高出15%。这些只是我们的照护团队通过基于价值的医疗服务，为真实的人群带来真实结果的众多方式之一。
Roger Connor
Simply put, our ambition is to make value-based care a reality across the entire health system for all providers and available to all patients, not just the people we serve at OptumHealth. And OptumInsight has been working with health plans and network providers to help identify social needs and track patient encounters for more than a decade. And now we're building on this business by offering a comprehensive portfolio of provider enablement solutions to help them develop their own value-based tools.
简单来说，我们的愿景是让基于价值的医疗服务在整个医疗体系中普及，惠及所有医疗提供者和所有患者，而不仅限于OptumHealth所服务的人群。OptumInsight十多年来一直与健康保险计划和网络服务提供者合作，帮助识别社会需求、追踪患者就医过程。如今我们在此基础上进一步发展，推出一整套综合性的“医疗提供者赋能解决方案”，帮助他们打造自己的价值导向工具。
As many of you know, these transitions are not as easy as flipping a switch. It takes time and support and specific insight into their individual markets, patient makeup and health plan relationships. We are helping them better understand their contracts and how different payment options like shared savings or competition can increase revenue.
大家都知道，实现这种转型并非“一键切换”那么简单。它需要时间、支持，以及对各自市场、患者构成和健康计划关系的深入理解。我们正在帮助医疗服务方更好地理解他们的合同条款，以及如何通过共享节省、绩效激励等不同的支付方式提升收入。
Our clinical support tools are helping providers prioritize patient engagement and outreach, growing their capacity to serve even more patients and spend even more time with each person. Using our capabilities, primary care physicians closed nearly 20 million care gaps. And as they deliver higher quality care, many will earn incentive payments, some for the first time.
我们的临床支持工具帮助服务方优先推动患者互动与外联，提升他们的服务能力，使其能服务更多患者并与每位患者花更多时间交流。借助我们的能力，初级保健医生已经弥合了近2000万个护理缺口。随着他们提供更高质量的护理，许多人也获得了绩效激励奖金，其中一些人是第一次获得此类奖励。
As we make our provider enablement services available to more practices, we're seeing strong results. Earlier this year, OptumInsight partnered with UnitedHealthcare to roll out a new program to help small to midsized independent practices. We were trying to transition to value-based care but struggling to find the right support.
随着我们将赋能服务扩展到更多的诊所，我们看到了显著成效。今年早些时候，OptumInsight与UnitedHealthcare合作推出了一项新项目，帮助中小型独立诊所。这些诊所试图向价值导向模式转型，但苦于找不到合适支持。
Across the tens of thousands of patients, we helped reduce medical costs by more than 10% with this group of providers. Our strength lies in pairing technology with the latest medical expertise, patient history and health data. Given these outcomes, we're expanding this effort. We'll reach more than 400,000 people in commercial plans in 2024, and we expect to grow that more than 20% year-on-year.
在覆盖数万患者的项目中，我们帮助这些医疗提供者将医疗成本降低了超过10%。我们的优势在于将先进技术与最新医疗知识、患者历史和健康数据相结合。鉴于这一成果，我们正扩大这一计划。到2024年，我们将在商业健康计划中服务超过40万人，且预计每年将实现超过20%的增长。
As more providers look to move into value-based arrangements, we're also creating a distinctive set of multi-payer solutions that not only deliver improved outcomes, but free clinicians from certain administrative tasks. Let's take medical necessity reviews, a vitally-important but time-consuming exercise. Powered by evidence-based guidelines that help clinicians determine the appropriate course of treatment, our AI tool can streamline administrative tasks, giving time and resources back to providers.
随着越来越多的医疗服务者希望转向基于价值的照护模式，我们也在开发一套独特的多方支付解决方案，不仅提升健康成果，也为临床医生减轻行政负担。以“医疗必要性审查”为例——这是至关重要却耗时的工作。我们基于循证指南开发的AI工具能够辅助医生判断最佳治疗路径，同时简化行政流程，把时间和资源还给临床团队。
We are continually updating our standard of care guidelines with the very latest medical knowledge to augment the expertise and decision-making of care professionals as they guide their patients along the care journey. Our goal is to deliver consistent data-driven recommendations to raise provider performance and increase both patient and provider satisfaction, not just for Optum providers and patients, but for the whole health system.
我们持续将最新医学知识纳入标准照护指南，以提升医疗专业人员的判断力与决策力，帮助他们更好地引导患者完成治疗旅程。我们的目标是提供一致、数据驱动的建议，提升服务方绩效，提高患者和医疗人员的满意度——不仅是Optum的服务方和患者，更是整个医疗系统中的所有参与者。
Margaret-Mary Wilson Executive VP & Chief Medical Officer
Every patient across health care. It's a bold vision, and it is the right way forward. Because value-based care is just that, it's care based in value. It's the value of a worrying symptom addressed before it becomes a disease to be managed. It's the value of remaining in the comfort of one's home. It's a value of savings realized across the health system when everyone involved is incentivized around the same indisputable goal, the greatest health of the patient, the person at the center of care.
每一位患者——这是一个大胆的愿景，但它正是我们应当前行的方向。因为“基于价值的医疗”本质上就是“基于价值的照护”。它体现的是这样一种价值：在令人担忧的症状尚未演变为疾病前便已得到解决；体现的是能安享在自己家中的舒适与尊严；体现的是当医疗体系中所有参与者围绕着唯一、无可争议的共同目标——患者健康最大化——而非数量导向，被激励协作时，整个体系实现的节约价值。
A system-wide transition to value-based care represents $3 trillion in market spend, moving away from a fee-for-service based system, which incentivizes volume and often results in unnecessary care to an outcomes-based system grounded in compassion and quality. And that's why we're investing today, to create the capacity and capabilities the market needs to support a change of this magnitude.
整个体系向价值导向医疗转型，意味着对约3万亿美元市场支出的重构，转离以数量驱动、容易导致过度医疗的按服务计费体系，迈向一个以同理心与质量为基础、以治疗结果为导向的新体系。这正是我们为何今天进行投资，为市场建立起支持如此规模变革所需的能力与资源。
Today, we serve more than 4 million people this way. By this time next year, that number will be nearly 5 million. Yet the opportunity to expand value-based care is nearly boundless, and here's why. Medicaid, already the largest health insurance program in the nation, serving more than 91 million Americans will continue to grow. Half of America's seniors choose Medicare Advantage today, but just half. And right now, more than 170 million people are in commercial plans, but only a fraction of health care payments flow through fully accountable value-based arrangements.
目前，我们已通过这种方式服务超过400万人。到明年此时，这一数字将接近500万。然而，扩展基于价值医疗的机会几乎无限，其原因如下：Medicaid已是全美最大的医保项目，服务超过9100万美国人，且还在持续增长；目前约有一半的美国老年人选择Medicare Advantage，但也仅仅是一半；而今有超过1.7亿人处于商业健康计划中，但真正通过全责任制价值导向安排流转的医保支付仍是极少数。
A decade in the future, what might these numbers be? How might we transform not only the care model for most Americans, but the very health of our population? The progress we've seen in Southern California, in Houston, in Boston, here in New York, that's just the start. People will continue to embrace value-based care because people appreciate high-quality care that's easier to find and simpler to pay for. People value unhurried interactions with their care providers. And they feel the difference when their own healthiest life is the guiding principle for providers and health plans alike.
十年后，这些数字会达到什么程度？我们又将如何改变的不仅是多数美国人的照护模式，更是我们整个群体的健康状态？我们在南加州、休斯顿、波士顿以及纽约所见的进展，仅仅是开始。人们将持续拥抱基于价值的医疗服务，因为他们欣赏高质量、易获取、支付简单的照护；他们珍惜与医疗服务者之间不慌不忙、用心倾听的互动；当“患者自身的最健康生活”成为医疗服务者和健康保险计划的共同准则时，他们切实感受到了不同。
Every patient across health care. With value-based care, the possibilities are legion. And now I'll invite Heather Cianfrocco up to introduce the second half of the session, taking us into the world of the consumer.
每一位患者，贯穿整个医疗体系。在基于价值的医疗模式中，可能性无穷无尽。接下来，我将邀请Heather Cianfrocco上台，引领我们进入会议的下半场——走进消费者的世界。
Heather Cianfrocco EVP of Governance, Compliance & Information Security
Thank you, Margaret. We've spent the first half of the morning together on the why and the how, why value-based care is the future of health care and how Optum and UnitedHealthcare are helping to lead this transformational change through comprehensive coordinated care delivery with realigned incentives, new tools and technology and clinical expertise, making care more accessible and affordable for more people at every stage of life.
谢谢你，Margaret。今天上午的前半段，我们一起探讨了“为什么”和“如何”：为什么价值导向医疗是医疗保健的未来，以及Optum和UnitedHealthcare是如何通过全面协同的照护交付、重新配置的激励机制、新工具与技术和临床专长，引领这场变革，使医疗服务在生命每一阶段都更易获得、更可负担。
But in the second half of the morning, we'll focus on the who, the consumer and all the opportunity we see to fundamentally change the way people engage with the health system, how they find care, pay for care, access medicine and feel supported and empowered in every interaction.
而接下来的下半场，我们将关注“谁”——消费者，以及我们看到的所有机会，去彻底改变人们与医疗体系互动的方式：他们如何寻找护理、支付费用、获取药物，以及在每一次接触中感受到支持与赋能。
Today, consumers influence more than $2 trillion of health care spend every year. We spend more of our household income on health care than any generation before us. We'll make more than 1 billion office visits this year, waiting average of 26 days in the waiting room, and we'll spend about twice as long of that time in the waiting room than we'll spend with the clinician. And we'll learn what it costs when the bill shows up a month or two later.
如今，消费者每年影响超过2万亿美元的医疗支出。我们用于医疗的家庭收入比例高于历史上任何一代人。今年我们将进行超过10亿次门诊预约，平均等待时间长达26天，而且我们在等候室中等待的时间将是与临床医生面对面交流时间的两倍。而真正了解这次就医花了多少钱，往往要等到一两个月后账单寄来时才知道。
There's no shortage of companies that are working to change these experiences for the better. But this dynamic only compounds the challenge. There's hundreds of digital properties offering alternatives for everything, from advice and benefits to treatments in virtual care. Consumers are overloaded. We're overwhelmed with options, and we're struggling with point solutions as we try to customize, compare and choose.
市场上并不缺少试图改善这些体验的公司，但这种局面反而加剧了挑战。有数以百计的数字平台提供从健康建议、福利服务到虚拟医疗的一切替代方案。消费者信息过载——我们被众多选择淹没，在尝试定制、比较和抉择的过程中，反而被点状解决方案搞得越来越混乱。
But for the American consumer, stakes are high. They need a team to bring it all together and help figure out what's best for their families. And there is no company in a better position to do just that than UnitedHealth Group. We're listening to what people want.
但对美国消费者而言，这并非小事。他们需要一个团队，把这一切整合起来，帮他们找出对家庭最合适的方案。而没有哪家公司比联合健康集团更有能力胜任这一角色。我们正认真倾听人们的真实需求。
We're not looking to simply exceed expectations for convenience, but we're aspiring to be a lifetime partner in their health and their well-being, a first point of consultation for every question and their trusted source for expertise and information, all backed by the power of nearly 130,000 trusted compassionate care professionals. And this means meeting people where they are, which at times means moving health care from a clipboard in the clinic to an app on their phone, developing the digital-first capabilities that enable our company to deliver on these ambitions of convenience and consumer confidence.
我们的目标不仅仅是提供更便利的服务，而是成为人们一生健康与幸福的合作伙伴，成为他们在任何疑问时的第一咨询点，以及值得信赖的专业信息来源——背靠我们近13万名值得信赖、富有同理心的医疗人员。这也意味着要真正“走到人们身边”，有时就是将医疗服务从诊所的纸板上搬到手机的App里，发展“数字优先”能力，使我们有能力兑现便利性与消费者信任的承诺。
So from innovation and health benefit design to modernize payment capabilities and simplified pharmacy interactions, we're working to change the consumer experience across every aspect of care, for the people we serve, but also for millions of others in the broader marketplace. Becoming a consumer-led organization means embracing process reinvention. It means tapping into AI and other technological innovation to drive productivity and to lower our own cost structure.
因此，从创新的健康福利设计，到现代化支付能力，以及简化的药房服务交互，我们正在改变从头到尾的消费者体验——不仅为我们服务的对象，也为更广泛市场中的数百万其他人。成为以消费者为导向的组织，意味着我们必须彻底重塑流程，意味着我们必须积极采用AI和其他技术创新，以提升生产效率并降低自身成本结构。
Now I'm going to turn it over to Krista Nelson, where she'll take you through the ways we're doing just that, transforming our own business from the front lines to the administrative office. Krista?
现在，我将时间交给Krista Nelson，她将带大家深入了解我们是如何实现这一转型的——从一线服务到行政管理，重塑我们整个业务。Krista？
Krista Nelson
Thanks, Heather. Today, we have relationships with more than 150 million consumers across UnitedHealthcare and Optum. Three years ago, about 70% of our interactions with consumers were digital. And three years from today, we expect that to be more than 90%. We're driving this transformation across the more than 52 million people we serve at UnitedHealthcare today. And within UnitedHealth Group, we have an unparalleled opportunity to drive this change across the entire health care system.
谢谢你，Heather。如今，UnitedHealthcare和Optum合计与超过1.5亿名消费者建立了关系。三年前，我们与消费者的互动中约有70%是通过数字渠道进行的，而再过三年，我们预计这一比例将超过90%。目前，我们正在UnitedHealthcare服务的5200多万人中全面推动这场转型。借助UnitedHealth Group的整体力量，我们拥有无与伦比的机会将这种变革扩展到整个医疗体系。
We are leveraging advanced technology like AI and ML at scale to improve the experiences for the people we serve as well as improve our administrative cost and operating productivity. In many ways, the value of digital and advanced technology lies in applying it in a way that makes life better for consumers and providers and for our people.
我们正在大规模应用先进技术，如人工智能（AI）和机器学习（ML），以提升我们服务对象的体验，同时降低管理成本并提升运营效率。从多个层面看，数字化与先进技术的真正价值在于其如何以改善消费者、服务提供者乃至员工生活的方式被应用。
This is exactly where we're spending our time. We've made tangible improvements because of this approach. In the past year, we've seen a 35% increase in digital engagement. We also have 12x as many chats year-to-date with members, and more than 85% of the time, we can resolve their inquiry through chat. And on top of all of this, across our digital channels, our NPS is up 65%. Not only is this good for members, but it's also good for our employees. I'm very proud of the gains that we've made in employee experience tied to the improvements we've made in technology and tools.
这正是我们当前主要投入的方向。得益于这一策略，我们已取得实质性进展：过去一年中，数字互动增长了35%；与会员的在线对话数量同比增长了12倍，其中超过85%的咨询通过聊天即可解决。此外，我们在各数字渠道上的净推荐值（NPS）也上升了65%。这不仅对会员有利，也极大改善了员工体验。我为我们在技术与工具升级带来的员工体验提升感到自豪。
Our approach to digital and advanced technology starts with listening to team members and consumers, and here are just three examples of how we're doing that in the moments that they need us the most. First, real-time access. People who choose our Medicare Advantage plans can use our mobile app even before their coverage begins. For the very first time, seniors get an overview of their benefits. They can find and select providers, and they can start earning rewards immediately. This eliminates a real sense of anxiety for people and also helps us build the relationship earlier in the process, which supports retention.
我们的数字化与技术应用战略始于倾听员工和消费者的声音。以下是我们在他们最需要时响应的三个例子：第一，实时访问权限。选择我们Medicare Advantage计划的客户，在保险生效前就可以使用我们的移动应用。这让老年人首次能提前了解自己的福利，查找并选择服务提供者，并立即开始赚取奖励积分。这不仅缓解了他们的焦虑，也帮助我们在流程早期就建立起关系，提升客户留存率。
Second, our digital document center. This makes it really easy for people to access their health history, including EOBs and health statements and other benefit communications all in one place, anytime, anywhere.
第二，数字文档中心。它让人们可以随时随地集中查看自己的健康历史，包括医疗账单摘要（EOBs）、健康说明及其他福利信息，操作更简单、体验更友好。
And third, our provider search. Finding a doctor is the #1 reason consumers reach out to us. Tens of millions of people have used this feature on our site and app this year alone. We have now connected our search with claim information and AI and ML to create personalized search results.
第三，医生搜索功能。寻找医生是消费者联系我们的首要原因。仅今年，就有数千万用户通过我们的网站或App使用了该功能。我们现已将搜索功能与理赔信息、AI与ML模型结合，实现个性化推荐结果。
These are just a few of the ways we are working to thoughtfully apply new technology to solve meaningful challenges for our consumers. And these examples, combined with enhancements to infrastructure and automation across our operation will translate into significant operational savings in the years to come. This is going to allow us to invest in benefits and innovation and technology that will drive future growth.
