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[On-screen text: Health Trend Talks with UnitedHealthcare]
[Video preview of the upcoming conversation]
DR. RHONDA RANDALL: In 2026, I think the main trend that I would really pay attention to is the presence of disease at a younger age, and what we can do to identify it earlier and intervene faster.
[On-screen text: Health Trend Talks with UnitedHealthcare]
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[Craig Kurtzweil speaking on screen]
[On-screen text: Craig Kurtzweil, Chief Data & Analytics Officer, UnitedHealthcare Employer & Individual]
CRAIG KURTZWEIL: Welcome to Health Trend Talks with UnitedHealthcare. I'm Craig Kurtzweil, our Chief Data and Analytics Officer for UnitedHealthcare’s Commercial Business. Today I'm happy to be joined by Dr. Rhonda Randall, Chief Medical Officer for UnitedHealthcare Employer & Individual, for a candid discussion about what the latest health trend data may tell us about where clinical strategies, care management, and whole person benefits need to go next. Thanks for joining us, Dr. Randall.
DR. RHONDA RANDALL: Thank you for having me.
CRAIG KURTZWEIL: Now, if I'm correct, you've been with UnitedHealthcare for over 20 years now. A lot has changed within your role and within what we're seeing across the healthcare landscape. Do you mind just starting with your career journey and where that's kind of led you within UnitedHealthcare?
[Craig Kurtzweil and Dr. Rhonda Randall sitting in a recording studio set, speaking into microphones, having a conversation]
[On-screen text: Rhonda Randall, D.O., Chief Medical Officer, Executive Vice President UnitedHealthcare Employer & Individual]
DR. RHONDA RANDALL: Yeah, sure. Really glad to be here. So, 23 years ago, I came here as a geriatrician, really, to focus on the populations that are most vulnerable in our government programs, Medicaid, long-term services and supports at a state level. And then spent a significant amount of my time in care delivery, what is now Optum before the Optum brand existed. And then supported our Medicare and retirement and group retiree segments for the first half of my career. And then that led me to working with the commercial population now for about a decade, been supporting employers, consultants, and brokers, and thinking about the care of the working population and their beneficiaries as well.
CRAIG KURTZWEIL: Now, during that time period, we've worked a lot together on different trends and drivers in the marketplace. A lot has changed for employers. Would you mind just talking about where you see some of the healthcare trends changing for employers, for what things were like 20 years ago versus what they're challenged with today?
DR. RHONDA RANDALL: Yeah, even a decade ago, most of the conversations were on singular diseases. And coming from that background of government programs and more vulnerable populations, it was very common to see individuals who had more than four chronic conditions. In the over age 65 population, more than 90% of people have one or more chronic conditions. And in a commercial population that used to be a much, much smaller population. If you look at the number of individuals who got admitted to the hospital 10 years ago was significantly lower than it is now. So, I think what we're seeing in that time, in that trend is what we've been following in population health reports. I have been very involved throughout my career also with UnitedHealth Foundation and America's Health Rankings. And we've been following America's data over that same period of time that internally we've been following UnitedHealthcare's data. And we have been seeing that through the broader definition of health, through socio and economic challenges, through lack of physical activity, through trends that have been happening positively and negatively with lifestyle and behavior, that more of that chronic disease is happening in a younger population. We first saw it with metabolic conditions like diabetes getting diagnosed at a younger age. But now in 2026, I think the main trend that I would really pay attention to is the presence of disease at a younger age, and what we can do to identify it earlier and intervene faster so that people truly are getting that same soundbite that we've all been talking about in this industry for a really long time. Right care at the right time, in the right place. It matters more now than ever as people are developing chronic diseases at a younger age.
CRAIG KURTZWEIL: And especially as you think about the complexity of some of the chronic diseases that are out there. How does that change the way an employer should think about their clinical strategy?
DR. RHONDA RANDALL: It’s a really insightful question, and I'm glad that you used the word complexity because that really is where to pay attention. When you develop diabetes in a younger generation, 20, 30, 40, for example, by the time that you are 10 years from that, you're going to have vascular complications. I think we often think about—and I don't mean to focus on a singular disease. It's just a really good example because of the prevalence. That is not a blood sugar disease. It's a vascular disease. And you have to think about the large and small blood vessels that it damages. So, we all know about the effects that it can have on your kidneys and your eyes and your heart and your brain, etc. So, you're starting to see those comorbidities develop younger as well. And then we can't forget about the comorbidities that are related to behavioral health, for example. So, people might be surprised to see—you won't be as a data scientist—that the most common chronic conditions that are related to behavioral health diagnoses are often cardiac conditions in nature. So, you often see these things all happening in the same population at the same time. And then here comes the inflammatory condition that comes with a significant price tag associated with the pharmacologic treatment of that. So, 10 years ago, you and I would have gone and spoken about a program for each disease. And we really were on the leading edge of moving away towards single disease management and to putting people into a complex care management system because they want navigation support. They want one individual to talk to throughout the course of their journey and not have it be fragmented.
