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Hello, everyone. This is Jacob Emerson with the
Becker's Healthcare Podcast.
Thrilled today to be joined by a really
special guest. Krista Nelson serves as the CEO
of Optum Health. Krista, thank you so much
for taking the time to be with me
on the podcast today. Well, thank you, Jacob,
for having me. It's great to be here.
Absolutely. It's a pleasure to get to talk
with you, Krista. And before we dive into
everything we wanna talk with you about today
and all the special work going on under
your leadership at Optum Health, can you first
fill in our audience on,
your health care career background and what it
is that you do today at Optum Health?
Of course. So,
today at Optum Health, I I lead the
organization. And prior to this role, I was
the chief operating officer for Optum Health.
And really before that, I have a broad
background in health care
both on the,
Optum side in our, you know, data analytics
and consulting organization,
but also,
extensive background on the payer side at UnitedHealthcare,
leading operations,
in our Medicare business, and then also,
leading our Medicaid and duals business
as well as operations on the UnitedHealthcare
side.
But I'm, you know, delighted to be
in, this role and really honored to be
leading this organization
through what is a, really incredible time in
health care.
Absolutely. So you've been with the broader company
for a long time now and serving in
different divisions of UnitedHealth and Optum.
And now you've stepped into this role leading
Optum Health during, as you know, a really
important period, a strategic shift
for this part of the company overall,
moving from rapid network expansion toward a more
focused direct employment model. We heard from Optum
CEO publicly,
last year talking a little bit about,
how how in the past, the the company's
rapid expansion maybe didn't align with clinically oriented
value based models.
So
given all of that, what's your vision now
moving forward for what Optum Health looks like
on the other side of this major transition?
Yeah. You know, when I joined Optum Health,
we, you know, we quickly assessed
the business and the capabilities
and and our contracts
and our, you know, our work with our
payer partners.
And it was, you know, clear right away
that we needed to make the
necessary shift
to your point, you know, moving from what
was really a rapid period of expansion and
growth just back towards our core model.
You know, before I answer your question on
our vision,
I just I thought I would share just
three things that,
really stood out to me from the very
beginning. Please.
You know, first and foremost is
we have just incredible capabilities inside OptumHealth. You
know, our primary and specialty care, behavioral health
care,
home health, hospice,
palliative care, as well as surgery centers.
You know, we care for people in clinic
as well as in their homes and in
their community,
and we still also support,
you know, transitions of care.
And, you know, our model is anchored in
primary care. And when we employ
and deeply partner
across these various service lines
with an aligned payment model, you know, our
value based care model delivers superior outcomes
at a lower total cost of care
while we see improved patient experiences
and provider satisfaction.
And, you know, maybe just give one example.
One of our markets, Houston,
where we serve
almost a million patients
across more than 50 different clinical settings.
We offer that full suite of services that
I mentioned, you know, primary care, labs, imaging,
specialty care, surgery,
care coordination.
You know, in this market, we have a
four and a half star health plan,
total cost of care that is 15 to
30% lower than the alternative,
patient satisfaction scores
in the nineties,
and
really low provider turnover.
So, you know, again, first, it's just this
incredible
set of capabilities inside Optum Health. You know,
second thing I wanna call out is just
well, we have a number of really
strong
examples like I just mentioned, like Houston.
You know, we have seen and we've discussed
this publicly. There's we do have some variation
in our performance across our markets.
And, you know, whether it's attributed to some
of the funding headwinds from b twenty eight
or, you know, consistently
elevated medical trends
and really just that significant growth in our
risk membership.
You know, our operating performance is, you know,
is inconsistent
across employed and contracted providers.
It's also, you know, we have some opportunity
in our current contracts with our payer partners,
and with our network providers. And so that
is really
creating a lot of opportunity
for us.