这些只是我们有策略地运用新技术、解决消费者实际痛点的几个例子而已。通过与基础设施升级和运营自动化结合，这些改进将在未来几年内带来显著的运营成本节约。这也将为我们在福利设计、创新与技术领域的持续投资提供更多空间，推动未来增长。
Now I'll turn it over to Vivian and Sandeep, who will share even more about how we're scaling advanced technology.
现在，我将时间交给Vivian和Sandeep，他们将进一步分享我们如何持续扩大先进技术的应用规模。
Vivian Hunt Chief Innovation Officer of Optum
Thank you, Krista. AI will soon change the way every health care plan, care provider, employer and consumer interacts with health care. From our own community of advocates and physicians to our frontline employees and patients, AI, machine learning and data are simplifying our products and services.
谢谢你，Krista。人工智能（AI）即将改变每一个医疗保险计划、医疗服务提供者、雇主和消费者与医疗保健互动的方式。从我们自己的医疗倡导者和医生群体，到一线员工和患者，AI、机器学习和数据正在简化我们的产品和服务。
And this is just the beginning. The opportunity to use clinical data differently, paired with the safe and responsible use of AI and machine learning is leading to transformative advances. Sandeep, let's get started and dive into AI.
而这仅仅是开始。以新的方式利用临床数据，结合安全而负责任地使用AI与机器学习，正在推动一场变革性进步。Sandeep，我们开始深入探讨AI吧。
Sandeep Dadlani Executive VP and Chief Digital & Technology Officer
We are at the cusp of a new era. And generative AI is spurring a groundswell of innovation across UnitedHealth Group. We have identified three core focus areas for our AI strategy. First, administrative simplification. Here's where we can make a big impact quickly, taking friction out of the system in areas like claims processing or provider search and payment integrity. Second, data science platforms and businesses that underpin our growth pillars and capabilities. This is key for enabling value-based care. And finally, medical and clinical insights. Our goal is to free up the clinician's time so they can focus on the care part of health care.
我们正站在一个新时代的门槛上。生成式AI正在推动UnitedHealth Group各领域掀起一场创新浪潮。我们已明确AI战略的三大核心重点方向：第一，简化行政流程——这是我们能够迅速产生重大影响的领域，比如在理赔处理、医生搜索和支付准确性等环节中去除摩擦；第二，打造支撑我们增长支柱与能力的数据科学平台与业务，这对实现价值导向医疗至关重要；第三，医学与临床洞察——我们的目标是释放临床医生的时间，使其专注于医疗本身。
Let's review a couple of examples. As Krista said, consumers visit our UHC app or website millions of times a year to look for a doctor. Let's take Jacob here. He needs to find an urgent care provider and he starts by using the United Healthcare app.
我们来看几个例子。正如Krista提到的，消费者每年会数百万次访问我们的UHC应用或网站寻找医生。以Jacob为例，他需要寻找一位急诊医生，于是他打开UnitedHealthcare的App。
Our AI-enhanced search experience immediately delivers personalized results, finding providers that are high quality, low-cost, in-network and closest to him, all this on an immersive map. He can also search by specialty such as dermatology, for example, or by symptoms such as headaches. And thanks to our advances in AI, when Jacob needs a little extra help, he can just type his entire problem in simple language and get fast results.
我们的AI增强搜索体验会立即为他提供个性化结果，筛选出高质量、低成本、网络内且离他最近的服务提供者，并显示在交互式地图上。他也可以按专科（例如皮肤科）或症状（如头痛）进行搜索。借助我们在AI方面的进步，当Jacob需要更多帮助时，他只需用简单语言描述整个问题，就能快速获得结果。
For example, if his child is complaining of stomach pain, he can type, "My son's stomach hurts." Many people may not automatically know how to search for a gastroenterologist. But here, using plain simple language, AI helps drill down to the right care and instantly delivers a list of nearby in-network, pediatric GI specialists.
比如，如果他的孩子喊肚子疼，他可以直接输入“我儿子肚子痛”。很多人可能并不知道该搜索“胃肠科医生”，但在这里，通过普通语言输入，AI可以快速识别问题本质，并立即推荐附近网络内的小儿胃肠专科医生。
Lastly, if Jacob searches for, say, something like a broken hand. Our search engine finds a hand specialist with matching experience for that specific procedure, not just a general orthopedist. How, you may ask. Our capability uses recent claims data with procedure codes that detail subspecialty and allow us to differentiate the broken hand procedure doctors from all the other orthopedics. So you see here by combining our member, provider, benefits, claims and search history data sets, UHG is uniquely positioned to dramatically elevate the search experience.
再比如，Jacob若搜索“骨折了手”，我们的搜索引擎不仅会推荐普通骨科医生，而是找到有相关手术经验的手部专科医生。你可能会问怎么做到的？我们的技术利用最近的理赔数据和手术代码，这些代码详细标注了专科细分，使我们能够将处理“手骨折”的专科医生与一般骨科区分开来。正因我们能整合会员、服务提供者、福利、理赔和搜索历史等多种数据集，UHG才具备独特优势，能够显著提升整个搜索体验。
保险公司所掌握的数据是很大的优势。
Vivian Hunt Chief Innovation Officer of Optum
Remember, Linda, our Optum nurse practitioner from earlier? We employ thousands of nurse practitioners just like her. Collectively, they complete upwards of 10 million home visits each year. Our goal and duties is to always provide the right care for the right person at the right time.
还记得之前提到的Optum执业护士Linda吗？我们像她这样的执业护士有数千名，他们每年合计完成超过1000万次居家探访。我们的目标和职责始终是：在正确的时间，为正确的人，提供正确的照护。
But with limited time and resources, we need increasingly real-time clinical insights to manage proactive outreach and ensure thorough health risk identification. We've developed a capability that provides actionable insights to clinicians like Judy and their administrative operations. This capability is underpinned by our integrated medical Rx claims data as well as EMR records spanning years of recorded outcomes.
但由于时间和资源有限，我们亟需实时的临床洞察，以管理主动外联行为，并确保全面识别健康风险。我们开发了一项能力，能为像Judy这样的临床人员及其行政支持团队提供可操作的洞察。这项能力建立在我们整合的药品理赔数据和多年来积累的电子病历（EMR）记录基础之上。
Here, you can see how AI tracked Bessie's diabetes risk over time. The orange line represents her risk levels. Each dot is a point in time where we receive new information. You can see that Bessie's risk has been generally rising over time. At any point, our nurse practitioner, Judy, can also look into the clinical evidence, understand the rationale for the predictions, helping to make our AI explainable to clinicians deciding on care.
这里你可以看到AI如何随时间追踪患者Bessie的糖尿病风险。橙色曲线表示她的风险水平，每一个点都代表我们收到一项新信息的时间节点。可以看到，Bessie的风险水平整体在上升。而我们的执业护士Judy随时可以查看背后的临床证据，理解预测背后的逻辑原理，从而让AI的判断对于作出医疗决策的临床人员来说变得可解释。
These insights form the basis for many possible use cases. I will highlight two examples that are currently being deployed. First, outreach and scheduling operations. Our teams have to prioritize proactive visits amongst large patient populations. By applying developed intelligence across the full population, the patients with the greatest risks are highlighted, helping our operators to schedule in a needs-based priority order.
这些洞察构成了众多潜在应用场景的基础。我想强调两个目前正在部署的实例。第一是外联和预约管理。在面对庞大患者群体时，我们的团队必须优先安排哪些人应接受主动探访。通过将AI智能应用于整个患者群体，我们能够突出显示最具风险的患者，从而帮助调度人员基于需求优先级进行安排。
A second instance provides insight during the visit. Let's go back to Bessie's home and Judy's home visit. Judy can review a list of suspected diagnoses and supporting rationale right from her tablet. Seeing Bessie may be at risk for type 1 diabetes, she can determine if an A1C test is appropriate. AI is supporting Judy, reducing the likelihood of a misdiagnosis. Judy, like all of our care providers is the one making the clinical decision.
第二个应用场景是在探访过程中提供洞察。我们再回到Bessie家中，Judy正在进行居家访问。她可以直接在平板上查看一份疑似诊断清单及其支持依据。注意到Bessie可能存在1型糖尿病风险后，她可以判断是否应该安排一次A1C检测。AI正在支持Judy，帮助她降低误诊风险。而Judy，就像我们所有的照护人员一样，始终是最终作出临床决策的人。
Sandeep Dadlani Executive VP and Chief Digital & Technology Officer
We employ thousands of call center advocates who answer the phones every day. Advocates like Mike here have one of the most difficult jobs in the company. He not only supports callers during live and complex interactions, but he has to search thousands of documents and then toggle between multiple screens to locate the right information. Then he has to summarize notes before moving on to the next call.
我们雇用了数千名呼叫中心服务代表，每天接听来电。像Mike这样的服务代表拥有公司里最具挑战性的工作之一。他不仅要在实时、复杂的交互中支持来电者，还要在成千上万份文档中查找信息，在多个界面之间切换，并在结束通话前完成记录摘要，然后才能接下一个电话。
Our advocates do an amazing job, but we can do better for them and for those they serve. AI will advance this work. Let me walk you through a simulated call between Maya, a UHC member and our virtual advocate voice bot, which will gather information to help make Mike's job easier.
我们的服务代表表现出色，但我们可以为他们以及他们服务的对象做得更好。人工智能将推动这项工作向前迈进。让我带大家了解一段模拟通话：Maya是一位UHC成员，与我们的虚拟语音助手进行了互动，这个助手将收集相关信息，帮助减轻Mike的工作负担。
So picture this, Maya is new to her company's health plan. She calls UnitedHealthcare because she lost her ID cards and wants to get a few questions answered. First, a virtual advocate voice bot connects with Maya to verify her information.
想象一下这个场景：Maya刚加入公司健康保险计划。她打电话给UnitedHealthcare，因为她丢了ID卡，还想问几个问题。首先，一位虚拟语音助手接入，核实她的信息。
Now let me level set. Automated tools like chatbots and voice bots have been helping us triage calls for some time now. But through advanced voice technology and generative AI, this initial interaction is now becoming intelligent. It can solve more problems than ever before. It recognizes Maya, answers many of her questions and provides recommendations based on a nuanced understanding of the conversation.
我先说明一下，像聊天机器人和语音助手这样的自动化工具，早已被用于初步筛选来电。但通过先进的语音技术和生成式AI，如今的首次交互已变得智能化。它能识别Maya的身份，回答她的大多数问题，并基于对话上下文的细致理解提供建议。
For example, Maya suspects an issue with her thyroid. The bot asks her specific questions. And based on clinical guidelines, it recommends Maya sees an endocrinologist. Now the voice bot could have provided local in-network options to Maya and even scheduled her appointment and the conversation could have ended there. But today, Maya still has a couple more questions and wants to speak to a real person, like Mike. So the voice bot collects, synthesizes the information and gets everything ready for Mike, saving them both time.
例如，Maya怀疑自己有甲状腺问题。语音助手会问她一些具体问题，并根据临床指南推荐她去看内分泌科医生。语音助手本可以向她推荐本地网络内医生，并为她预约挂号，结束通话。但今天，Maya还有几个问题，想和真人交谈，比如Mike。因此，语音助手会整理并总结对话信息，提前为Mike准备好一切，为双方节省时间。
Before Mike even begins his conversation with Maya, he takes a few seconds to review the generative AI summary of her background and the reason for her call. Now he's ready to help. As the call starts, Maya asks Mike to find her an endocrinologist. Mike uses the same fine care functionality we just showed earlier to find a provider in network based on Maya's location. AI is at work in the background, sifting through information and helping him in real time. Mike no longer needs to toggle from app to app.
在与Maya正式通话前，Mike会花几秒钟查看生成式AI整理的来电背景和原因摘要。这样他已充分准备好。在通话开始后，Maya请Mike帮她找一位内分泌科医生。Mike使用我们之前介绍过的“找医生”功能，根据Maya的地理位置在网络内搜索服务提供者。此时，AI在后台实时筛选信息，协助他处理请求，Mike无需再在多个应用程序之间切换。
Here, you'll see on top of the screen, our AI suggests an article for Mike to explain what's covered at her upcoming visit, including benefits like in-network lab work. Maya also asks Mike if he can help her find a lower cost option for her allergy prescription. AI auto generates suggested answers based on the seamless integration with OptumRx's pricing tool.
在屏幕上方，AI会建议一篇相关文章，供Mike向Maya解释她即将就诊的保障内容，比如网络内实验室检查的福利覆盖范围。随后，Maya又问Mike能否帮她找一个价格更低的抗过敏药替代方案。AI自动生成建议答案，基于与OptumRx定价工具的无缝整合。
On the spot, he invites Maya to a screen share, so she can review the list of affordable generic options and pharmacies near her home. Maya thanks Mike for all his help and the call ends. Remember, AI is summarizing the call along the way. So Mike can use that time saved to help the next person who calls.
随后，Mike邀请Maya进行屏幕共享，让她可以查看附近药房中经济实惠的通用药品列表。Maya感谢Mike的帮助，通话结束。别忘了，AI在整个过程中也在同步生成通话摘要，因此Mike可以把省下的时间用来服务下一位来电者。
There are dozens more generative AI use cases being rolled out. And as you can see, we are using AI to solve our consumers most frustrating pain points, support our frontline workforce and enable clinicians to practice at the top of their license. Our collective vision is for a world where AI can aid in the prediction and ultimately, the prevention of disease.
目前还有数十种生成式AI应用正在逐步推出。正如你所看到的，我们正借助AI解决消费者最令人头疼的问题，支持一线员工，并帮助临床医生充分发挥专业所长。我们的共同愿景是构建一个AI可以辅助预测并最终预防疾病的世界。
Daniel Kueter CEO of UnitedHealthcare Employer & Individual
As I began my civilian career out of the Army, signing up for health benefits did not require a lot of decision-making. I was offered one plan and the option to add vision and dental, that was it. Today, people want real options, coverage designed for what they'll need and coverage for the unexpected. They want to know which doctors are best and know how much they'll pay before the appointment.
我从军队退役，开始平民职业生涯时，选择健康保险几乎不需要太多决策。当时只有一个方案可选，加上视力和牙科福利，就这么简单。而如今，人们希望有真正的选择，希望保险计划能覆盖他们所需的日常护理以及突发状况。他们想知道哪个医生最好，也想在预约之前就知道自己要花多少钱。
That's why we're building these experiences for millions of employers and individuals around the globe. And our customers are responding. Our national accounts business is on track for a record selling season for 2024. Next year, we'll serve as many as 1.5 million more people through our commercial products. Surest, our fastest-growing commercial offering is a big reason why. Elizabeth Koonin will show you how it works.
这正是我们为全球数百万雇主和个人打造这些体验的原因。我们的客户也作出了积极回应。我们全国大客户业务正迈向2024年销售新纪录。明年，我们预计通过商业健康产品服务多达150万人。而我们的Surest计划——增长最快的商业健康产品——正是推动这一趋势的关键力量。接下来请Elizabeth Koonin为大家介绍其运作方式。
Elizabeth Koonin
Thanks, Dan. It's a radically different approach to health benefits, no deductibles, no coinsurance. Instead, consumers know their out-of-pocket cost upfront in a simple co-pay. Using UnitedHealthcare's data to evaluate care provider quality, safety and effectiveness, we present consumers with clear information and choice in the palm of their hand.
谢谢你，Dan。这是一种彻底不同的健康福利方案——没有免赔额（deductible），没有共同保险（coinsurance）。取而代之的是，消费者可以通过简单的共付额（co-pay）在事前明确知道自己的自付费用。我们借助UnitedHealthcare的数据评估医疗提供者的质量、安全性与效果，并将清晰的资讯和选择权直接交到消费者手中。
Care providers and facilities with the optimal set of attributes are generally assigned a lower co-pay, creating an ideal alignment of incentives between employers, consumers and providers. And through a user-friendly digital experience, the plan is designed to make it simple, clear and easy for consumers to compare care providers and facilities that have been evaluated for quality and value, helping them access higher value care and make decisions that are right for their budgets in individual situations.
具备最优服务属性的医生和医疗机构，其共付额通常更低，从而在雇主、消费者与服务提供者三方之间建立了理想的激励对齐机制。通过简洁易用的数字化体验，该计划让消费者能够轻松对比经过质量与价值评估的医疗资源，帮助他们获取更高价值的护理，并根据自身预算做出合适决策。
Let me walk you through the math of a high-cost procedure to underscore the significance of the potential savings. In Chicago, the in-network contracted price of an outpatient lumber fusion back surgery can range from $40,000 to $180,000 with comparable quality depending on which hospital you choose.