CRAIG KURTZWEIL: There's also a lot of discussion these days around a term whole person health. I've heard you talk about this. So, would you mind simplifying that for employers? What do you view as whole person health and how can employer take that and apply that to their benefit strategy?
DR. RHONDA RANDALL: It’s why I became an osteopathic family physician and then a geriatrician is whole person health. Thinking about, like last I looked, your mind and your body are very connected. And also thinking about areas like specialty, so dental, vision, hearing, and how important these things are to our overall health. That vision exam can be a significant window into other conditions. A dental exam can be a significant window into other conditions. Hearing, all these areas as well. So, for me, whole person health is considering all of that. Not only medical, pharmacy, behavioral and specialty, but also our social connectedness, really important to our health as well. And then last but not least, something that matters in this industry is our financial health. So, ability to be able to pay for the health care that you need and that affordability is also, I think, a part of whole person health.
CRAIG KURTZWEIL: I know you and I worked hard on completing the latest health trends report that we just published. In that report, we found, obviously we're in a period of higher-than-expected trend than we've historically faced in the healthcare space, driven by an increase of catastrophic claimants. We have specialty medications, pharmacy broadly increasing. And when you look through that in your clinical lens, what's the one area that you really focus in on as a unique trend driver that we're facing right now?
DR. RHONDA RANDALL: I would say there's not one unique trend driver. That's what's different. As you and I talked before, like we could see that there was an emergence of a particular class of medications, or there was an emergence of a new technology for diagnosis or treatment, or there was an emergence of a significant diagnosis or a chronic condition. I think what we're seeing now is not a singular thing. So, working with entities and businesses that really understand that complexity and are looking at solutions that really help the person rather than the condition, I think are becoming more and more important in an employer situation. And that is where we can lean on a lot of what we've learned with complex populations in our sister segments. They already have a lot of expertise in taking care of individuals who have multiple chronic conditions. And now we have something that is incredibly valuable to us, and I'm sure that we'll talk about, is earlier acquisition of those signals, the data that tells us this person is starting at an important point in their journey, where if we intervene now, we can make a significant difference, not just in the cost and affordability, but most importantly, from my perspective as a physician, the outcomes and that experience.
CRAIG KURTZWEIL: And some of those early indicators don't come from medical data.
DR. RHONDA RANDALL: Correct.
CRAIG KURTZWEIL: A lot of that comes on the pharmacy side where there's a lot more interactions, a lot more early indications. As you think about an employer and their benefit strategy, how does the integration of medical and pharmacy play into what you would view as the appropriate way to handle the clinical needs of a population?
DR. RHONDA RANDALL: I've always thought that there was incredible value in integrating them. Back in the day when it was mostly managing pharmacy from a unit cost perspective, are we getting the best price for the commodity of a pharmaceutical. Now it's really thinking about what does that mean as far as outcomes are concerned. So, it's beyond just the coordination of benefits with pharmacy, of is the cost lower on the medical benefit or the pharmacy benefit if it could be paid for either way? There's some significance there. But you're absolutely right. The transaction of a medication happens at such a frequent rate in US healthcare system. That is the most common thing that happens when you go to a healthcare professional's office, is the writing of a prescription. And so, using that as one of our early data signals, among others, diagnostic tests, that is for me as a physician, really valuable to understand and identify who needs our navigation support, who could benefit from care coordination, and doing it in that moment in time where it matters the most.
[On-screen text: Rhonda Randall, D.O., Chief Medical Officer, Executive Vice President UnitedHealthcare Employer & Individual]
Because if you wait too long for that claim to build up, you want that real time signal of the pharmaceutical was just dispensed. That’s a real time point of service signal that's incredibly valuable.
[On-screen text: Craig Kurtzweil, Chief Data & Analytics Officer, UnitedHealthcare Employer & Individual]
CRAIG KURTZWEIL: I think as you look back over the last, you know, a couple of decades, the real time signals is probably the thing that's changed the most. To me, the quicker you can get a hold of the data, those of those indications, the better success rate you're going to have in actually engaging that population.