And, you know, the third thing I would
just say is
the culture,
the mission, the passion
for value based care
is still,
you know, alive and well and just really
deeply rooted in the organization. So those three
things are really incredible signals
that, you know, have helped me think about
kinda what could the other side of this
look like.
And I guess to answer your question now,
you know,
you should expect Optum Health,
you know, on the other side of this,
to really more consistently
deliver
market leading integrated value based care.
A system that is anchored with our employed
groups,
but with the help of technology
and, you know, operational improvements,
more scale,
and a more tightly managed network to help,
enhance that scale.
So we will have a much stronger base
to grow on whether that's in our existing
markets
or in new service lines
and in new markets.
And, you know, what does that mean?
You know, what does that mean for patients?
It means
improved health status and quality of life.
You know, for example, today, even with those
challenges I mentioned that we're navigating,
our Medicare Advantage patients
served by our model have,
you know, twenty one percent fewer hospitalization
admissions overall.
You know, our patient outcomes
improve
and care coordination increases
and really patients
should continue to expect
a high quality experience when they come to
Optum Health.
For clinicians and care teams that that work
here and and partner with us,
it means we'll have more technology enabled
improved
workflows
that are focused deeply on reducing administrative burden.
We talk a lot about reducing pajama time,
improving
the consistency
in our clinical excellence and our clinical workflows.
And then, you know, last, I would just
say for payers and and health system partners,
you know, more reliable,
execution,
deeper
reach in our existing markets,
so we can serve more patients across more
service lines
and continue to ex execute,
really the promise of value based care and
the outcomes that we continue to generate.
Understood. So, really,
building on and improving that base to deliver
more market leading care, that's your vision for
the other side of this, Christa. And, of
course, you know, as you know, at the
center of that is your clinicians, and you
mentioned just the the incredible,
abilities of OptumHealth all over the country with
primary and specialty care, home health, palliative, surgery
centers, behavioral.
So
as the company evolves,
how are you working to intentionally improve that
clinician experience? And I know you just touched
on that a bit, but how are you
actually on the ground enabling those care teams
so that they can practice at the top
of their licenses
and then ultimately ensure that they feel heard
and aligned with,
this massive organization
across
markets, individual markets all over the country?
Yeah. For me, this
is critically important
and, you know, improving
the clinician experience for me starts with listening,
listening to our clinical teams,
observing,
the workflow, the experience,
and really ensuring that we design our system
that supports
how they practice value based care and their
needs,
you know, relieving burden,
like I mentioned, kind of making it easier
for them to practice that model. And, you
know, in addition to listening to our clinicians,
I would also say it's deeply important to
listen and understand
how, you know, advanced technology and how rapidly
technology
is is changing and making sure we're taking
advantage of of modernized technology to enable
that clinician experience.
But there are other you know, there are
three other things that come to mind.
The, you know, the first is,
what's important to us here is really strong
dyad models.
So our physician leaders
and our operating
leaders and partners,
you know, being aligned
and leading the change really together,
across our markets
to make sure we're advancing our models.
And that dyad partnership at the top of
the organization
all the way through the organization at the
local care delivery level is critically important to
to enabling
our care teams to be practicing at the
top of your license like you mentioned.
You know, the second thing is
having strong engineering and product teams
paired with our dyads,
to build technology solutions and workflow capabilities that
actually work and to do that,
with speed.
Today, we have,
you know, really good relationships and partnerships with
our Optum Insight partners.
And we've done a lot of intentional work
to, again, make sure that our engineering and
product teams are really, you know, colocated
with our strong dyad partners. Again, so that
we're we're listening, we're learning, we're actively adapting,
and we're deploying
capabilities faster,
at the market level to get that real
time feedback and scaling
quickly.
And that that really is part of,
some of what we're doing to improve our
operating performance is is making some of those,
scaled improvements happen faster
across our practices and across our our delivery
service lines.
And then third,
we we just continue
to remain deeply committed to value based care,
and that is at the core of our
mission,
our purpose,
and our why.