让我用一个高价手术的例子来说明这类计划的潜在节省效果。在芝加哥，同为网络内医院、质量相当的门诊腰椎融合手术，价格可能从4万美元到18万美元不等，取决于你选择的医院。
For a consumer and a traditional plan, and let's assume the plan has a $2,000 deductible at 20% coinsurance and $3,500 out-of-pocket max, you may have no way of knowing that the cost varies so widely between the two hospitals you are considering for care. And ultimately, that range in cost is irrelevant to you. Here's why.
对于传统保险计划的消费者，比如设有2000美元免赔额、20%共同保险以及3500美元自付上限的情况，他们根本不会意识到自己考虑的两家医院在费用上有这么大的差距。对他们而言，这种差异最终是“无关紧要”的。为什么？
If you choose the lower cost hospital, you'd pay your deductible and an additional $1,500 in coinsurance before hitting your out-of-pocket max. Your total cost, $3,500. Your health plan or employer would pay the difference of $36,500. And it's the same story if you choose the most expensive hospital. You pay the same $3,500 out-of-pocket max amount. But the health plan or employer is now on the hook for more than $176,000, 5x the lower cost option.
如果你选了费用较低的医院，你要先支付2000美元免赔额，再加1500美元的共同保险，直到达到3500美元的自付上限。而剩下的3.65万美元由保险计划或雇主承担。同理，如果你选的是最贵的医院，你自己还是只需要支付3500美元，但保险计划或雇主将承担高达17.6万美元的其余费用——是低价选项的5倍。
In this plan, consumers can know their actual cost in the form of a co-pay before they schedule surgery. They can shop and choose from providers where the co-pay for high-value providers is priced lower. We bring that difference into their decision-making process.
而在Surest计划中，消费者可在预约手术前通过共付额方式清楚知晓自己的实际开销。他们可以“货比三家”，选择那些共付额较低的高价值提供者——我们把价格差异带入他们的决策过程中。
In the lumbar spine surgery example, the app would display a co-pay of $1,600 for the high-value hospital and $3,000 for the more expensive hospital. What's more, the single co-pay covers all the services and providers during the episode of care, ranging from imaging, anesthesia, lab work and surgery itself. By using an intuitive digital experience, upfront cost information and value-based co-pays, the consumer saves $1,400 by selecting the high-value option, while the health plan or employer saves more than $135,000.
以腰椎手术为例，应用程序会显示：高价值医院的共付额为1600美元，而费用更高医院为3000美元。更重要的是，这一共付额包含整个治疗过程中所有服务和人员的费用，包括影像、麻醉、化验及手术本身。借助直观的数字化体验、透明的前期费用信息和基于价值的共付策略，消费者可通过选择高价值医院节省1400美元，而保险计划或雇主则可节省超过13.5万美元。
What we find is at more than 90% of the time, consumers are choosing care providers who demonstrate high quality, efficiency and overall effectiveness of care. And on average, consumers who move from a traditional plan to Surest are paying about 50% less out of pocket.
我们的数据显示，超过90%的消费者最终会选择那些在质量、效率和总体效果方面表现突出的服务提供者。而平均来看，从传统保险转向Surest的消费者，其自付费用降低了大约50%。
Meanwhile, compared with standard plan designs, employers may reduce their total cost of care by up to 15%, with an average savings of 11% compared with traditional offerings. In 2021, 1 in 25 of our national account customers offered these plans. For 2024, it will be 1 in 5. And 90% of people reenroll each year, including the Kueter family, right, Dan?
与此同时，与标准计划相比，雇主的总体医疗支出最多可降低15%，平均节省幅度为11%。2021年时，我们全国大客户中每25家才有1家提供Surest计划；到了2024年，这一比例将提升到每5家中就有1家。而且每年有90%的用户选择续保——包括Kueter一家，对吧，Dan？
Daniel Kueter CEO of UnitedHealthcare Employer & Individual
That's right, Elizabeth. We are happy customers. There is strong demand for products that enable consumer choice. So we're using insights gleaned from Surest and other products to address another major pain point for employers, helping people engage with the many third-party point solutions they offer and doing it in one place.
没错，Elizabeth。我们一家人也是Surest的忠实用户。市场上对支持消费者选择权的产品有着强劲需求。因此，我们正利用从Surest及其他产品中获得的洞察，去解决雇主面临的另一个主要痛点：帮助员工更便捷地使用他们提供的多种第三方点状解决方案，并将这些整合于一个统一的平台中。
Even large employers, managing vendors and evaluating options can be a chore, so we're going to do that for them. Launching next year, we will integrate more than 20 stand-alone health care programs for healthy living, nutrition, starting a family, cancer care, among others, into their United Healthcare supported benefits platforms. Employers choose what programs to offer and we make them accessible via our advocates, myuhc.com and the UnitedHealthcare app.
即使是大型企业，管理众多供应商、评估各类选项也会成为一项负担，所以我们将为他们代劳。从明年起，我们将把20多个独立的健康护理项目——涵盖健康生活、营养指导、家庭建设、癌症照护等——整合进UnitedHealthcare支持的福利平台中。雇主自行选择要提供哪些项目，我们则通过专属服务人员、myuhc.com网站和UnitedHealthcare App，让员工一站式访问这些服务。
These are building blocks to a broader goal, developing a truly consumer-oriented marketplace where employees receive a set dollar amount they use to select the products and services that best fit their needs, whether it's more coverage, think lower deductible, enhanced prescription coverage, expanded dental and vision or clinical programs like diabetes management or additional services focused on family building, app-based health coaching or wearable technology. It's a consumer coverage model that's vastly different, one that's personalized and customizable, making accessing health care as convenient, connected and easy to understand as other aspects of daily life.
这些举措都是迈向一个更大目标的基石：打造真正以消费者为导向的健康福利市场。在这个模式中，员工将获得固定额度的资金，自主选择最符合其需求的产品与服务，无论是更高保障（如更低免赔额、更优处方药保障）、更丰富的牙科与视力计划，还是糖尿病管理等临床项目、家庭建设相关服务、基于App的健康指导或穿戴设备支持。这是一种与传统截然不同的消费者保险模式，强调个性化与可定制化，让获取健康服务变得如日常生活中其他事务一样便利、互联且易于理解。
Kurt Adams
Using technology to make the consumer experience more convenient and intuitive is exactly what we're doing around health care payments. Health payments is a large, often overlooked market that we are uniquely positioned to serve. Our network is connected to over 2.7 million care providers making payments on behalf of hundreds of health plans.
我们正致力于通过技术手段让消费者的支付体验更加便捷直观，而医疗支付正是我们重点推动的领域。这是一个庞大但常被忽视的市场，而我们具备独特优势为其赋能。我们的支付网络已连接超过270万名医疗服务提供者，并代表数百家健康计划机构处理付款。
We have relationships with more than 24 million consumers and our growing retail footprint includes 6 of the 10 largest grocers in America and most pharmacies. We aspire to operate the industry's most trusted secure payment network, serving as the foundation of our strategy.
我们与超过2400万名消费者建立了关系，并在零售领域快速扩展，覆盖全美10大超市中的6家以及绝大多数药房。我们志在打造行业中最值得信赖的安全支付网络，并将其作为我们战略的核心支撑。
Now let me hand it over to Betsy with UnitedHealthcare, one of our largest customers to share more.
现在，我将时间交给UnitedHealthcare的Betsy，她将介绍更多相关情况。UnitedHealthcare是我们最大的客户之一。
Betsy Chin
Each year, more than $4 trillion of health care financial transactions take place. But the payment experience is full of pain points for consumers, care providers and health plans. It's too complex and full of friction.
每年，医疗体系中发生的金融交易总额超过4万亿美元。但对消费者、医疗服务者和健康保险机构而言，支付体验仍存在诸多痛点——流程复杂、摩擦频发。
A year ago, we showed you how we're bringing together our strong network capabilities and broad-reaching relationships across health care and retail to create a payment experience unlike any other. Simplifying the consumer experience is a cornerstone of our growth strategy in this market. At the center is our benefits card with SKU level adjudication technology riding along the rails of a proprietary world-class payment network.
一年前，我们展示了我们如何整合强大的网络能力以及在医疗和零售领域的广泛关系网络，构建前所未有的支付体验。简化消费者体验，是我们在该市场增长战略的核心。而其中的关键，是我们那张福利卡——它采用SKU级别的清算技术，并运行在专有的世界级支付网络之上。
This card is the only card consumers need to access care, shop in stores and online, fill prescriptions, use fitness benefits, spend rewards, pay utility bills and buy healthy food. And all transactions can be viewed by the consumer online. Today, more than 6.4 million people at UnitedHealthcare are using the card. They've made more than 80 million transactions, amounting to billions spent on their health and well-being this year alone. And as more use it, we are seeing strong results, including a nearly 150% increase in digital engagement, an almost 10-point increase in NPS, which is driving both satisfaction and retention.
这张卡是消费者所需的唯一卡片——既能看病，又能在线或实体店购物、取药、使用健身福利、花积分、缴水电费、购买健康食品。所有交易也都可在线查看。目前已有超过640万UnitedHealthcare用户在使用该卡，今年至今已完成超过8000万笔交易，涉及健康与福祉相关的数十亿美元支出。随着用户增加，我们也观察到显著成效：数字互动增长近150%，NPS净推荐值上升近10分，有效提升了满意度与用户留存率。
No one else in the marketplace brings together network capabilities and cross-system relationships like Optum can, and we are just beginning to realize our full potential.
市场上没有任何其他公司能像Optum这样整合网络能力与跨体系合作关系，而我们目前所展现的，还只是潜力的开始。
Kurt Adams
Let me expand on that. New features coming out in 2024 are all about giving consumers even more convenience and choice by expanding our network to leading e-commerce platforms and related categories. Early next year, we will give consumers easy access to an extensive transportation network. People will be able to schedule rides to medical appointments through an app they likely are already using in their daily lives. They will no longer have to go through their benefits call center to arrange a ride. They also won't have to file a claim and wait to be reimbursed.
让我进一步说明。2024年即将推出的新功能，核心在于通过扩展我们的网络到主流电商平台及相关服务领域，为消费者带来更多便利与选择。从明年初开始，消费者将可以轻松通过他们日常使用的应用程序预约前往医疗机构的交通服务，不再需要打电话给福利中心安排出行，也不再需要报销流程，节省时间与麻烦。
In addition, consumers will be able to use their benefits for convenient delivery of groceries and over-the-counter products. It's a powerful new way to enable people to access a much underutilized benefit. The difference lies in how our payment network understands transactions.
此外，消费者还可以利用福利卡来便捷地购买和配送杂货及非处方药。这是一种强大的新方式，使人们能充分使用此前未被充分利用的福利。而关键在于我们的支付网络如何理解交易的结构与内容。
For example, when a person is checking out, our network can tell the difference between bananas and chocolate and selectively applies benefits, discounts and savings to the purchase. Across health plans, more than 15 million people are using our card technology, and we continue to see growth in engagement with card spend increasing nearly 140% year-over-year to nearly $7 billion.
例如，当用户在结账时，我们的系统可以识别香蕉与巧克力的不同，并智能匹配福利、折扣与补贴。当前，已有超过1500万名健康计划成员在使用我们的卡片技术，卡片消费同比增长近140%，总金额接近70亿美元，使用度持续上升。
While we primarily offer the card to people on Medicare Advantage and Medicaid plans today, we will be expanding this offering to millions of people in UnitedHealthcare's commercial portfolio, and employers are showing a strong interest. Our longer-term ambition is to make this available to everyone, either through their health benefit plan or employer. Ultimately, consumers are the winners.
目前，这张卡主要面向Medicare Advantage和Medicaid的成员提供，但我们计划将其扩展至UnitedHealthcare商业健康产品中的数百万人，雇主群体对此展现出强烈兴趣。我们的长期愿景是，让每个人都能通过健康保险计划或雇主渠道获得这一服务。归根结底，受益的将是消费者。
We are continuing to evolve our network, making it broader and smarter. The convenience, simplicity and choice we are getting people is exactly what they are looking for. And it's driving both strong customer loyalty and growth in a whole new way.
我们将持续扩展并升级网络，使其更加广泛和智能。我们为人们带来的便利、简洁与选择，正是他们真正所期望的——这不仅赢得了强大的客户忠诚，也开启了一条全新的增长路径。
Patrick Conway CEO of Optum Rx
In my earliest days of the position, I learned a tough lesson that I will never forget. I had sent a child home who had been hospitalized with a mild infection with a prescription for an antibiotic. In less than 24 hours, the child was back, readmitted with sepsis and very sick. The child was readmitted because when the mother took the prescription to the pharmacy, it cost $200 that she didn't have. She was asking friends and family for the money to try to pay for the medicine, but then her child got sick. A scared kid and a terrified parent spent 7 days in a Boston Hospital because the antibiotic was unaffordable.
我刚上任时学到的一个残酷教训至今难忘。我曾让一名因轻微感染住院的儿童回家休养，开了一张抗生素处方。但不到24小时，这个孩子因感染恶化被送回医院，患上败血症，病情严重。而他之所以再度住院，是因为他的母亲拿着处方到药房却发现要价200美元——她付不起。她四处找亲友借钱以支付药费，结果孩子病情加重。一位惊恐的母亲和一名害怕的小孩因此在波士顿医院住了7天，仅仅因为药物太贵。
Experiences like that one, seeing the realities people face when it comes to paying for medicine and accessing care informs so much of our work in pharmacy. As our foundational pharmacy benefit management business continues to grow, we are thoughtfully evolving into the pharmacy of the future, building capabilities to make medicine more affordable and care more accessible for the more than 62 million people we serve and doing it like no one else can.
这样的经历——亲眼见证人们在支付药品和获得医疗服务方面所面临的现实——深深影响了我们在药品服务领域的工作方向。随着我们的核心药品福利管理业务不断发展，我们正在审慎而坚定地向“未来药房”迈进：为超过6200万人打造更可负担的药品、更易获取的医疗照护服务，以其他任何机构都无法比拟的方式服务他们。
Let's start with how we are aggressively enhancing consumer affordability, especially for the 15 categories of critical medications, including antibiotics, where we've capped out-of-pocket cost at $35 a month for the vast majority of consumers. Had this program been in place for that family in Boston years ago, that $200 antibiotic would have been more affordable, costing less than $20.
首先，我们正积极提升药品的可负担性，特别是涵盖抗生素在内的15类关键药物。我们已将大多数消费者的自付上限设定为每月35美元。如果这项计划早年已实施，那么那位波士顿家庭所需的200美元抗生素将仅需不到20美元。
This year, we've also introduced a consumer pricing tool that scans and compares prices of generic drugs and automatically provides the most competitive available price, whether that's on benefit or cash price. More than 3.5 million people have the tool today and we'll roll it out to nearly 3 million more people next year.
今年，我们还推出了一个消费者定价工具，可扫描并比较通用药物的价格，并自动提供最具竞争力的选项，不论是基于保险福利还是现金支付。目前已有超过350万人使用该工具，明年将推广至近300万人。
We are also supporting pharmacists, especially independent and rural pharmacies. This year, we launched our community pharmacy support services, which included increased reimbursement, access to enhanced tools and innovative health equity programs. In 2024, we'll be offering a community pharmacy network, which will enable clients to pay pharmacists for additional health interventions.
我们同样在支持药师，特别是独立药房与农村药房。今年我们启动了社区药房支持服务，内容包括提高报销标准、提供更多数字化工具，以及推出创新的健康公平计划。2024年，我们将设立一个社区药房网络，使客户可为药师的额外健康干预服务支付费用。
In addition to affordability, access to care is another important factor in driving improved health outcomes. What makes our care services unique is how we reach people. We use the pharmacy as a touch point, as an opportunity to connect people to integrated whole person care, built around their personal care needs and the way they want to receive that care.
除了可负担性，“可获得性”也是提升健康结果的关键。而我们的照护服务之所以独特，在于我们触达人群的方式。我们以药房为接触点，借此将人们连接至围绕其个体需求和偏好方式构建的整合式“全人照护”。
We engage a broad spectrum of individuals with widely varying needs through the pharmacy. 70% of adults take at least 1 prescription medicine. Some are managing a single chronic condition like high blood pressure, but others are managing complex conditions. Specialty pharmacy drives more than 50% of our total pharmacy revenue. With more than 800 specialty drugs in development, we expect this market to grow double digits each year. Today, Optum's dedicated concierge teams provide support to patients across more than 200 specialty conditions, helping patients manage side effects and engage their care providers.
我们通过药房触达具有广泛差异的个体。70%的成年人至少服用一种处方药。有些人仅需控制高血压等单一慢病，另一些人则面临更复杂的疾病管理。特药业务占我们药品总收入的一半以上。目前有800多种特药正在研发，预计每年该市场将保持两位数增长。目前，Optum的专属礼宾团队已为200多种特药疾病提供支持，帮助患者应对副作用、协调医疗服务。
Within the specialty drug population is an even smaller but rapidly expanding group, the more than 30 million Americans managing rare diseases whose therapies account for about 20% of the spending in the specialty market. Our pharmacists and clinicians who interact with patients are experts on the condition that their patient is managing. They are well versed in removing obstacles to care, and they list it and talk with the families to understand exactly what support is needed for that patient.