DR. RHONDA RANDALL: You’re absolutely right. And when we talk about real time signals, I think for a number of years now, the hot topic has been ADTs, that's admission, discharge, and transfer data. It comes over on an HL7 feed. It's the same technology that checks for benefits and eligibility, is letting us know that your beneficiary is in our emergency room. They've left the hospital. We're transferring them somewhere else. And that's a really valuable signal. But it's beyond that. It's real time lab data, which we get at a very high rate, those real time lab signals. Notification data. When a when a physician tells us we don't need prior auth on this anymore. We've decreased our prior authorization requirements quite significantly over the last several years, and more is coming. But when we get the notification that isn't a clinical review, but it's, I'm letting you know that we're going to do a surgical procedure on this individual. That's a really valuable real time signal for us. It’s a really valuable signal for us in cancer, for example, when somebody's going through an advanced cancer journey. That's when we know, when that chemo has been ordered, within hours, we can know that this is an individual who would benefit the most from having somebody support them and navigate their benefits and navigate their journey for them and help them with those complex decisions. In the future, and in the near future, the richness of the data that we get from the integration that we have from EMRs, for example, it's going to give us much richer clinical information, not just a simple signal, but data that's very actionable.
CRAIG KURTZWEIL: As you think about, we've gone from months to weeks to now days as far as speed of data to understand what's happening with those individuals, and we're headed towards a world of predictive, of even before the events have occurred, to be able to predict where people are going and how we can intervene with them sooner, leveraging AI and capabilities like that. How do you see some of those more advanced analytic technologies kind of morphing into the clinical model?
DR. RHONDA RANDALL: Well, I'll start with this. The artificial intelligence that's been around in healthcare the longest is a predictive model. Identification and stratification of a population, that's been around longer than you and I have been in healthcare. Today's additional investments in AI are really toward providing the healthcare delivery system with the real time answer and the transparency that they need about what those requirements are in order to submit the request and getting the answer. Often, when the patient has, still in the exam room, before they've left to go get their prescription filled, or before they've gone to schedule that procedure so that the treating physician and the member have the answer, in many circumstances, much faster.
CRAIG KURTZWEIL: We know that UnitedHealthcare has made a lot of changes when it comes to prioritization, and you've been heavily involved in that. Would you mind just briefly covering what are some of those changes we made recently, and what sort of impact is that going to make?
DR. RHONDA RANDALL: We’ve made some incredibly positive changes over the last three years. So, we've been on this journey for quite some time. And that first one was in 2023, where we reduced prior authorizations by 20% of our volume. The next part of that journey was to gold card physicians that have a consistently high rate of getting to yes and removing some of that administrative burden from them. The third is things that we've announced just this year. An additional 30% reduction in prior auth volume, a focus on the pediatric population that was very data and analytics based. Some of the things that we noticed, particularly with diagnostic studies in children, is over time, there was less variation in what was being requested, resulting in very high rates of approval. So, removing that unnecessary step in the process in the pediatric population for many codes, particularly a lot of the diagnostic services. And the third is for rural areas. We know how important those rural healthcare delivery systems are to our communities where many of us live and work. So, providing some support for them in faster payments and thinking about some of these additional reductions, are investments that we're making, and leading the industry in this regard. We were the first out the gate with these commitments, and we're hoping that others follow us.
CRAIG KURTZWEIL: Let's go back to some of the trend drivers. So, you mentioned pharmacy. Specialty pharmacy is a huge driver. And as part of that, we spent a lot of time talking about cancer. Cancer has gone through a seismic change over the past five years, in my view, analytically looking at it. We haven't seen a tremendous uptick in the prevalence of cancer, but it's more so about the cost of treatment for cancer. What do you see clinically going on in the cancer space?