And I think to have a really good,
clinician experience,
we need to stay rooted in that that
core, which is really why we exist. You
know, our clinicians and our care teams are
passionate passionate about value based care.
It allows them to deliver holistic care.
It allows them to spend time with our
patients
to avoid
chronic disease.
Instead of, you know, rushing through high patient
volumes, I mean, they they they came and
they're choosing value based care because it reduces
burnout and stress and allows them,
to practice medicine the way they they wanna
practice it. And so, you know, while we
stay focused on operational improvements,
we are certainly not losing sight of why
we exist,
in the environment that attracted
physicians and incredible care teams to work here
and keeping that core to everything we do,
you know, to make sure we're bringing value
based care
at scale with the appropriate outcomes,
cost management, and an improved patient and provider
experience each and every single day.
Absolutely. It's very clear that you see value
based care as as core,
as a core model to continue moving towards
improving,
certainly not straying away from that as your
core mission, Christa. And and you mentioned
Medicare Advantage there in your in your last
answer. And I wonder if we're talking a
little bit about what's going on in the
industry more broadly,
of course, c CMS put out their proposed
rates for for Medicare Advantage for next year,
basically flat funding overall for the program if
if that proposal
stands.
And the federal government received record comments from
the industry this year about that proposed rates.
And then it comes as a time, as
you know, where utilization is up, care costs
are up for for caring for seniors.
So everybody is talking about this. You'd be
hard pressed to find, an insurer that is,
satisfied with the proposal.
So from from your perspective and and giving
your your expertise,
because of your long career in this industry,
can you talk to us a little bit
about how stability in Medicare Advantage policy and
in funding,
going beyond the payer perspective and how that
enables providers like yourself to invest in better
care models
and and then ultimately, of course, delivering better
outcomes and experiences
over time for for seniors.
Yeah. This is it's an important topic.
And,
you know, I think just to reiterate where
you started, you know, our deep conviction,
and belief in value based care being the
right path forward.
Maybe I'll just unpack that for for a
moment and then, definitely wanna get to, you
know, the question around, you know, the the
advanced rate notice.
You know, I think, again, we've continued to
reiterate this, but I think it's just incredibly
important to to remember that a major contributor
to high costs and low value care in
The US is this
current systems, you know, reliance on fee for
service payment models, which
reward for volume of products and services consumed.
You know, it's a system that's really built
on the intensity of treating people when they're
sick rather than one that's focused
on proactively keeping people healthy and and keeping
them cared for.
And I I mentioned,
you know, some of the outcomes.
You know, today, our Medicare Advantage patients served
by value based care models
have twenty one percent fewer hospitalization
admissions overall.
And those numbers actually grow,
for members with certain conditions. So for example,
members with hypertension, it's, you know, thirty five
percent reduction in hospital admissions and,
forty four percent reduction in, hospital admissions for
those with COPD and and asthma and other
acute and chronic conditions. So
so,
you know, we we have
the data,
and the support to support value based care
and why it's it's really needed now more
than ever.
And and as we think about the, you
know, advanced rate notice,
and what's, you know, kind of just sparked,
you know, significant discussion
is, you know, bottom line when
when there's
rate pressure and lack of rate stability, it
does squeeze funding,
which does, you know, unfortunately, impact value based
care.
We've seen that with,
the changes with, you know, v '28. We've
seen that with
the growth rate maybe not keeping up with
medical cost trends and and that cost trend,
you know, impacting
value based care. And and frankly,
it also,
you know, payers
respond in that environment. And and while we're
all focused on reducing administrative cost and waste
in the system,
you know, unfortunately, some of those rate cuts
do result in,
benefit
cuts for seniors.
And then it also results in
in in some cases mispricing,
which that has been a effect of what's
happened in value based care. And for us
in particular,
you know, that mispricing kind of does impact
downstream value based care providers like us. And
so, you know, we just believe in stability
and Medicare Advantage
funding because we continue to see,
the outcomes are better, the quality is better,
the costs are lower, you have more benefits
inside Medicare Advantage
than compared to,
you know, Medicare Supplement or Medicare fee for
service.