在特药人群中，还有一群更小但快速增长的群体——3000多万名罕见病患者。他们所用的治疗方案占特药市场支出的约20%。我们的药剂师和临床人员都是他们所治疗疾病的专家，擅长排除照护障碍，倾听患者和家属的声音，深入理解他们所需的精准支持。
In addition to the people caring for patients, we have an incredibly deep and talented team at OptumRx that is working each day to make pharmacy care services more efficient, more affordable and more accessible. Let's hear from some of them now.
除了照护患者的一线人员外，我们在OptumRx还有一支深厚且充满才华的团队，每天都在努力让药房服务更高效、更可负担、更易获取。接下来，让我们听听他们的声音。
[Presentation]
Patrick Conway – CEO of Optum Rx
That is the future of pharmacy that we are creating, reaching and serving consumers from home delivery to community pharmacy, meeting people where they are, every step of the way, from chronic to rare diseases with affordable access to drugs and comprehensive services delivered as only Optum can. And we continue to make investments to streamline prior authorizations to enhance EMR, interoperability and communications and deliver the right affordable medicine to the right person every time.
这就是我们正在构建的药房未来：从药物配送到社区药房，全方位服务消费者，在他们所处的每一个环节给予支持。从慢性病到罕见病，保障他们以可负担的价格获取药物与全面服务——只有Optum能够实现这一切。同时我们也持续投资于简化事前授权流程、增强电子病历（EMR）系统互通性与沟通能力，确保每一次都将正确且可负担的药物送达正确的患者手中。
Daniel Schumacher – Chief Strategy & Growth Officer
Let me close where Dirk started. Those early days at UnitedHealth Group hinted at something special. It was a time full of decisions that would fundamentally alter our course and the very fabric of who we are. We have learned how to be a health plan, focused on large employers and benefit design at a time when consumers were all but left out of the equation.
让我回到Dirk开场提到的主题。UnitedHealth Group最初的那些岁月已经预示着非凡的起点。那是一个充满决策的时期，这些决策从根本上改变了我们的航向与企业基因。我们逐步学会成为一家面向大型雇主、专注于福利设计的健康保险公司——而那时，消费者几乎被排除在医疗方程之外。
But there was this momentum, and we could feel it. We could feel the influence of the American consumer in nearly every other aspect of our lives and that health care struggled to keep pace. That restlessness you've seen on display today, it had us thinking. How could we design and push a health system forward to a system that is more responsive, more connected, that offered better choice and real transparency, one that value their input and put it into practice? How we answered those questions changed us.
但我们感受到一种蓄势待发的动力。我们看到美国消费者在生活的几乎所有方面都拥有强大影响力，而医疗体系却未能跟上。这种“焦躁不安”的改革冲动催促我们思考：我们是否能推动一个更具响应性、更具连通性、提供更多选择、更透明的医疗体系？一个真正尊重消费者声音、并将其落实于实践的体系？我们对这些问题的回答，彻底改变了我们自己。
Today, we believe value-based care is the best version of health care for people, no longer a concept in a journal, but an enduring practice. It is the common thread of this company. It is why care providers make up our largest employee group and why more than half of our business is built to provide and enable care.
如今，我们坚信“价值导向医疗”是医疗保健的最佳形态——它不再是期刊中的理念，而是长期实践中的核心准则。这是贯穿我们整个公司的主线。这也正是为什么护理人员是我们员工中最大的群体，也正是为什么我们超过一半的业务是围绕提供和支持医疗服务而建立的。
And for the consumer that is requiring different, the strategy we've stepped through this morning is helping us transform the way we operate, removing waste, cost and the old rundown things we know people don't like, always rechallenging and reinvesting. So with a better understanding of what this future looks like, there are a few things we hope you take away from our time together.
对于那些提出更高要求的消费者而言，今天上午我们介绍的战略正帮助我们转变运营方式，去除浪费、削减成本、摒弃那些人们早已不满的陈旧机制，不断自我挑战与持续再投资。现在，随着大家对这个未来图景有了更清晰的认识，我们希望你们从今天的分享中带走以下几点要义：
First, we are more confident than we've ever been in our approach to value-based care and the opportunity that lies ahead. We're creating the capacity and capabilities that providers of every shape and size need to make this transition while empowering our own care teams in markets both new and emerging.
第一，我们对“价值导向医疗”的路径及未来机遇，比以往任何时候都更有信心。我们正在构建各类医疗服务者转型所需的能力与资源，同时赋能我们自己的护理团队，覆盖新兴与现有市场。
Second, our teams are building on the momentum of our benefits innovation, accelerating a consumer-first digital strategy that is offering more than 52 million people more for less.
第二，我们的团队正乘着福利创新的东风，加速实施以消费者为核心的数字化战略，为超过5200万人带来“花更少、享更多”的医疗服务体验。
Third, expect our approach to AI and ML to support our progress, removing waste from the system and unlocking efficiencies across our operating model, transforming the ways we are able to invest in this innovation and improve care quality.
第三，我们的AI与机器学习策略将持续助力这场转型，从体系中剔除浪费、释放运营效率，并彻底改变我们投资于创新与改善医疗质量的方式。
And finally, the leaders you've met today are just a small window into the extraordinary high-performing talent of this company, each of whom are deeply committed to making health care work better for everyone.
最后，今天你们所见到的公司领导层只是我们卓越人才阵容的一个缩影。他们都怀着同样的承诺——让医疗服务对每一个人来说变得更好。
Rechallenging and reinvesting. This is the UnitedHealth Group we're after every day. It's the UnitedHealth Group we've always been.
不断挑战自我，持续投入未来。这就是我们每天追求的UnitedHealth Group，也正是我们始终如一的UnitedHealth Group。
With that, I'll hand the stage over to John Rex.
现在，我将舞台交给John Rex。
John Rex – President & CFO
Good morning. It's great to see all of you here. New location, some new seating, but a lot of familiar faces and long-valued relationships. We so appreciate the commitment you make to spend the day with us and hope you're finding it worth your while. I know our entire management team gets a lot out of the time with you.
大家早上好。很高兴看到你们来到这里。虽然是新场地、座位有些变化，但在座的仍是许多熟悉的面孔和长期建立的宝贵关系。我们非常感激你们抽出时间与我们共度今天的会议，并希望这段时间对你们来说物有所值。我知道，我们整个管理团队也从与各位的交流中收获良多。
Those images behind me on the screens are a sampling of some of the charts, tables and numbers we've shared with you over the course of this morning. By my count, between the materials that went out earlier in the presentations, you're getting many hundreds of measures of all shapes and sizes. It's a lot of numbers.
我身后屏幕上展示的是我们今天上午分享过的一些图表和数据样本。据我统计，加上早前发布的资料，大家今天看到的度量指标多达数百项，形式多样、规模不一。这确实是大量的数字。
We all know the phrase, "The numbers speak for themselves." But, and at the risk of being sent to the CFO penalty box, they rarely do. If they did speak for themselves, none of us would be here today. This combination of past, current and future measures is one part of communicating the potential of this company and providing you with a sense of our ability to achieve it.
我们都听过那句老话：“数字本身会说话。”不过，作为财务长，我冒着被“罚下场”的风险告诉你，其实它们很少真的自己开口。如果真如此，我们今天也就不必在这儿了。这些覆盖过去、现在与未来的数据，只是我们传达公司潜力、展示实现能力的一部分方式。
But up there, without context, the numbers really don't speak for themselves. It's why we believe that it's important for you to be able to engage directly with dozens of our leaders each year to get a sense of the qualities that enable us to deliver for the people we serve and how we expect to do so into the future. These efforts reflect a profound ambition for serving others and the nimbleness of our growing organization. Importantly, they also reflect an ability to anticipate, adapt and consistently perform even in shifting dynamics.
没有上下文的数字，无法真正“发声”。正因如此，我们认为，让你们每年与我们数十位领导直接接触至关重要。唯有如此，才能理解我们如何具备交付承诺的品质，以及我们未来会如何持续兑现。这些努力不仅反映了我们深植于心的服务使命，也展现了一个不断成长的组织的灵活性。更重要的是，它们体现了我们在环境变化中预测、适应并持续交付成果的能力。
Qualities like these don't just happen. For me, a couple of traits come to mind that help account for the many measures you've just seen and support our confidence as we look to the future. For the first, I'll borrow the childhood developmental term, temporal awareness. That's the core human ability to connect time with movement. A toddler, for example, has to learn the relationship between how long it takes to move the spoon from a bowl to her mouth so that her mouth opens in time. An older child learns how to anticipate more complex time frames such as how long it takes to get a soccer ball from a player's foot to the goal.
这样的能力不是凭空产生的。在我看来，支撑我们今天看到的众多数据成果，并支持我们对未来保持信心的，是两个关键素质。首先，我借用一个儿童发展心理学术语：“时间感知（temporal awareness）”。这是人类将时间与动作连接起来的核心能力。例如，小婴儿必须学习从碗里舀起一勺食物到张嘴吃下之间的时间关系；而年长些的孩子则能预测更复杂的时间跨度，比如从脚下踢出足球到它射入球门需要多久。
For us, it develops into keeping at our forefront multiple time horizons as we make decisions about our businesses and about taking steps to ensure success at different times and, of course, under different circumstances. All of you who invest with us, do so for a variety of reasons, and with a variety of time horizons, 1 year, 5 years, even decades. All reasonable. And when it comes down to it, most of you take all these various time frames into account to inform your own decision-making.
对我们而言，这种能力体现在决策时始终将多个时间维度纳入考量——针对不同的阶段、不同的情境，采取对应的行动策略。各位与我们合作投资者的投资动机与周期各不相同，有人看重一年内的成果，有人关注五年，甚至是数十年的长期表现。这些都是合理的。最终，你们大多都会综合各种时间因素来判断决策的方向。
Likewise, so do we. It can be a demanding balance, but it makes us better. We feel highly accountable for delivering strong performance across all periods for patients, care providers, consumers, customers of all sizes and of course, for you, our shareholders.
我们亦是如此。这是一种高要求的平衡技巧，但正是这种坚持，让我们不断进步。我们对在不同周期内为患者、医疗人员、消费者、各类客户，以及你们——我们的股东，提供稳健绩效负有高度责任感。
The second trait is fundamental to the first, continuous improvement, especially in cycle times and execution. While there are moments when aspects of health care shift abruptly, it often evolves more gradually, largely because there was so much at stake for people. Regardless of pace, the benefits of taking months, days, even minutes out of our cycle times are amplified by our market presence and the breadth of our capabilities. Trimming one day may not sound like much, but multiply that across the efforts of more than 400,000 dedicated colleagues serving more than 150 million people.
第二项素质，是建立在前者之上的：持续改进，尤其是在流程周期与执行效率上的改进。虽然医疗行业有时也会发生剧烈变动，但多数时候它是渐进式演变的，因为它关乎人的重大福祉。无论节奏快慢，我们在周期中节省几个月、几天、甚至几分钟所带来的效益，都会因我们在市场的覆盖范围与能力广度而被放大。或许节省一天听起来微不足道，但如果你将它乘以我们40多万员工、服务超过1.5亿人的影响力，那就是巨大的改变。
For example, about 4 years ago, it took us 36 to 48 months to fully transition a fee-for-service medical group to a successful value-based practice. Today, we accomplished this in 18 to 24 months, delivering greater value sooner for patients and care providers.
举个例子，大约四年前，我们将一家按服务收费（fee-for-service）的医疗集团全面转型为成功的价值导向医疗实践，通常需要36到48个月。而现在，我们能在18至24个月内完成这一转型，为患者和医疗提供者更早地实现更大价值。
Another example. Earlier today, you heard about innovations and benefit offerings. These are a direct result of accelerating our digital development efforts, where just this year, we drove a fivefold increase in the number of mobile features delivered, resulting in a multifactor increase in consumer engagement. With this approach to performance and keeping multiple time horizons in mind, we constantly evaluate how we can apply our capabilities in new ways to anticipate and meet the changing health needs of the people we serve, the needs of today and those on the more distant horizon.
再比如，今天早些时候你们听到了关于创新福利产品的介绍，这些成果直接源于我们数字化开发的加速推进。今年，我们上线的移动端功能数量增长了五倍，用户互动也出现了多重增长。在保持多时间维度绩效视角的前提下，我们持续评估如何以新方式应用我们的能力，以前瞻性地满足服务对象不断变化的健康需求——既包括眼前的，也包括遥远的未来。
Just as a child advances in temporal awareness through trial, error and continual learning, we innovate, test and nurture the businesses that will be the franchises of UnitedHealth Group in the near, mid and long term. It's not an either/or, it's all of the above. Thus, OptumHealth value-based care initiatives are today, a significant contributor to our near-term growth and will continue to be over the extended long term.
就像儿童通过反复试错和持续学习来提升“时间感知”能力一样，我们不断创新、测试并培育那些将在UnitedHealth Group未来扮演重要角色的业务——不论是短期、中期还是长期。这不是非此即彼，而是全面推进。例如，OptumHealth的价值导向医疗举措已成为我们短期增长的重要推动力，并将在长期持续贡献增长。
巴菲特比较多的交易是有道理的。
Care in the home is proving to be highly effective. We see expansive potential there over the mid and the long term. Our pharmacy businesses have a multi-decade trajectory as specialty drugs expand. And as one of the few stakeholders with the incentive to drive both quality and value, health financial service offerings have the distinctive ability to simplify consumer and care provider experiences. Think care delivery 10 years ago. And our benefits businesses remain foundational and central to our ability to serve people across all time horizons.
居家护理已被证实极具成效，我们认为其中在中长期内蕴含广阔潜力。随着特药市场的扩张，我们的药品业务具备几十年的增长轨迹。作为少数具备同时推动医疗质量与成本价值激励机制的参与者之一，我们在健康金融服务方面拥有独特优势，能简化消费者与医疗提供者的体验。想想十年前的医疗交付方式，就能看出如今的变化之深。而我们的福利业务仍然是公司服务所有时间维度客户能力的基础与核心。
Our responsibility is to ensure each business is receiving the right support and investment wherever it sits along the temporal spectrum, being both adaptable and consistent enables us to reliably deliver for the people we serve. And that brings us back to some of those numbers we shared at the top, starting with a brief recap of 2023.
我们的职责是确保每项业务——无论处于哪个时间周期——都能获得恰当的支持与投资。这种既灵活又稳定的机制，使我们能可靠地为服务对象持续创造价值。接下来让我们回到开场时提到的一些数字，先回顾一下2023年的整体情况。
As noted with our third quarter report, we expect adjusted earnings to be in the range of $24.85 to $25 per share. The growth comes from across the enterprise with particular strength in OptumHealth as it serves more patients in value-based care and in UnitedHealthcare as more consumers and employers choose its benefit offerings.
根据我们第三季度财报，我们预计全年调整后每股收益将在24.85至25美元之间。此次增长来自公司各个业务板块，尤其是OptumHealth——它服务了更多价值导向医疗的患者；以及UnitedHealthcare——随着更多消费者和雇主选择其福利产品，表现尤为突出。
Consistent with our midyear comments, we expect our '23 medical care ratio to be at the upper end of our initial range. Moving nimbly to address shifting care patterns is a good example of that temporal awareness and improved speed at work. We adapted rapidly and made timely adjustments for next year.
与年中展望一致，我们预计2023年的医疗赔付率将处于最初预测区间的上沿。快速应对不断变化的就医模式，正是我们“时间感知”与执行速度提升的最佳体现。我们反应迅速，并已为2024年及时做出调整。
Moving now to 2024. Our initial adjusted earnings outlook is $27.50 to $28 per share with growth across the enterprise. Revenues of $400 billion reflect growth of $30 billion, even when incorporating the significant effects of the Medicare funding reductions. We expect a full year medical care ratio of 84%, plus or minus 50 basis points. This is driven by those Medicare revenue impacts and business mix, particularly our growing public sector offerings for the historically underserved.
展望2024年，我们初步预计全年调整后每股收益为27.50至28美元，企业整体实现增长。营收预计达4000亿美元，同比增长300亿美元，即使考虑Medicare资金削减的重大影响。我们预计全年医疗赔付率为84%，正负50个基点，主要受Medicare收入减少和业务结构变动影响，尤其是我们针对历史上服务不足人群的公共部门业务正在快速扩大。
Optum revenues will grow by 11% in '24 to over $250 billion. This diversified growth will be led by OptumHealth, with the number of patients served in value-based care increasing by 750,000, consistent with our '23 stepping-out point. At OptumHealth, revenues will approach $110 billion, growth of $15 billion or 16%. Key drivers include value-based care patients and expanding and deepening the levels and types of care we offer, so we can serve patients more comprehensively. Our capacities and cycle times have advanced strongly in these areas, and we've established great foundations for expansion.
