Clinical insights reveal the health trends and issues defining early 2023

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BRANDON CUEVAS: Good afternoon. Thank you for joining. We can see that there are quite a

few folks joining us

[VIDEO OF BRANDON CUEVAS SPEAKING ALONGSIDE SLIDE 1]

from all over today. Well, it's great to be back together. I'm Brandon Cuevas. I'm the Chief

Growth Officer for UnitedHealthcare's Commercial Business. I know for those of you that maybe

missed last time and are just joining again, you may wonder what happened to Phil Kaufman.

Well, I'll say it again, I’m the – I would say the new and improved, but if you saw Phil and you

saw me, you would see that I'm just the new Phil Kaufman. My new growth office actually has

all of Phil's organization inside of it, as well as Phil's moved on to become the CEO of our

individual exchange business. So, it's been a minute since we've been together. We got together

at the end of August. And I want to welcome back those that joined us then. And for those that

are new, welcome. We're happy that you're here. Before we get started, up on the screen,

you're going to actually see that we have a QR code with some instructions. You can hit the QR

code or you can follow the instructions to go to menti.com and use the code that's on the

screen. And the whole point here is we want to hear from you. A lot of what we've done with

these webinars was intended originally to provide insights and continues to be insights as we're

seeing what's going on with the pandemic. But as we start to shift, we begin to start to think

about what are some additional insights that you want to see? Things are happening in the

industry. Obviously, we're hopefully going to see, coming to the end of the PHE timeframe, but

we want to hear from you. We want to know what your topics are, what you want to hear from

us about. And so we'd encourage you to go ahead and log in, go into the Menti, and also, if you

have your questions, we want to make sure that you get your questions put into the Q&A box at

the bottom of your screen. Now, we might not be able to get to every one of the questions, but

we can for sure guarantee that we have a team that's looking at it and that we'll be responding

back and getting either at the Q&A session time or if we don't get to that, getting back to you

after the meeting concludes. So with that, we want to just talk about today's agenda, if we can.

[VIDEO OF BRANDON CUEVAS SPEAKING ALONGSIDE SLIDE 2]

[Text On Screen – Agenda]

Today you're going to hear from Craig Kurtzweil, our VP in our Center for Advanced Analytics.

Dr. Rhonda Randall, our Chief Medical Officer. And today we're primarily going to be talking

about respiratory illness, return to health, and we'll talk a little bit about the PHE, and I'll spend

some time today talking about a topic that we probably haven't hit too much on, which is this

process of redeterminations, which will be, I think, an interesting topic for you to hear about.

Before we do that though, a few housekeeping items before we get into our agenda. Oh, and by

the way, we will have time for Q&A so, again, another plug for putting your Q&A in so we can

get to your questions. Couple of other housekeeping items that we want to get to is number

one, call’s being recorded and will be sent out and we'll send out a replay through our standard

publications. If you are a UMR client, your UMR rep will send you the replay link once it's

available. And as always, our sales teams are here to support you with any questions that you

might have if we can't get to them today. So we do, as a reminder, we have a pretty broad group

on the phone today and there's a lot of different flavors and considerations in our products and

the features that you have, and I encourage you to talk to your UnitedHealthcare or UMR

account rep for any specific details to you and to your plan that you have with us. And again,

final housekeeping item is no call would be complete without our legal disclaimer.

[VIDEO OF BRANDON CUEVAS SPEAKING ALONGSIDE SLIDE 3]

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alongside verbal commentary]

So up on the screen you can see and you can read the full legal

[FULL SCREEN OF SLIDE 3]

disclaimer on your screen. However, the call is intended to provide general information. It's not

legal advice. We're here to assist and support you as we go. But before we get going, it's been a

busy year, we're kind of rounding out. It feels like many of you probably feel like we are

counting down the days before we can start to maybe have some time going into the holiday

season. But we just want to thank you for your business, your trust in us. It's been a lot of great

things accomplished this year. It's been, obviously, an interesting time for everyone, but I just

want to thank you for taking the time with us today. Thanks for your business and we hope that

this time today's valuable to you. So with that, we're going to dive right into the agenda, and I'm

going to turn it over to Craig Kurtzweil, who's going to talk a little bit about

[Text On Screen – Respiratory Illnesses]

what we're seeing in a respiratory illness.