DR. RHONDA RANDALL: Well, here's the good news. Cancer deaths are either leveled off or slightly declining over the last several years. That's terrific news. Early detection is getting better. We're seeing still not enough, I will say. If you look at colorectal cancer screenings, breast cancer screenings, some of the ones that are really expected to be at very high rates, we still have a long way to go in our nation around getting those cancer screenings done. We're very proud of the work and the outcomes that we do here. We can see it in the external actuarial reports that the work we do in prevention in those early screenings absolutely is making a difference. But the treatments that are available are doubling at an incredibly high rate. It's very challenging to keep up with the frequency of new evidence and new regimens that are out there. So, when we have tools that are available to the treating oncologists that use their own guidelines and put it in front of them in a way that is straightforward, transparent, and also gives them information on which of those regimens has lower toxicity, which of those regimens has a lower out-of-pocket cost for the patient sitting in your office right now. It’s helping them make more informed decisions. But as we move forward and invest, it is beyond just that treatment regimen. It's what is the arrangement and the contractual arrangement we have with the oncologist? What's the member experience and the member navigation look like? What is the important role of getting your care from a center of excellence, depending on the condition that you have. I'm not talking about common stage one cancers, the more advanced cancers. And now we have therapies that are available for a broader range of conditions, but they come with substantial price tags associated with them. And employers want to see, and what they should be measuring is outcomes.
CRAIG KURTZWEIL: I think you said that very well. It's an amazing time. It's exciting for—my family struggle with cancer, historically. So, it's an amazing time, a lot of hope in that space for people to be able to live with cancer now. But as you mentioned, how do you do that in an affordable way? How do you do that in a way that doesn't bankrupt the system, and we can help employers migrate through that strategy. As you mentioned, some of the decision-making that members make around screening, compliance, mammography rates, things like that. We always study member decision-making. It's a core part of what we look at in a population. Are people making good choices, bad choices. And that's obviously a key role of our navigation features of our clinical model. How do you see those types of programs helping members make better choices?
DR. RHONDA RANDALL: I think it really all is about being individual centric. It ties back to what we talked about just a few moments ago, not looking at this is a population that has this constellation of diseases, but this is an individual. Every single one of us experience that journey differently. Your family members who went through their cancer journey are not going to have the same experience as someone else's family member who went through their cancer journey, as we have invested more and more in digital technology and in investing in that experience of how people want to interact with their healthcare, starting with the making a good choice of where to go to get their care. Whether it's a UHC plan or a Surest plan, having that navigational support up front really sets up everything on the back end. So, I think the personalization is so important. And it's what people expect now, is that predictive personalization. And as we acquire more clinical data from EMRs, etc., it only bolsters the ability to do that more in the future.
CRAIG KURTZWEIL: As you think about all the trends that we're analyzing and studying, what's one trend that employers should really, if they're going to pick one, what's one trend that employers should focus on today? And maybe the opposite of that. What's one trend of a topic that employers have focused on for the last decade that maybe shows better value or not as much need for an employer to really focus on today?
DR. RHONDA RANDALL: Well, I think it's apropos that you and I are having this discussion because my answer really is all around measurement. I think, historically, we have measured things one program or product at a time. We've measured pharmacy separate from medical benefits. And even within medical benefits, we've measured a clinical program for heart disease separately from a program for high-risk maternity. I think the future really is looking at not only total cost of care, but outcomes that are associated. So, what are you getting for the value of what you've invested in that treatment, in that care pathway and the individual experience in healthcare.
CRAIG KURTZWEIL: Add to that AI digital platforms. Everyone's staring at their phones all the time, and we're entering a new phase. How is that going to impact the health care of America?
DR. RHONDA RANDALL: I think it's all about responsible use and trust. And you want to make sure that as you're employing these technologies, that you continue to be thoughtful, that you're trustworthy and that you can prove that you're trustworthy in the use. That matters. And I think with that, we'll see tremendous acceleration in not only the experience of our beneficiaries, but the healthcare professionals who are at the bedside taking care of them. I think of that as well as a physician leader here, is what's the experience of the physicians who take care of our beneficiaries and the healthcare professionals that are part of that workforce? They used to have to go home and chart all night long for the work that they did during the day. And there's now technologies that they're gaining some of that time back because they're not typing. Thinking about the experience and the satisfaction of the healthcare delivery system, and it's one of the reasons I'm really proud of the investments we've made as an organization to reduce friction, to reduce abrasion, and to really focus on that alignment and what's important being the outcomes associated with the populations that we serve. Actuaries outside of UnitedHealthcare, that shows that inpatient management, because of the real time signal, results in significant cost savings for the employer.
CRAIG KURTZWEIL: Well, speaking of time, I know your time is very valuable, and I can't thank you enough for joining us today. Thank you, Dr. Randall.
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DR. RHONDA RANDALL: Thank you for having me. Be well.
CRAIG KURTZWEIL: And thank you for joining our Health Trend Talks podcast.
[On-screen text: Health Trend Talks with UnitedHealthcare]
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I'm Craig Kurtzweil with UnitedHealthcare, and we'll see you again next time.
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