2024年，Optum预计营收将增长11%，达到超过2500亿美元。这一多元增长主要由OptumHealth带动，其价值导向医疗服务的患者将增加75万人，与2023年的基础保持一致。OptumHealth的营收预计将达到约1100亿美元，同比增长150亿美元，增幅为16%。关键推动因素包括服务人数的增长，以及我们在护理深度与广度上的持续扩展。我们在这些领域的能力与交付周期都有显著提升，为后续扩张打下坚实基础。
Even with over 4 million value-based patients served today, when considered in the context of the needs and market size, it is a small fraction of the vast potential. Our intent is to continue to expand these offerings for seniors and continue to invest today for long-term expansion of other areas, including commercial and state programs. That's because we see value-based care as fundamental to the shared goal of improving health outcomes for people and cost for society.
尽管我们目前已为超过400万名患者提供价值导向医疗服务，但放在整体需求与市场规模的背景下，这仍仅是冰山一角。我们计划持续扩展该类服务，尤其面向老年人群，同时今天就为其他领域（包括商业与州政府项目）的长期扩张进行投资。因为我们相信：价值导向医疗，是实现“提升人民健康结果、降低社会医疗成本”这一共同目标的基石。
Revenues at OptumInsight are expected to increase to about $22 billion, and the revenue backlog will approach $35 billion, growth of $3 billion. The expanding capacities of our offerings, in particular the number of care providers and consumers with whom we can connect and the ways we can connect with them, are important elements of our objective to improve experience and system performance.
OptumInsight 的收入预计将增长至约 220 亿美元，积压订单量将接近 350 亿美元，增长 30 亿美元。我们服务能力的持续扩展——尤其是连接更多医疗服务提供者与消费者，以及我们与其互动方式的多样化——是我们提升患者体验与医疗系统绩效的核心目标之一。
OptumInsight is also developing offerings in new areas our customers value highly, such as AI-first process optimization, advanced quality services and broadened health system partnerships.
OptumInsight 也在开拓客户高度重视的新领域，包括以 AI 为先导的流程优化、先进的质量管理服务，以及更广泛的医疗体系合作伙伴关系。
At OptumRx, revenues will increase to $125 billion, growth of about $10 billion. There are multiple pathways on multiple time lines to continue this growth far into the future. Our pharmacy services are growing strongly in many areas. We see a rising need for our unique ability to offer deep clinical support and value for patients and care providers as more specialty drugs come to market. Heading into 2024, OptumRx has had another strong selling season and high customer retention, reflecting our ability to anticipate and quickly adapt to changing customer preferences and market dynamics.
OptumRx 的收入将增长至 1250 亿美元，年增约 100 亿美元。我们有多种路径和时间维度来推动这一业务的长期增长。目前，我们的药品服务在多个领域都在强劲发展。随着更多特药上市，市场对于我们在临床深度支持和医疗价值方面的独特能力需求也在上升。展望 2024，OptumRx 再次实现了销售旺季的强劲表现和高客户保留率，反映出我们对客户偏好和市场动态变化的快速响应能力。
Turning to UnitedHealthcare. Revenues will exceed $300 billion, reflecting diversified growth of over $20 billion across our offerings. In our commercial products, we expect another strong year of growth, adding 1.5 million consumers. This growth will be led by self-funded offerings, which serve larger employers who are among the most sophisticated buyers of health benefits.
再来看 UnitedHealthcare。其收入将突破 3000 亿美元，来自各项业务的多元化增长将超过 200 亿美元。在商业保险产品方面，我们预计又将迎来强劲增长，新增消费者达 150 万人。这一增长主要来自自筹资金（self-funded）计划，服务对象多为在健康福利购买方面极为成熟的大型雇主。
Across our Medicare, Individual, Group and dual special needs offerings, we expect to serve up to 550,000 more consumers, strong growth while not matching the nearly 1 million out of this year, and let me tell you why.
在 Medicare、个人、团体及双重特殊需求（dual special needs）产品方面，我们预计将新增最多 55 万名消费者，虽然这一增长不及今年近 100 万的增幅，但其背后有着明确的原因。
We consciously and strategically approached '24 with balance with multiple time frames in mind, keeping benefits as stable as possible for seniors while adapting to program funding changes and care patterns. Again, not an either/or. Our long-held approach drives sustainable growth, consistent performance and durable consumer relationships.
我们在制定 2024 年战略时，有意识地兼顾了多时间维度，在努力维持老年人福利稳定的同时，积极适应政府计划资金变化与就医模式的转变。再次强调，这不是“非此即彼”的选择题，而是“兼而有之”的系统策略。这种长期坚持的路径能够推动可持续增长、维持稳定表现，并建立长期消费者关系。
With only half of seniors in Medicare Advantage today, the growth outlook will remain strong for years to come. In Medicaid, we expect the state's redetermination processes will be more than halfway complete by year end. Our focus has been on engaging with individuals who have been displaced and helping them find other affordable health coverages or retain existing coverages, and we have been able to secure coverage for the majority of those with whom we engage.
目前仅有约一半老年人选择 Medicare Advantage，因此未来几年该市场仍具有强劲增长潜力。在 Medicaid 方面，我们预计各州的资格重审程序将在年底前完成一半以上。我们的重点是与失去原有资格的人群建立联系，帮助他们找到其他可负担的保险覆盖方案或保留现有保障。到目前为止，我们已经帮助大多数联系上的个体成功获得保障。
In '24, we expect the number of consumers served by community and state to decline 100,000 to 200,000 with their redetermination impacts, partially offset by growth in other areas, such as our North Carolina expansion and new opportunities in several states.
2024 年，预计受资格重审影响，我们的社区与州级项目服务人数将减少 10 万至 20 万人，不过这部分下滑将被包括北卡罗来纳州扩张在内的多个州新业务增长部分抵消。
Our growing businesses support and are supported by substantial financial capacity and a strong balance sheet. Cash flow from operations in '24 will approach $31 billion or 1.2x net income.
我们的增长型业务既支撑着，也得到了强大财务能力与稳健资产负债表的支持。2024 年，我们的运营现金流将接近 310 亿美元，相当于净利润的 1.2 倍。
Returning capital to you, our shareholders, is an enduring commitment. In '23, we will return nearly $15 billion through dividends and share repurchase, a 14% increase over last year. Our annual dividend has grown by double digits for well over a decade, and share repurchase has been both consistent and meaningful over time.
我们始终致力于回馈股东。2023 年，我们将通过股息与股票回购向股东返还近 150 亿美元，同比增长 14%。我们的年度股息已连续十多年保持两位数增长，而股票回购也一直保持稳定且具实质意义。
You can expect us to continue to grow the amount of capital we returned to you in '24 and beyond. Even with this level of activity, our growth capital capacities remain strong. Over the past 2 years, we have deployed well over $30 billion. And we are steadfast in our commitment to building long-term value by strengthening our capabilities through internal investment and strategic combinations.
在 2024 年及更长时间里，我们将持续扩大回馈股东的资本规模。即便当前资本回馈强度已高，我们的增长资本能力依旧强劲。过去两年，我们已投入超过 300 亿美元。我们将继续通过内部投资与战略组合强化能力，坚定地构建长期价值。
Our capital deployment approach reflects the fact that the nearly $5 trillion U.S. health care system remains highly fragmented, resulting in uneven quality and outcomes for people and higher costs for all. Helping to smooth the patient experience, improve quality in outcomes, align incentives and reduce costs remains the very core of our mission and underpins our every investment decision.
我们的资本部署策略反映出当前美国近 5 万亿美元规模的医疗系统仍高度碎片化，导致服务质量和结果不均，以及全系统性成本居高不下。因此，优化患者体验、提升质量与结果、对齐激励机制并降低成本，始终是我们使命的核心所在，也支撑着我们每一项投资决策。
These numbers we have provided you today reflect the temporal awareness I mentioned earlier. They are the result of decisions made 10 years ago, 1 year ago, even a month ago. And those decisions were made with the conscious perspective of the near, mid and long-term positive impact we can deliver for the people we are privileged to serve. Further, they fully support continued delivery upon our long-term 13% to 16% earnings growth objective far into the future.
今天提供的这些数字，正体现了我此前提到的“时间感知”。它们是我们十年前、一年前、甚至一个月前所做决策的结果。这些决策都是在明确思考短期、中期与长期影响的前提下做出的，目标始终是为我们有幸服务的群体创造正向价值。更重要的是，这些成果也全面支撑我们长期 13% 到 16% 盈利增长目标的持续实现。
With that, we thank you for listening, and again, for spending the day with us. We hope you have a sense of our confidence in the opportunities ahead and our ability to execute on them.
感谢大家的聆听，也再次感谢你们抽出整天与我们共度时光。我们希望你们能感受到我们对未来机会的信心，以及我们把握与实现这些机会的执行力。
And now we'll take just a moment to set up for a Q&A session.
我们现在稍作准备，进入问答环节。
Andrew Witty – CEO & Non-Independent Director
Thank you, everybody, for spending the time this morning with us listening, and now it's our pleasure to give you the opportunity to ask questions. If I could ask some of the team to come back up on to the stage to take your seats, we'll get ready to start that just as soon as we can.
感谢大家今天上午抽出时间聆听我们的内容，现在我们非常高兴为大家提供提问的机会。请我们的团队成员重新回到舞台入座，我们将尽快开始问答。
In addition to people who've already met today, you're going to meet with Erin McSweeney, who's our Chief People Officer; and Patricia Lewis, who is our Chief Sustainability Officer and leads all of our ESG agenda across the company. Otherwise, you've met everybody else at some point during the morning already.
除了今天已经见过的嘉宾之外，接下来你们还将见到我们的首席人力官Erin McSweeney，以及首席可持续发展官Patricia Lewis，她负责推动公司范围内所有的ESG议程。其他各位嘉宾你们在今天上午已陆续见过。
If you do have a question, if you could just raise your hand, Zach and Julie are both in the audience. They'll get to you. And I'll literally flip flop between Julie and Zach. If you could just wait until you get the mic before you start, then folks who are listening in can also hear you.
如有问题，请举手示意，Zach 和 Julie 都在现场，他们会把麦克风递给你们。我会依次在他们之间轮流挑选提问者。请在拿到麦克风后再开始发问，以便远程听众也能听清。
So Zach, if you're ready, let's go.
Zach，如果你准备好了，我们就开始吧。
Zachary Sopcak – Senior VP of Capital Markets Communications & Investor Relations
In the back, Andrew, we have Steve Baxter from Wells Fargo.
Andrew，有位在后排的听众是富国银行的Steve Baxter。
Stephen Baxter – Wells Fargo Securities
Just a couple on the commercial business. I guess the commercial self-funded growth really stands out. Can you talk a little bit about how much of that is being driven by Surest specifically?
关于商业业务有两个问题。首先，自筹资金（self-funded）业务增长非常亮眼。请问其中有多少是由 Surest 产品直接推动的？
And then within the commercial value-based care opportunity, I think the 20%-ish type growth you're expecting, from a market share perspective, a percent of your book is maybe only 50 basis points on an annualized basis. What could lead to that ultimately developing more quickly than that? What would you need to see from employers and their response?
另外关于商业价值导向医疗的机会，你们预计将有大约20%的增长，但从市场份额来看，这大概只是年度增长率的50个基点。未来如果这一块加速发展，会有哪些推动因素？雇主方面你们希望看到什么样的反应？
Andrew Witty – CEO & Non-Independent Director
Thanks so much. Brian?
非常感谢。Brian，请回答一下？
Brian Thompson – Former CEO of UnitedHealthcare
Sure. There's a variety of factors driving the growth in our ASO business here. Surest is certainly one of them, but one of many. I think the strength of our network has really differentiated itself. And I think I would just point out product innovation overall. Our advocacy model has really emerged. It's been something we've invested meaningfully in over the last couple of years.
当然。我们ASO（Administrative Services Only，自助式健康计划）业务的增长有多种因素推动，Surest 无疑是其中之一，但绝非唯一。我认为我们网络的强大实力本身就很有差异化优势。同时，我想强调一下整体的产品创新。我们的倡导服务模式（advocacy model）已经初具规模，这是过去几年我们持续加码投资的方向。
And you heard about how we're bringing together a variety of point solutions into a single system that is very different for UnitedHealthcare. And I think the culmination of all of those elements with Surest as a really fresh, new element that we've been bringing to new customers has driven not only this year, but 2 years in a row, really strong growth overall.
你们也听到我们正在如何将多个点状解决方案整合为一个统一系统，这对于 UnitedHealthcare 来说是一次非常独特的转型。Surest 作为其中非常新颖的组成部分，与这些要素共同发力，不仅推动了今年，也推动了过去两年的强劲增长。
When I think about commercial capitation, last year, we talked about that as a key driver for our ambitions coming into this year. And I think what I'm most proud of, first and foremost, we have 500,000 lives in commercial cap today. I think that's oftentimes lost. But what I'm most proud of as we look to this year is what we're doing in the individual and family plans.
说到商业人头付费（commercial capitation），去年我们就将其视为今年增长战略的关键之一。让我最自豪的是，我们目前已经在商业人头付费计划中覆盖了50万人，这个数字可能常被忽视。而今年我最看重的，是我们在个人与家庭计划（IFP）方面的进展。
I think you remember, we had Tony Lin up here last year. We talked about the ambitions of joining with him and learning from his capitation in other marketplaces. And it is a really strong grower for us right now in our annual enrollment period for the individual and family plans. We're seeing that really emerge.
你们可能还记得，去年我们请 Tony Lin 上台介绍了我们如何与他合作并学习其他市场上的人头付费实践。而今年，在我们个人与家庭计划的年度注册周期中，这一领域已成为我们真正强劲的增长点。
So pleased with our traction in capitation and a variety of factors, certainly, one of which is Surest for our overall growth and momentum in self-funded.
因此，我们在整体增长及自筹业务中的势头非常令人满意，既包括人头付费计划的推进，也包括 Surest 在内的多项驱动力。
Andrew Witty – CEO & Non-Independent Director
Great. Thanks, Brian. Julie?
太好了，谢谢你，Brian。Julie？
Julie Murphy
We have Ann Hynes from Mizuho.
我们请到的是来自瑞穗证券的 Ann Hynes。
Ann Hynes – Mizuho Securities USA
So Medicare Advantage penetration is now 50%. What do you think the max penetration is and over what time? And is there something structural that, over time, you could get to 90% or 95%?
Medicare Advantage 的渗透率现在已经达到 50%。你们认为它的最大渗透率是多少？预计多久能达到？从结构性角度来看，是否存在某些因素可以让这个比例最终达到 90% 或 95%？
Andrew Witty – CEO & Non-Independent Director
Ann, thanks. Let me ask Tim Noel, I think you have a mic over on the far left there. Tim, do you want to address that?
谢谢 Ann。Tim Noel，你左边有麦克风吧？你来回答这个问题？
Timothy Noel – CEO of UnitedHealthcare Business
Yes. Thanks for the question. When I think about that question, the first place I start is the overall value proposition of Medicare Advantage. And when you think about the alternatives, Medicare Advantage is just unmatched in the cost to consumers, the outcomes, the satisfaction. So I see a lot of runway north of this 50% rate that we sit at today.
是的，谢谢你的问题。每当我思考这个问题，我首先会看 Medicare Advantage 的整体价值主张。与其他选项相比，无论是对消费者的成本、健康成果还是满意度，它的表现都无可匹敌。因此，我认为当前这个 50% 的渗透率之上还有很大的增长空间。
And the rate that we've talked about of 7% to 9% growth in the overall industry is something that I still view in the foreseeable future as the right place to orientate around. And I think there's a variety of different coverage types that we're starting to find inroads into in Medicare Advantage. But again, I just think the overall value proposition that has been resonating with consumers so much recently will continue to.
我们所提到的行业整体每年 7% 至 9% 的增长率，在可预见的未来仍然是合理预期。我也看到，Medicare Advantage 正逐步渗透到各类不同的保障形式之中。但归根结底，仍是它强有力的价值主张持续打动消费者，这种趋势还将继续。
Andrew Witty – CEO & Non-Independent Director
Great. Thanks, Tim. Zach?
很好，谢谢 Tim。Zach，下一个提问？
Zachary Sopcak – Senior VP, Capital Markets Communications & IR
Going to the front, Josh Raskin from Nephron Research.
前排是来自 Nephron Research 的 Josh Raskin。
Joshua Raskin – Nephron Research
I've got sort of a 2-parter, both on the value-based care. So the first is, just help us understand what fully accountable really means. Is that capitation? And I'm specifically interested in how the provider benefits financially in these relationships.