And,
and I think the last thing I would
say is when that funding is not stable,
what happens is then we are gonna need
to make, you know, choices in how we
manage that that cost environment and that cost
reduction. So,
you know, I mentioned benefit cuts for seniors,
but it also means maybe less time spent
on preventive care or it means us having
to think about trade offs with,
wraparound services or
investments we make in in care teams and
care coordination.
And what happens then is, you know, patients
may end up in the ER or getting
fewer preventive screenings or things of that nature.
And so, you know, we're advocating strongly on
behalf of our patients,
on behalf of our providers,
and in partnership with our payer partners to
ensure
that we can continue to advance and scale
the value of value based care,
because we again, we believe that it is,
the right approach
to,
reward a system and and really incent a
system to focus more on on preventive holistic
care
for Americans.
Certainly. And to your point, Krista, I mean,
we've already heard from industry groups, from individual
insurers about what this this advance rate notice,
what it would mean for benefits for seniors
down the line,
if it if it becomes reality as as
currently proposed. So,
it will be fascinating to see what happens
there, but I I and I know that's
something we could talk about during this entire
conversation, Medicare Advantage alone. But I wanna also
make sure to ask you a little bit
about AI. I know it squeezes its way
into every conversation right now.
But but we've been hearing from UnitedHealth more
broadly
about how much work the company and investment
the company is making into this technology.
We we heard about how the company has
deployed more than 2,000
engineers
into AI initiatives and integrated over a thousand
AI use cases across the broader business.
So where you
in in the part of the company that
you lead, where you already seen AI,
technology more broadly,
meaningfully reduce
burden or or improve the experience overall for
for for your patients, for your care teams,
on the ground? What is that looking like?
Yeah. There's really there's so much opportunity here,
and I'm, we remain deeply committed and really
excited about what AI can do to,
again, reduce administrative burden, kind of reduce, you
know, waste in the system, and really enable
our care teams to operate at the top
of their license. And also really create more,
you know, access for people so they can
they can focus on care and not, not
as much on the, you know, whether it's,
like, the documentation side or the summarization side.
So a couple of examples that are that
are already live on our end.
First is, you know, just ambient scribing, which
allows
clinicians to really focus more on that face
to face conversation
with their patient and, you know, that scribe,
you know, really taking all the notes,
and allowing physicians again to focus on their
patient and really just kind of review and
approve the notes at the end of the
day so they're not, you know, face down
in a computer
or having to work on notes,
in their pajamas at home later at the
end of the day. That's just, you know,
one example.
Another is,
you know, beyond that documentation,
using technology to really kind of summarize
care.
So kind of pull different, you know, medical
records, charts, claims,
labs,
history,
information,
that the patients are sending us in advance
their appointment, kind of pull all that together
to help care teams,
be more prepared for the visit
and have a kind of a prioritized set
of of things that they wanna make sure
they're addressing with the patient in addition to
listening to what the patient needs are. You
know, that's one. And third, a way in
which that comes to life not just in
a clinical setting,
but,
as you know, we have a number of
nurses
that do home health visits.
And,
we use that same kind of summarization tool
to help our nurses that are, you know,
driving to patients' homes
by allowing them to have this summary and,
like, an easy to listen to audio summary.
So, again, they get to know their patients,
they get to digest that history,
on their way to the visit. So they're
not having to spend as much time kind
of redoing all that history, but instead validating
it and focusing more on the patient needs
in front of them. And I would just
say these are, you know, three
very simple examples, but the opportunity
is is truly vast. We are
absolutely
investing dollars and resources and, you know, putting
teams deployed to these exact same things.