我有两个问题，都关于“价值导向医疗”。首先，请解释一下“完全负责制”（fully accountable）究竟是什么意思？它是否等同于人头付费（capitation）？我特别关心的是，医疗服务提供者在这些安排下如何获得经济上的好处。
And then second, could you talk a little bit more? I'm hearing more about this provider enablement strategy now, and I'm curious if that's part of OptumInsight and not Optum Health. And what really is the opportunity and what you're trying to do there?
第二个问题，我现在越来越常听到“赋能服务提供者”（provider enablement）这个战略。它是 OptumInsight 的一部分吗？不属于 Optum Health 吗？这个方向的机会和你们的目标具体是什么？
Andrew Witty – CEO & Non-Independent Director
Yes, Josh, thanks so much for the question. Amar, if you want to pick up the first point around fully capitated and accountable. And Roger, if you then pick up Practice Extend and the like, that would be great. Thanks. Amar?
好的，Josh，非常感谢你的问题。Amar，麻烦你先回答关于 fully capitated 和 accountable 的部分。Roger，你随后补充 Practice Extend 相关的内容。谢谢。Amar？
Amar Desai – CEO of Optum Health
Thanks for the question, Josh. So on the fully accountable point, it's exactly that. It's capitation payment for our provider network. Obviously, in some cases, it's within the context of our employed physician base. In other cases, we're doing that with a broader network of contracted providers. The capitation premium is delegated down to Optum Health as a care delivery organization.
谢谢你提问，Josh。关于“完全负责制”，它确实就是指人头付费的安排，我们会向服务网络中的医疗服务提供者支付预付费用（capitation payment）。有时候这些提供者是我们自己聘用的医生团队，有时候则是通过更广泛的签约服务商网络。这些人头付费保费是下放到 Optum Health 作为医疗交付组织来执行的。
And then importantly, within that, we're making investments, right? Investments in technology, investments in clinical programs, investments in practice support. And to your question around how do the providers benefit, it is to actually be able to deliver within a much more outcomes quality-oriented program to best benefit the patients, but also create a much better practice environment for them and their teams.
更重要的是，在这个体系中我们持续进行投资——包括技术、临床项目以及诊所运营支持方面的投入。至于服务提供者如何受益——他们能够在一个更加聚焦成果质量的体系下提供服务，不仅为患者带来最大利益，也为他们及其团队营造更优质的执业环境。
只能慢慢推进，这中间的问题不少。
Andrew Witty – CEO & Non-Independent Director
And do you want to just make a comment on relative burnout rates between both lives who are in this model versus fee-for-service?
你能不能再补充一下，在我们这个模式下执业的医生和传统按服务收费（fee-for-service）模式下的医生之间，在职业倦怠率方面有何差异？
Amar Desai – CEO of Optum Health
Yes, no. Thanks, Andrew. Yes. So to my point around practice support, administrative complexity, a lot of the things that bring fulfillment in the practice of medicine, what we found within our model is 21% reduced burnout rates relative to benchmark. So physicians, care providers, get to do more of the care, less of the pieces that create some of the challenges in the day-to-day. And most importantly, the patients also get to engage with their providers much more around the practice of medicine and the clinical issues that are going on.
好的，谢谢你，Andrew。是的，正如我之前所说的，关于诊所支持、行政复杂性、以及医疗执业中真正带来成就感的部分——我们在自己的模型下发现，医生的职业倦怠率比行业基准低了21%。也就是说，医生和护理人员能花更多时间在真正的医疗照护上，而不是那些日常造成负担的繁琐事务上。而更重要的是，患者也能在临床问题上与他们的医生有更深层次的互动。
Andrew Witty – CEO & Non-Independent Director
That's a great response, Amar. And I think, Josh, if you also just extend a little bit, think about the video you saw of the physician in New York in Hudson Valley. She was talking there about how she spends some of the day in value-based care and some of the day in fee for service, and that's where a lot of the space and the capacity is for us to extend our value-based platform, right?
谢谢你的精彩回答，Amar。Josh，我想补充一点——你还记得我们展示的那段视频吗？一位来自纽约哈德逊谷的医生，她提到自己一天中一部分时间从事价值导向医疗，另一部分时间从事传统服务收费模式的工作。其实这正是我们扩展价值导向医疗平台的重要空间和切入点。
So particularly, obviously, more seniors potentially. But also as those commercial lives become more interested in or available for a value-based approach. So as you look at that blend of a typical clinic, we have relatively few pure senior-only clinics. We have very much more of the kind of blended clinic mix.
这其中当然包括老年群体，但也包括越来越多的商业投保人开始关注或转向价值导向模式。如果你去看我们典型的诊所运营模式，会发现纯粹面向老年人的诊所其实非常少，更多的是混合型诊所。
That's why we see this model very applicable, whether it's a senior, whether it's commercial, whether it's Medicaid. And actually, once the physicians got comfortable with that way of working, it makes more sense for them to just carry on working that way the whole day. So as we start to bring in lives in that kind of shape, it actually makes life a lot easier for the clinics because they start to shift over that way.
这也是我们认为该模式适用于老年人、商业保险人群、甚至 Medicaid 群体的原因。一旦医生熟悉了这种工作方式，他们更愿意一整天都采用这种模式开展工作。所以，当我们引入更多这类人群时，实际上也让诊所的运营变得更加流畅和统一。
可能需要借助人工智能的能力。
Roger, do you want to touch on enablement?
Roger，你来讲一下赋能策略吧。
Roger Connor – CEO of Optum Insight & EVP of Enterprise Ops and Services for Optum
Yes, on provider risk enablement, what I would say is, obviously, the transition to value-based care is such a big market driver in OptumInsight. We're looking at that very hard in terms of opportunity to innovate and to bring products to the market, and we're doing that, as I mentioned on the stage.
关于赋能服务提供者、帮助其承担风险这块，我想说的是：向价值导向医疗转型是 OptumInsight 当前最重要的市场驱动之一。我们正在高度关注这方面的创新机会，并积极将解决方案推向市场。正如我在演讲中提到的那样。
Practice Extend is our offering. That is where we're working with from a payer side to work with them and bring -- let's really call it value-based care in a box. Because many of our providers that we're working with really don't know all of the stepping stones and all of the things that they need to go in that journey, and we're bringing that. And the feedback is actually very strong.
我们推出了“Practice Extend”这一解决方案，实质上就是为服务提供者“打包交付价值导向医疗”。因为我们合作的许多提供者，并不了解自己在转型过程中应走的每一步、需要做哪些准备。而我们正好能为他们提供完整的路径。市场反馈也非常积极。
So it includes everything from the road map to get there, the need for population health analytics, what they need in terms of just contracting, both with the payer and the provider, and we're solving all those problems for them.
这个方案涵盖了从转型路径图、人口健康分析、到与付款方及服务方的合同签订等各个方面，我们能帮助他们解决全流程的难题。
We're going to take Practice Extend and also extend and go straight to providers. And I think that's where we're very well placed. We have access to a very large market with our large health system partnerships. We're also talking to them about using those same tools on their value-based care journey, too.
我们计划将 Practice Extend 不仅用于付款方合作，也直接提供给服务方使用。这是我们非常具备优势的领域——我们与大型医疗体系有广泛的合作关系，也在与他们探讨如何用这些工具推动自己的价值导向医疗转型。
In terms of how we work with Optum Health, complete partnership. We just picked the best tool that exists in this group and put it in that toolbox that I described.
至于我们和 Optum Health 的合作，完全是伙伴关系。我们从整个 Optum 体系中挑选出最优秀的工具，放入我刚才描述的“工具箱”中，服务整个市场。
Andrew Witty – CEO & Non-Independent Director
And this whole area of physician enablement, taking the value -- taking the kind of insights and the models we've been spinning up over the last several years around value-based care, it's just another example of how we're United. We work to innovate, oftentimes UHC, Optum together, innovating, identify, test-drive, pilot.
关于赋能医生这个领域，我们其实是将过去几年在价值导向医疗中积累的洞察力与模式加以延伸与推广，这再次体现了“United”的核心理念——我们协同工作，共同创新。UHC（UnitedHealthcare）与 Optum 常常联手，从创新构思，到识别机会，再到试点测试。
Those things that succeed, we take them out into the broader marketplace, right? So whether it's UCard, whether it's physician enablement, whether it's payment integrity, insights, whatever it is, the goal of the company is to work together, figure out how to innovate, test-drive it and then make it broadly available not just through our own networks. And that's been a very successful model for us now over many years in many different areas.
那些试点成功的方案，我们就将其推广到更广阔的市场。无论是 UCard（联合健康福利卡）、医生赋能、支付合规，还是数据洞察，我们的目标始终如一：协同合作，持续创新，反复测试，最终不仅在自己的网络中应用，还向整个行业推广。这种模式多年来在不同领域都取得了显著成效。
Julie?
Julie Murphy
Yes. Ken Fischbeck from Bank of America.
现在请 Bank of America 的 Ken Fischbeck 提问。
Kevin Fischbeck – BofA Securities
So I guess I wanted to know a little bit more about the shift of value-based care into commercial and Medicaid. I think you gave us a little less than 5 million, about 400,000 in commercial. So what was the Medicaid percentage today in value-based care? And as you think about adding the next 5 million lives, what does that mix start to look like?
我想更深入了解一下价值导向医疗向商业和 Medicaid 领域的渗透情况。你们刚才提到大约有不到 500 万人，其中约 40 万是商业险客户。那么 Medicaid 部分目前的价值导向医疗占比是多少？当你们计划再扩展 500 万覆盖人群时，预期的结构比例会是怎样？
And I guess to your point, Andrew, how much of that growth in the non-Medicare is about an existing physician panel that has commercial Medicaid shifting over, versus having to go out and find a different type of doctor who's maybe more commercially oriented or Medicare-oriented to make that...
还有一个问题，Andrew，结合你之前所说的，非 Medicare 领域的增长中，有多大比例是通过现有医生群体中已有的商业或 Medicaid 患者转换过来的？又有多少是需要主动寻找新类型、更偏商业或 Medicare 专向的医生来实现的？
Andrew Witty – CEO & Non-Independent Director
Great questions. Brian, do you want to start off on the Medicaid piece?
问题非常好。Brian，你先回答 Medicaid 相关部分吧？
Brian Thompson – Former CEO of UnitedHealthcare
Sure. Well, for me, Medicaid includes duals and our complex care, and it's been a big driver of where we've seen that growth this year and into next. So keep in mind, many of our duals, we consider inside our community and state business. And complex care, I think, is the perfect sweet spot and intersection of our capabilities in UnitedHealthcare and Optum, and that's grown nicely. And I continue to see that grow at the same rate that we've seen the last couple of years for many years to come. So first and foremost, it's in complex care.
当然。从我的角度来看，Medicaid 包括双重资格（duals，即同时具备 Medicare 和 Medicaid 资格）人群以及复杂护理（complex care）人群，这些领域是我们今年和明年增长的主要来源。要注意，很多双重资格用户我们是放在社区与州级业务板块内管理的。而复杂护理则是 UnitedHealthcare 与 Optum 能力交汇的完美结合点，近年来增长表现非常好。我相信这种增长在未来几年还将持续。因此，增长的核心首先来自复杂护理。
We haven't seen much value-based care in the traditional Medicaid side yet. I'd say that's in the really nascent stages. And then back to commercial right now, the bias is towards a real fast mover in the individual and family plans and continuing to grow nicely again inside our commercial book.
至于传统 Medicaid，我们在价值导向医疗方面看到的进展还非常有限，仍处于起步阶段。而回到商业险，目前增长最快的是个人与家庭计划（IFP），在我们的商业业务组合中也持续表现强劲。
I also want to point out a capability we have called Level 2, where we're actually taking risk back from some of our ASO customers on complex diseases, in particular diabetes, and that's grown nicely for us here into 2023 and '24 as well. So still a variety of different ways that we're growing outside of the Medicare Advantage business.
我还想提一下我们的一项能力，叫做 Level 2。它是指我们从一些 ASO（行政服务外包）客户那里回收高风险责任，特别是关于慢病如糖尿病的管理。这块在 2023 和 2024 年也表现得不错。所以除了 Medicare Advantage，我们在多个路径上都实现了增长。
Andrew Witty – CEO & Non-Independent Director
Yes. And I think from the perspective of where would we go to essentially create the physician capacity to absorb that kind of growth. Firstly, as I said earlier, many of our clinics already have a blended population running through them. But where that doesn't necessarily match, we've got the home and community platform, which has played a big role this year in absorbing a very substantial increase, particularly in the dual special needs. It's allowed us to go much more into rural areas, much less populated areas.
是的。我认为从扩容角度看，要满足这种增长所需的医生承载能力，我们有几条路径。首先，如我之前提到的，我们很多诊所已经在服务混合型人群。但在诊所分布不匹配的地区，我们的居家与社区护理平台今年起到了重要作用，特别是在“双重特殊需求人群”（dual special needs）方面的显著增长。这使我们得以深入许多偏远和人口较少的地区。
Our partnership with Walmart is another way in which we've taken an opening up strategy of clinic access for value-based care into geographies where you may not historically have found a very high density of clinic presence.
我们与沃尔玛的合作也是推动价值导向医疗进入原本缺乏诊所覆盖区域的方式之一，拓展了新的地理市场。
And then of course the way in which Amar builds out his organization, some of the physicians are employed by United, some are contracted, some are affiliated. So that's a very flexible mechanism to increase the kind of hinterland of the Optum Health platform.
此外，Amar 在组织搭建方面采取了灵活策略，有些医生是 United 的正式员工，有些是签约合作，还有些是松散附属的。这种组合让 Optum Health 平台具备非常灵活的“外延拓展”能力。
So if you think about all of those dimensions, the opportunity for us to shift and move and build capacity underneath an evolving market need is strong. It takes us probably a year or 2 to get it right, to the right level. And you've seen a bit of that this year as we've extended our home and community to meet the outsized growth we saw in the duals this year, you're going to see the benefits of that in '24. But the bottom line is, over any sort of sensible period, we can be pretty responsive to those shifts.
综上所述，我们在多个维度上都具备灵活调动与扩容的能力，足以应对市场的演变。通常需要一两年时间来达到理想规模。今年我们已经开始扩展居家与社区服务，满足“双重资格人群”的高速增长。你们将在 2024 年看到由此带来的成果。归根结底，我们可以非常有效地应对这种结构性转变。
Zach.
Zachary Sopcak – SVP, Capital Markets Communications & IR
Lisa Gill from JPMorgan.
来自摩根大通的 Lisa Gill。
Lisa Gill – JPMorgan Chase & Co.
You talked today about the changes for Medicare Advantage and the risk adjustments for '24, '25, '26. As I think about it specifically to '24, how much of that is borne on the side of Medicare Advantage versus Optum Health? And specific to Optum Health, we're looking at the margins improving in '24. So just curious if that is a big headwind there. What are some of the other things that are either offsetting it or improving as we move into '24?
你们今天谈到了 Medicare Advantage 的变化以及 2024、2025、2026 年的风险调整。就 2024 年而言，这部分影响在 Medicare Advantage 和 Optum Health 之间是如何分担的？另外，Optum Health 的利润率在 2024 年预期将改善，那这项风险是否是个重大阻力？有哪些其他因素正在抵消这个压力，或正在推动利润改善？
Andrew Witty – CEO & Non-Independent Director
That's a great question, Lisa. So clearly, it affects both businesses. So again, what we're really talking about -- the best way to think about it, Lisa, the way I think about it, is it's essentially a price cut on MA. And so that price cut comes in at the top. Obviously, some underlying lines remain held in UHC. That price cut therefore affects UHC's MA book. But the lives which have been delegated to Optum, it essentially then flows into Optum as a price cut, right? So the same kind of phenomena flows in.
这是个很好的问题，Lisa。这项变化显然对两大业务板块都有影响。说得直白点，这其实就是一次 Medicare Advantage 的“降价”。这项降价从顶层开始，部分人群仍由 UnitedHealthcare 管理，因此直接影响其 MA 业务；而另一部分人群则委托给 Optum 管理，所以同样会以降价的形式影响 Optum Health。
The responses are kind of the same mix. So both businesses have response capabilities which were around choices on benefit design, obviously, choices on taking cost out of our own organization and driving, let's call it, internal efficiency as a contributor towards responding to that pressure like any normal company would do.
我们的应对措施基本一致。两个板块都可以在福利设计、内部成本优化、效率提升等方面做出调整，就像任何正常公司在面对压力时应采取的方式。
And then the third area which I would say is particularly important within Optum Health is doubling down on the affordability, so elimination of waste and unnecessary care within the system, which in many ways, I think, ought to be a key tenant of value-based care anyway. It is already. And in many ways, it's why I said at the beginning, if there's a good thing from all of this, it's to catalyze an effect to double down on that piece of the agenda. That's how we respond.
第三点，特别对 Optum Health 来说，我们会更大力推进“可负担性”提升，也就是消除系统中的浪费和不必要的治疗。这其实正是价值导向医疗的核心原则。某种意义上说，这次变化也带来了一个“好处”——迫使我们在这方面更加坚定和快速推进。
Now to the issue of why you're seeing health margins strengthen during '24, yes, you have the headwind of the rate notice, which is going to flow through the next 3 years. But you have tremendous underlying mix dynamics changing as you see these large cohorts which have come into the company over the last 24 months move into a much higher level of managed stability. So higher levels of engagement.
至于为什么我们预计 Optum Health 的利润率在 2024 年将改善，尽管“费率通知”确实是未来三年的逆风因素，但我们正在经历强劲的结构性变化——过去两年新加入的客户群体，逐渐进入高管理稳定性阶段，互动率（engagement）显著提高。
The key for the strong performance of health is obviously grow the number of lives, then achieve good, strong, relevant engagement, allowing us to work with the patients and get their care under control. Because a lot of these lives come in with very unattractive BCRs or MCRs, right? They come in pretty much uncontrolled, not well managed. Particularly in the duals, they've almost been lost to the system in some cases.
健康业务的关键在于：一是扩大覆盖人群，二是实现高质量、高关联度的互动。这样我们才能真正介入病患管理，控制医疗支出。因为很多新加入人群一开始的索赔率（BCR、MCR）是很不理想的，几乎没有有效管理，尤其是“双重资格”人群，甚至在系统中处于“游离状态”。
What we're doing, particularly through home and community, reaching out maybe for the very first time in a comprehensive engagement. Takes a little while to do that. You've seen that this year. Once it starts happening, that's going to be a big piece of it.
我们目前正通过居家与社区服务体系，首次实现这些人群的全面接触与管理。这是一个渐进过程，今年你们已经看到部分成果，一旦系统全面运转，这将是利润改善的关键推动力。
So it's a combination of the cost management, the affordability agenda, the mix dynamic, all plays out. And what's been -- what I hope you will all take away is that we've made very, very deliberate decisions and trade-offs in '24, not just for '24, but to make sure we're positioned for '25 and '26 because the rate notice drops 3 years, not 1 year.
所以，这背后是成本控制、可负担性提升、业务结构变化的综合结果。我们希望你们看到的是，我们在 2024 年做出的是非常有意识、深思熟虑的决策和平衡，不只是为了 2024，也是在为 2025 和 2026 做好准备——因为费率影响是持续三年的，不是一年。
Julie?
Julie Murphy
Yes. In the front, we have Dave Windley from Jefferies.
前排是 Jefferies 的 Dave Windley。
David Windley – Jefferies
In light of, Andrew, your comments that you just made around Optum Health and the maturing of some of the cohorts, your guidance for MLR in '24 is higher. So what is -- if not O Health and the headwinds that you just highlighted, what is driving the higher MLR? And kind of the conservative posture maybe around that.
Andrew，你刚才提到 Optum Health 中部分人群进入成熟阶段。但你们给出的 2024 年的 MLR（医疗损失率）指引却比以前更高。如果不是 Optum Health 本身的问题，也不是你提到的那些负面因素，那推动 MLR 上升的真正原因是什么？这是否也反映了一种保守姿态？
Andrew Witty – CEO & Non-Independent Director
Yes. So let me -- I'm going to ask John to comment on that in a minute. But just to be super simple. Again, that price cut has a direct effect on MLR. I mean, it is a straightforward shift in the denominator, you immediately get it, and it represents the bulk of what you're seeing in the change. But let me ask John to go a little deeper on that.
好的。让我简单说一下，然后请 John 补充更深入的解读。其实最直接的原因，就是医保优势计划（MA）的“降价”，这直接影响了 MLR 的计算分母——也就是收入。这一变动本身就占了 MLR 上升的绝大部分原因。John，请你进一步说明。
John Rex – President & CFO
And that's really it. Really, the funding changes took billions out of the system, essentially. And revenue is the denominator in this and that impacts the denominator in calculating the medical care ratio. And so it has impact as that flows through. And I don't want to -- none of us want to underplay that impact. It's a significant impact in terms of the billions that came out of the system.
没错，核心原因就是政策变化导致系统中减少了数十亿美元的资金。因为 MLR 的分母是收入，这些资金的减少就直接推高了 MLR。我们不希望轻描淡写这个影响——它确实很重大。
And this is what Andrew and the team have been talking about in terms of, as we started in February, looking at how we would approach it thoughtfully almost like a long-term planning process, right, for us in terms of looking ahead over the next few years.
这也是 Andrew 和我们整个团队从 2 月份开始就一直在关注的重点。我们是以一种长期战略的视角在规划未来几年的应对策略。
So that's it. And then making sure that we are able to do all we could to keep benefits as stable as possible as we could for seniors as we work through that process. So maintain as much stability as possible, but the denominator change was significant.
总结来说：一方面我们竭尽所能在这个过程中保持老年人医保福利的稳定；但另一方面，不可忽视的是收入分母的变化确实非常明显，推高了 MLR。
Andrew Witty – CEO & Non-Independent Director
And I think as you think through the next 3 years, the way we think about it, is externally then happens, puts pressure on the MCR, puts pressure on the revenue, puts pressure on the MCR. We respond to that in the way I've just described.
接下来这三年，我们的判断是：外部变化将持续对 MCR（医疗成本率）造成压力，也同时压缩营收。我们会采取刚才提到的多种方式进行应对。
We believe that is a response model which is very durable. So it's not like you're just breathe it in for 12 months and you can't sustain it. You have to breathe out at month 13.
我们认为这种应对模式具有高度“可持续性”。这不是那种“短暂忍耐一年，第十三个月就崩溃”的策略。
This is a situation where we truly think we're shifting the shape of our cost base, shifting the shape of our affordability capabilities externally.
我们实际上是在重塑公司的成本结构，也在提升我们在外部系统中的“可负担能力”。
And what that will do over -- so in the short run, what that does, and you see it in our guidance, despite the movement -- a little bit of movement in the MCR for the reason we just discussed, overall earnings performance continues to be exactly where you'd hope it to be.
短期来看，正如我们在财测中展示的，即便 MCR 有所上升，我们的整体盈利表现仍然稳健，达到了市场预期。
That's due to all of these other pieces being addressed in response.
这正是我们前面所说的“多方面联动应对”所起的作用。
And then as you roll through the next 2 or 3 years, you'll see things like affordability tenders and the like, ought to start to help us rebuild the MCR position, right?
接下来两三年，你将看到“提升可负担性”等措施开始逐步发挥作用，帮助我们恢复 MCR 的表现。
So you're starting to get at the core because MCR is obviously a function of the revenues and your underlying medical costs. So how we really tackle that over the next 2 or 3 years, we'll start to address how we manage the MCR going forward.
这就是核心——MCR 的本质，是收入和医疗支出之间的比值。未来两三年，我们将专注于如何在这两端持续优化，从而系统性地改善 MCR。
So I think Zach.
Zachary Sopcak – SVP, Capital Markets Communications & IR
Over down in the front, we have got Scott Fidel from Stephens.
前排是 Stephens 的 Scott Fidel。
Scott Fidel – Stephens Inc.
First, just to follow up on the MLR. So basically, it sounds like you're thinking about 2024 as sort of the -- arriving at sort of a peak level for MLR that then you could try to work through over the next few years. Because obviously, we do have the incremental risk model pressures coming in '25 and '26.
首先关于 MLR 的问题跟进一下。听起来你们似乎把 2024 视为 MLR 的“高峰年”，随后在 2025 和 2026 年逐步消化掉这部分压力？因为我们知道这两年还会有新增的风险模型带来的影响。
And then my main question was just I was hoping that you can maybe drill a little bit into your expectations for D-SNP market growth specifically. That's been a really strong driver of growth for the industry. United has achieved almost 40% market share there. We have heard about some more variability though in some of the competitor offerings in that particular category for 2024. So just curious in terms of how that drives your thinking on D-SNP.
然后我的主要问题是，能否详细说明你们对 D-SNP（双重特殊需求计划）市场增长的预期？这是行业强劲增长的一大引擎，United 已经拿下了接近 40% 的市场份额。我们听说一些竞争对手在 2024 年这块业务上有波动，你们如何看待这一情况？这对你们的战略规划是否会产生影响？
Andrew Witty – CEO & Non-Independent Director
That's a great question, Scott. So maybe, Brian, if you might like to start on the duals. And then, Amar, maybe ask you to talk a little bit about how it represents within the 750,000 growth in value-based lives next year. But maybe, Brian, if you could start.
这个问题非常好，Scott。Brian，你能不能先谈谈关于双重资格人群（D-SNP）？然后请 Amar 再补充说明，这部分在明年新增的 75 万名价值导向护理人群中占据怎样的比例。Brian，你先开始？
Brian Thompson – Former CEO of UnitedHealthcare
Sure. On duals, you heard the 450,000 to 550,000 range. Inside that, I'd say it's pretty well balanced between duals growth, individual Medicare Advantage and our group growth. So expecting continued growth, albeit a little more tempered in comparison to what we've seen in the last couple of years.
当然。关于 D-SNP，你们听到的预测范围是 45 万到 55 万人。在这个范围中，双重资格人群的增长、个人 Medicare Advantage 计划的增长，以及团体计划增长之间相对均衡。所以我们预计这块业务会继续增长，虽然增速相比过去几年会略微温和些。
As you pointed out, we have seen a strengthening in some of the benefits as we approach this year. As you heard from John, we're taking a very multiyear approach to how we've positioned our 2024. And really wouldn't change a thing.
正如你提到的，进入 2024 年我们在部分福利项目上确实增强了竞争力。就像 John 也说过的那样，我们对 2024 的战略是基于一个“多年度”的整体规划。从这个角度讲，我们并不打算对当前策略做出重大调整。
I think as we look over the long term over this 3-year period, it's important that we feel good about our pricing going into '25 and '26. And certainly from this vantage point, I feel very good about the benefits that we've put in the marketplace, the pricing, et cetera, how we've accommodated for some trend elements that we spoke about earlier in the year.
从长期三年视角看，我们必须确保 2025 和 2026 年的定价具备竞争力。就目前来看，我对我们在市场上推出的福利、价格结构，以及年初谈到的一些趋势性因素的应对方式都感到满意。
So I feel really good about where we're positioned. Do expect to continue to grow it. And of that overall MA growth, about 1/3 of it pretty well balanced, again, between those 3 products.
我对我们的整体定位非常有信心，预计 D-SNP 业务会持续增长。总体而言，我们 Medicare Advantage 的增长中，约三分之一是由 D-SNP、个人 MA 计划和团体 MA 计划三者共同驱动。
Amar Desai – CEO of Optum Health
And for health, look, when we think about all of our growth, it's related to our plan partners or geographies and the places where we're building out our networks. And consistent with Brian's comments, we will expect to continue to grow within the duals base.
从 Optum Health 的角度来说，我们所有的增长都与合作保险计划、地理覆盖区域，以及我们网络建设的进展密切相关。与 Brian 的观点一致，我们预计双重资格人群仍将是持续增长的重点。
We're intensifying some of the work that Andrew talked about in terms of patient engagement with the most complex of those members, particularly around home-based care. So we built more of the home capacity within those geographies and expect it to be a continued important part of our growth.
我们正在加强 Andrew 所提到的一个关键方向——与复杂患者的互动，尤其是在居家护理方面。我们在这些地区扩建了居家护理能力，预计这将是我们未来增长的重要组成部分。
Andrew Witty – CEO & Non-Independent Director
Excellent, thank you. Julie?
非常好，谢谢。Julie？
Julie Murphy
Over here to Whit Mayo from -- oh, never mind. George. George Hill from Deutsche Bank.
这边是 Whit Mayo——哦，不对，是 George。德意志银行的 George Hill。
George Hill – Deutsche Bank AG
And I kind of wanted to come back to the risk model and the changes in the reimbursement environment again in MA. And I was just wondering if you could talk a little bit more about how you -- how that changes how you contract and interact with your risk-bearing provider organization partners, both as the Medicare Advantage plans contract with Optum Health and other provider organizations.
我想回到 Medicare Advantage 的风险模型变化以及报销环境的变化问题。能否详细谈谈这些变化是如何影响你们与承担风险的医生机构之间的合同安排和合作关系？包括 MA 计划与 Optum Health 之间，以及与其他提供者之间的关系。
I guess, can you talk about how you guys change -- talk about how you change the allocation of economics or how you work to support your provider partners both internally and externally.
具体来说，你们是否会调整经济利益的分配方式？你们又是如何在内部和外部支持这些提供者合作伙伴的？
Andrew Witty – CEO & Non-Independent Director
Yes. Again, maybe I'll ask — in a second, I'll ask Amar just to reflect on how it felt from the non-UHC payers. But maybe, Brian, you might want to address how you've looked at it as the UHC payer to Optum.
好问题。我会请 Amar 从非 UHC 付费方的角度谈谈他的观察。但先请 Brian 来说明，从 UHC（UnitedHealthcare）作为付费方对 Optum 的角度，你们是如何应对的？
Brian Thompson – Former CEO of UnitedHealthcare
Yes, absolutely. Well, we talk a lot about stability in benefits. And I think it's equally important to talk about stability in network and our partnerships, particularly in a fully accountable arrangement.
当然可以。我们经常谈“福利稳定性”，但我认为“网络和合作关系的稳定性”同样重要，尤其是在“完全问责制”（fully accountable）模式下。
So first and foremost, we are very transparent and make sure that as we approach a year, our provider partners, particularly those that take risk, are fully aware of the changes in implications.
首先，我们始终保持高度透明，确保在年度开始之前，所有风险承担型的合作医生都清楚相关变化及其影响。
So just as I try to protect my benefits, I want to make sure that the relationships we have stay in place for a very long time.
正如我们会致力于维持客户的福利稳定性，我们同样重视与这些医生合作关系的长期稳固。
I think you will see some disruption in this marketplace with provider partners over time. We've seen it in the past in other markets, and it's certainly not our intention to do that.
在这个市场中，未来确实可能会看到一些医生网络的波动。我们在其他市场中也曾见过类似情形，但这绝非我们所追求的结果。
So we are fully receptive to and make sure that we've got full awareness to the capitation rate changes, et cetera, the implications and then how we together go to market with benefits.
因此，我们非常愿意倾听，并确保医生合作方了解人头付费率（capitation rate）等变动的详细信息，并且我们会一起协作推出有竞争力的福利。
Amar Desai – CEO of Optum Health
As we think about our external payer partners as well as comment around the provider networks. I mean, the core piece of this is the level of relationships we've had with these providers over many, many years around value-based constructs and around risk models.
当我们思考与外部付费方的合作关系，以及提供者网络的发展时，最核心的因素是：我们与这些医生群体在价值导向型结构和风险模型方面，已经建立了多年深厚的合作关系。
And so there is a ton of provider education that is going on both around areas like diagnosis and documentation, but also to Andrew's point around affordability and medical management or clinical programs, how do we build and grow the clinical programs together with our physician partners, with the medical groups, both our employed as well as our contracted physicians.
因此我们正在大量开展“医生教育”工作，内容涵盖诊断、病历记录，同时也涉及 Andrew 提到的“可负担性”、医疗管理和临床项目。我们会与医生合作伙伴——无论是雇佣制还是签约医生群体——共同建设并扩展这些临床项目。
That provider education process, just to be super clear, is about talking about specifically how has the diagnosis models change? How do you do education around what goes on the clinics?
所谓“医生教育流程”，说得更明确些，就是要让他们理解诊断模型是怎么变化的，临床一线需要注意哪些地方、怎么去适应这些变化。
How, through our physician portals and other technology, do we support them to make the right, both documentation decisions, but also gaps in care and quality decisions? So all of that goes into supporting them through the risk model change.
我们还会通过医生端入口和其他技术手段来支持他们，让他们能够做出正确的病历记录、识别治疗缺口、优化质量管理。这些支持都是帮助他们顺利过渡到新的风险模型的重要保障。
Andrew Witty – CEO & Non-Independent Director
And I think central to, I think, both UHC's logic of how it thinks about its relationship with Optum and also very much what we're seeing from non-UHC payers of Optum is Optum Health has got real credibility in what it's able -- what it has delivered for those payers over the years.
我认为，无论是 UHC 如何看待与 Optum 的合作关系，还是来自非 UHC 付费方的反应，都显示出：Optum Health 过去几年在执行方面建立了非常强的可信度。
And obviously, as you see this group, as you see this type of population grow in terms of value-based care, payers want to sustain that. They want to see that sustained.
很明显，随着这类人群在价值导向护理中不断扩大，付费方希望这种成果能够持续。他们希望这种能力延续下去。
And so when you see something like this funding reduction flow through, which obviously is going to have an effect, both at the payer level and the provider level, people are looking to say, "Okay, how do we make sure we don't have what ought to be a manageable event over several years become a distraction?"