I go back to what I said in
the beginning, which is,
really starting with listening to our clinicians
and starting with what they need to improve
patient care and patient outcomes and always making
sure that, you know, they're operating at the
top of their license.
One other thing I just wanna mention here,
which is really important to us is while
AI,
will be able to do a lot in
health care, I think there's something really critically
important in health care, which is kind of
humanity and empathy and care.
And that's something
that, you know, AI isn't replacing
yet,
and may not. And that's where our clinicians
and care teams
being able to practice medicine,
enjoying their work environment,
focus on value based care,
bring you know, being able to bring that
empathy,
into every one of our our visits and
our experiences with our patients is always going
to remain critically important.
Understood. So it really sounds like at the
core of these investments, you wanna make sure
that you're enabling and better supporting that that
human,
to patient to to clinician connection.
Krista, before we go today, you know, we
we've talked a lot about,
the pivotal time for Optum Health, what's going
on in the industry more broadly,
and then your your conviction that value based
care, that that strategy is the correct one
moving forward.
Has anything surprised you so far in in
your role? I know you've you're coming up
on just about six months,
of leading OptumHealth.
How how is
leading such a critical company for the industry
overall? How has it shaped your your personal
view of where this industry is headed?
You know, I,
I am even
more convinced
that,
you know, value based care is is,
truly the the answer right now in health
care when, you
you know, when people aren't getting the quality
care they deserve, when costs are rising and
not affordable,
when patients
aren't satisfied with the experiences and providers are
burned out. I just I continue
to remain convinced that we have the right
value based care model,
and there's a lot more opportunity to grow
and to scale this to even more and
more people.
And,
you know, you was you mentioned what has
surprised me the most.
This business has really been going through,
significant change,
and we've, you know, we've talked at the
beginning about, you know, operational opportunities to improve
performance.
But what is really alive and well
is,
you know, resilience,
a deep
purpose
and commitment to our patients
and to the promise of value based care
and truly,
an innovative
spirit to,
and kind of that growth oriented spirit to
always show up and do better tomorrow for
our patients
than we're doing today. And I just think
maybe I shouldn't have been surprised by that,
but I'm so pleasantly surprised with
the that purpose
and the potential of this business. And I
couldn't be more thrilled to be here at
this time when health care needs us now
more than ever, and you've got a team
that is truly ready to deliver better outcomes
for patients that we serve and,
just honored to be here. Yeah. I'm sure
it's a very satisfying thing to be surprised
by. I my last question for you super
quick. You know, we're being listened
to by thousands
of hospital executives around the country, health insurance
executives,
all facing similar pressures,
as you and your colleagues.
Anything else you'd you'd wanna share with them?
Final bits of advice.
You know, I think there's never gonna be
just one simple answer, one simple solution or,
you know,
to the challenges that we're facing in health
care.
It is really gonna take all of us
to work together,
find common ground,
align
incentives,
and, you know, work together to deliver a
better experience for patients
and and better quality outcomes for society.
And
we welcome those partnerships. We welcome those conversations
and those relationships
and the ability to work through,
those aligned incentive models to make sure that
that we are improving,
for all of us. We have that responsibility
to improve what we do each and every
day for the patients that need us the
most. And I think,
I'm
really optimistic
that,
you know, we have great relationships today, but
I'm even more optimistic that with the results
that we
have in our clinical models today and with,
the relationships that we have and and frankly,
the momentum we're gaining that
I think we're in a great position to
come together with whether it's hospital system partners
or payer partners,
other clinical leaders, network providers in our communities,
and actually just start to action
against this and, you know, continue to hold
ourselves accountable to do that together as a
society and together as partners.
Wonderful. Well, Krista, I can't thank you enough
for taking the time to chat with me
today on the podcast and for sharing your
insights, your expertise
with our listeners. We truly appreciate it. Thank
you so much for having me.
And to our listeners, if you'd like to
listen to more podcasts from Becker's Healthcare, you
can visit beckershospitalreview.com.