所以当这类“资金缩减”情况出现，势必会影响付费方和服务方两个层面。大家真正关心的是：“我们如何确保这件本应可控的长期事件不会演变成破坏性的干扰因素？”
And I've been -- I've actually been very impressed by the kind of the way in which the other payers have come into this conversation and the way in which Brian and his team have come into this conversation to say, "Look, actually, this whole thing is much bigger than a rate notice change. This whole thing is about how do we work together to sustain value-based care growth?"
我对其他保险公司的参与方式、以及 Brian 和他团队的应对方式印象深刻。他们都在说：“看，这不仅仅是一次费率调整通知的问题。这关乎我们如何协作，把价值导向医疗持续推向更高水平。”
And that's what's got us into a good position in terms of how we manage through this period and how we feel like we have a pretty decent, let's call it, new foundation, post rate notice, to plan for '24, '25, '26, which is exactly what you're seeing play out.
正是这种合作思维，让我们在应对这个时期时处于有利位置。现在我们在“降价通知”之后，已确立了一个相当不错的新基础，去为 2024、2025、2026 年做出稳健的规划——这就是你们现在看到的成果。
Zach?
Zachary Sopcak – Senior VP of Capital Markets Communications & Investor Relations
Coming to the front again, Lance Wilkes from Bernstein.
前排提问，Bernstein 的 Lance Wilkes。
Lance Wilkes – Sanford C. Bernstein & Co.
Question on the overarching strategy going forward with OptumInsights. What I was particularly interested in is how you look at distribution to the provider organizations, how you're looking at AI enablement for care extension and maybe using Optum Health as a customer and what the outlook is for that.
我想请教一下关于 Optum Insight 未来总体战略的问题。我特别感兴趣的是，你们如何面向提供者机构进行分发？如何通过 AI 支持护理延伸？Optum Health 是否会作为“客户”使用这些能力？以及未来发展前景是怎样的？
And then I'm also interested in that value-based care enablement aspect that was asked earlier. How much of that is embedded in Insights today as far as the capability versus how much of it is embedded in Health?
另外，我也想了解一下之前提到的价值导向护理赋能部分：目前这块能力中，多少是属于 Optum Insight 的？多少又是内嵌在 Optum Health 的？
Andrew Witty – CEO & Non-Independent Director
That's a great question. So I think OptumInsight, we've had now 2 or 3 years where we've been waiting for and then executing the transaction with Change. And I think it's inescapable that, during that period, there's a heavy focus on that process.
这个问题问得非常好。过去两三年，Optum Insight 主要都在等待并最终完成与 Change Healthcare 的合并交易。这段时间的重点确实被放在了这项事务上。
I think as that closed out in the middle of this year, and with the new management team well and truly established, what we're now seeing is a much more exciting future for OptumInsight largely stimulated by the integration because Change brings in a lot of new capabilities, a lot of new network connectivity, which you see a little bit echoed in the financial service conversation.
随着这项交易于今年年中正式完成，新的管理团队也基本就位，我们现在看到的是：得益于整合，Optum Insight 拥有了更令人振奋的未来。Change 带来了大量新能力和网络连接，这一点你们也可以从我们早前关于金融服务的讨论中有所体会。
And when you then start to say, okay, what could this business now do as a not just a B2B business, which I think is what you might characterize the old Optum Insight, but much more as an organization which not only supports big other businesses in health care, like hospital systems, but also how does it support the small providers?
而当你进一步思考这个业务现在可以做什么时，它已经不再仅仅是传统意义上的 B2B（企业对企业）服务平台。现在它不仅支持大型医疗企业，比如医院系统，还可以去支持“小型服务商”——这是一个全新的发展方向。
You heard Roger just talk about that. How does it actually start to power some of the consumer agenda? How does it start to drive much greater insights from the information that we have that provide -- consumers have given us about themselves? How can we help them do that?
你刚才也听到 Roger 提到这个方向——我们如何借助已有的数据资源推动“消费者议程”？我们如何从消费者授权给我们的信息中挖掘更深层次的洞察，并帮助他们？
And so the agenda that Vivian and Sandeep began to lay out all plays into the innovation agenda for OptumInsight. I'd say all of which is not in the run rate. I think there's a remarkable opening up of potential around OptumInsight as it really starts to move on from the integration moment.
因此 Vivian 和 Sandeep 提出的那些议题，全都是 Optum Insight 创新议程的一部分。我可以说，这些新业务目前都还未完全体现到常规财务指标中。一旦 Optum Insight 真正从整合阶段走出来，它将迎来极具潜力的拓展期。
Maybe, Roger, you might want to add a couple of comments. And Sandeep, I'd love to hear just a couple of your kind of the next things that we're working on.
Roger，你可以补充几点。Sandeep，你也可以谈谈我们下一阶段的重点开发方向。
Roger Connor – CEO of Optum Insight & EVP of Enterprise Operations and Services for Optum
I think honestly, when you look at what has happened now that the Change portfolio is in, I think there is a unique portfolio to offer to the whole industry from OptumInsight.
坦率说，现在 Change Healthcare 的产品组合已经整合进来，Optum Insight 现在具备了一个独一无二的产品组合，可以面向整个医疗行业提供服务。
You look at the service offering, the software-enabled services, yes. But just look at some of the software assets that came in as part of the Change portfolio. There's the leading clinical guideline tool in InterQual. And that's not even a product, that is a portfolio that is, I think, something that we're going to build off going forward.
不光是服务本身——包括“软件支持型服务”——更值得一提的是一些具体的软件资产，比如 InterQual，这是行业领先的临床指南工具。它不只是一个产品，而是一个我们今后将不断拓展的重要产品组合。
Then you look at the revenue cycle, software like Assurance, again, a leading software package.
还有营收周期管理方面的软件，比如 Assurance，也是业界领先的系统。
I mention these point solutions because, to Andrew's point, we think the next stage is about how we connect these point solutions to actually differentiate and bring differentiated assets to the market, whether that be in administrative efficiency using AI working with Sandeep, or actually taking something as basic as the payment cycle in this industry and turning it on its head because we can link those elements together to do claims faster, more accurately and settle more correctly. We think that could be transformative.
我提这些“点状解决方案”，正如 Andrew 所说，我们接下来的重点是在于如何把这些点连接起来，打造有差异化竞争力的综合能力资产。不论是通过与 Sandeep 合作，用 AI 提升行政效率，还是颠覆支付周期的运作方式——我们可以把这些要素联通起来，让理赔更快、更准确、结算更合理。我们认为这可能产生变革性的影响。
Sandeep Dadlani – EVP and Chief Digital & Technology Officer
Yes. And just building up on that, 10 years back, we had this big step-up of reading clinical charts using AI. And that was like the Holy Grail to step up on capabilities. OptumInsight had a capability, Clinical Language Intelligence using natural language programming.
是的，我来补充一下。10年前，我们用 AI 读取临床病历是一个重大突破，几乎是业内追逐的“圣杯”。当时 Optum Insight 就已经具备了一项技术能力，叫做“Clinical Language Intelligence”，基于自然语言处理。
Now Roger has that in 7 products for different things. Whether it's determining prior auths or claims or medical necessity and so on and so forth.
而现在，Roger 已经把这项能力应用到了7个不同产品中，涉及到事前授权、理赔判定、医疗必要性评估等各类场景。
We're just taking that a step forward with generative AI. So to Andrew's point, how Optum and UHC innovate together and then use Roger to sort of spread that innovation across the industry just comes to life. AI is going to be one leading way of doing it.
现在我们正在借助生成式 AI 把这项能力再推进一层。正如 Andrew 所说，Optum 和 UHC 的联合创新，将由 Roger 把这些成果推广到整个行业。而 AI 将成为实现这一目标的关键途径。
Andrew Witty – CEO & Non-Independent Director
Thanks, Sandeep. I think we have time for maybe one last question. Julie?
谢谢你，Sandeep。我们大概还有时间回答最后一个问题。Julie？
Julie Murphy
Over here, we have John Ransom from Raymond James.
这边是 Raymond James 的 John Ransom。
John Ransom – Raymond James & Associates, Inc.
Following up on that interesting discussion in OptumInsight, a picky financial question. I think the company has said that you managed the EBITDA down, Change, to basically 0 in the first half of the year. How do we think about the margin progression of Change Healthcare back half of '23 and '24? And how much of a good guy is it for OptumInsight margins?
接着刚才关于 Optum Insight 的有趣讨论，我想问个具体的财务问题。贵公司曾表示，在今年上半年把 Change 的 EBITDA 控制在了基本为零的水平。那么我们该如何看待 Change Healthcare 在2023年下半年以及2024年的利润率走势？它对 Optum Insight 的利润率提升有多大帮助？
Andrew Witty
John?
John？
John Rex – President & CFO
So you're absolutely right, John. So last year was a big year of investment as we looked to accomplish the integration of Change in a more compressed time period than perhaps we had set up, envisioned initially.
你说得对，John。去年我们进行了大规模投资，因为我们希望在比原计划更短的时间内完成 Change 的整合。
But very important to get that done and get done as quickly as we could to move on with some of the things that Roger is talking about in terms of as we move through this period.
我们之所以这么做，是为了尽快把整合任务完成，从而尽早推进 Roger 刚才提到的后续战略方向。
So very supportive in terms of last year probably was a year of investment in just in terms of the integration component. Roger is building out a lot of tools. So you can see kind of the -- where we set up in terms of the -- both the margin for all of OptumInsight for this year and kind of the range that we set out here for the long term.
换句话说，去年更多是“整合期投资”。Roger 那边也正在开发大量工具。从今年的利润率起点和我们对长期的目标区间来看，你们可以看到全盘的安排是非常有支持性的。
So that will increasingly be additive to OptumInsight in their operating earnings growth over the next several years. Some really super interesting, compelling build opportunities we have here as we manage within that also though.
因此，今后几年里，Change 将逐渐成为 Optum Insight 经营收益增长的重要组成部分。我们现在正处在一个极具吸引力的构建期，未来潜力很大。
Andrew Witty – CEO & Non-Independent Director
So I mean just picking up on that, Dirk, do you want to just comment on the way in which Change is helping us reenvision financial services and all of that because remember, some of the change impact picks up within OptumInsight, Financial Services sits within Optum Health. So some of the value of the acquisition of Change is going to play out through that agenda. And Dirk, you might want to just update the folks about that.
那么，接着这个话题，Dirk，你要不要谈谈 Change Healthcare 如何帮助我们重新构想金融服务？要记住，Change 整合后的一部分成果体现在 OptumInsight，而金融服务则归在 Optum Health 下面。因此，Change 并购案的一部分价值，将通过金融服务议程来体现。Dirk，可以向大家更新一下这部分进展。
Dirk McMahon – Former President & COO
Yes. I think if you look broadly, what we've tried to do, as John mentioned very well, we've done a lot of the integration work this year. The next step is really to be able to develop more products within OptumInsight. We mentioned a few of them today. The first one is clearly provider enablement, clinical decision support, Roger mentioned InterQual, about how we've been expanding our ability to actually deliver software and get it really granular about one of the things that the hospital systems are looking for from us within the middle of the revenue cycle.
是的，我认为，如果你从整体来看，正如 John 所说，我们今年已经完成了大量的整合工作。下一步是在 OptumInsight 内部开发更多新产品。我们今天已经提到了其中一些，第一个显然是“提供者赋能”，再来是临床决策支持。Roger 提到了 InterQual，我们正在扩大软件交付能力，尤其是在营收周期的中段环节，为医院系统提供更精细的解决方案，这是他们非常关心的一点。
I was talking to a prospect that we have. And she said, "Look, we don't have things like natural language processing in the middle of the revenue cycle to be able to code more accurately, to be able to improve the way we code to reduce friction between the payer and us." So that kind of tool is important.
我曾和一位潜在客户交流，她告诉我：“我们在营收周期中段环节没有自然语言处理技术来提升编码准确率，从而减少我们和支付方之间的摩擦。” 所以，这类工具变得非常重要。
But I would say with respect to financial services, one of the key things is our ability to get to real-time settlement over time, right? A lot of what we are doing today involves taking waste out of the system. With payment integrity and revenue cycle management, we're sort of moving the waste down, right?
至于金融服务，我认为关键之一是我们最终能否实现“实时结算”。我们现在做的很多事情，其实是在帮系统去除浪费。通过支付完整性（payment integrity）和营收周期管理，我们在“降低浪费”，但我们希望更进一步。
What we want to do is try to reinvent that to have these less friction, to have the payments be much more seamless between payers and providers. So a big part of the system is that payment technology and make it work really seamlessly within the claim payment process.
我们想要的是彻底重构这个系统，实现更少的摩擦，让支付在付款方与服务提供方之间变得更加流畅。因此，支付技术是这个体系中的关键组成，要让它与理赔支付流程高度整合，实现真正的无缝衔接。
Andrew Witty – CEO & Non-Independent Director
Great. Thanks, Dirk. I'm afraid we're out of time. Unbelievably, that went incredibly quickly. Let me first of all just say a very big thank you for you all spending the time with us this morning.
太棒了，谢谢你，Dirk。很遗憾，我们的时间用完了——令人难以置信，这个上午过得如此之快。首先非常感谢大家今天早上抽出时间来与我们一起。
And I hope you got a sense of the agenda that's laid out for us at UnitedHealth Group, both in terms of how we're responding to short-term events, which of course they happen. But more importantly, the progress we've made over the last several years to bring together many aspects, components, individual parts of our capabilities, really trying to bring that together behind these driving agendas of really being a leader in value-based care because we do think it's the best way to deliver care, and empowering the U.S. health care consumer because we believe over the next decade or so, that will be an absolutely must-win agenda for a company like this.
我希望大家能从今天的内容中清晰感受到 UnitedHealth Group 的发展蓝图，不仅在应对短期事件方面（当然这类事件是不可避免的），更重要的是，我们过去几年持续取得的进展——把多个方面、多个环节、多个能力拼接起来，最终整合在两大核心议题之下：其一，我们致力于在“价值导向型医疗”领域中担当领导者，因为我们坚信这是最优的医疗服务交付方式；其二，我们致力于赋能美国医疗消费者，因为我们认为在未来十年，这将成为像我们这样的公司必须赢得的核心战场。
And I hope what you saw today was maybe a selection of ideas you've heard before, but actually suddenly, wow, they're actually on apps and millions of people have them and they work. They're not just theories, they're not just things that appeared in journals, as somebody said earlier on the stage. But they're now appearing -- and by the way, it's not just one thing, it's many things all being pulled together.
我也希望你们看到的，不只是你们过去听说过的那些“想法”——而是如今已经变成现实的东西，比如它们已经出现在应用程序里，被数百万人使用，而且确实发挥了作用。它们不再只是理论、也不再只是某篇学术期刊里的概念，正如台上的几位同事所说，这些想法已经真正被落地，而且不是零星一个，而是众多创新同时汇聚、整合在一起。
And really behind all of that, what we're trying to do is take all of the complexity of the U.S. health care system. What we can't streamline, we're going to basically hide from the consumer in the sense of why do we need to expose all this complexity? Can't we just be a great translator of what this incredible system tries to achieve and just make it easy for everybody to engage with? That's what I hope you take away from today. I hope you get a sense of real progress and momentum around it.
归根结底，我们正在努力的是：面对美国医疗系统的高度复杂性，我们希望能将其中无法简化的部分“屏蔽”起来，避免让消费者承受它们。我们为什么要把这一切复杂性暴露给用户？我们完全可以成为这个庞大系统的“翻译器”，让它的运行目标清晰易懂、让每个人都能轻松使用和接入。这是我希望大家从今天的交流中带走的核心感受：我们确实在取得实质性进展，势头也正在加速。
Finally, I also hope you very much take away our super-strong commitment to continue to deliver for our shareholders and owners. You're incredibly important to us. We can only do what we do with the support that you give us.
最后，我希望你们也能深切感受到我们对股东和投资者持续交付价值的坚定承诺。你们对我们至关重要。我们所能取得的每一步成就，都离不开你们的支持。
I hope that you feel that what we're laying out for you is ambitious. We believe it continues to demonstrate the application of some of the best minds in health care, combined with, without doubt the most committed workforce in health care, to deliver every single day for literally tens of millions of people across this country and beyond. And we hope that, that continues to demonstrate to you the seriousness with which we undertake our mission on behalf of the people who rely on us and on behalf of the people who own us.
我希望你们觉得，我们为你们所展示的，是一套真正具有雄心的规划。在我们看来，这正体现了医疗行业中最优秀的人才，与无疑最具使命感的员工队伍携手合作，共同为全美乃至全球数千万民众，日复一日提供服务。这也正是我们承担使命的诚意所在——我们不仅为信赖我们的人服务，也为拥有我们的人服务。
Thank you very much for today, and we look forward to plenty more engagement during the rest of the seminars. Thank you.
再次衷心感谢大家的参与。我们期待在今天余下的研讨中继续深入交流。谢谢大家。
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