CRAIG KURTZWEIL: Thank you, Brandon. Good to be talking with all of you again.

[Text On Screen – US COVID-19 experience]

We have a few different topics to cover within respiratory. We no longer are calling it just COVID

because there's lots of topics under respiratory that we will hit on today. But we have to start

with COVID. So we thought it'd be good just to take a step back and review the analytics of

where have we been and where are we going associated with the pandemic. I start here with

the view of what the CDC is showing. So, what you're looking at is the bars in the background

are the number of cases that are being reported every week. We know that those cases have

changed dramatically. The reliability of those case numbers have changed, especially as less and

less people are being tested in showing symptoms related with COVID. So, we've added to that

the orange line, which is looking at the number of hospitalizations that are coming through

nationally. You can see how that tracks. And then the black line is looking at unfortunately,

those that have passed away from COVID-19. And the good news is if you look on the far righthand

side, you can see for the last, basically since March of 2022, we've been at a really, a lull,

right? There's been a few blips on the screen and we are seeing some ramp up of cases right

now, but net, net admissions remain low, cases remain low, and mortality remains low from a

national level. Next page.

[Text On Screen – UHC Commercial COVID-19 admissions/1,000 and mortality]

We do also start to track this a lot, obviously internally, within UnitedHealthcare. So it's one

thing to look at CDC data. We thought it'd be good to look at our own data to see what are we

seeing from a COVID perspective. Same sort of waves. And these are, by the way, our

admissions within our commercial population. So you can see the green lines are the admissions

that are coming through and the waves represent very similar to what the CDC is showing. And

again, for the last six months or so, we've seen very low rates of admissions for COVID-19 during

that time period. I did add in, in case you're interested, I think it's a very important metric.

Obviously, admissions are more important than cases, and mortality is likely more important

than admissions. And so the purple line is a look at mortality. So for those members that are

admitted into the hospital, what percent of them, unfortunately, are deceased from COVID-19

admissions. And so you can see during the heart of the issue in the fall of last year, we were

approaching 8% of people being admitted for COVID-19 passing away during that admission.

Whereas now, and there's a little bit of lag in these numbers, but as now, for the last five six

months, we've been at about 2% and that actually continues to drop. So, mortality admissions

are both down significantly over the past quarter related to COVID-19. We're starting to see a

little bit of ramp up, but as long as the mortality remains low, it's going to be a very different

season than we saw last year at this time. Dr. Randall, kick it to you.

[Text On Screen – New COVID-19 strains]

RHONDA RANDALL: Thank you. Let me just for one second stay on the slide that Craig just

shared with you, while I

[Text On Screen – UHC Commercial COVID-19 admissions/1,000 and mortality]

have a few comments on this one. We did show you throughout the course of all of our briefings

and it does remain consistent that we see lower rates of hospitalization and death, as well as

long COVID, which I'm going to show you. Craig and I are going to show you data on that in a

little while, with those who have claims for vaccinations, right, where we can see that we paid

for the administration of a vaccine. Of course, we know that may be underreported. We didn't

always get that claim. But there continues to be from CDC, as well as our data, supporting

evidence that although we still see similar numbers of cases, we see lower rates of

hospitalization, lower rates of death, and lower rates of long COVID in those who are

vaccinated. Approximately 13 to 14% of the United States population has received five or more

doses of a vaccine, regardless of, you know, where they got – what the first baseline vaccine was

and then the boosters now, with the bivalent boosters available. So, we'll talk a little bit more

about that in testing and treatment. Let's move to the next slide. I always share with you

[Text On Screen – New COVID-19 strains]

the circulating variants. These are the CDC referral areas. These come from, there are certain

labs that do this reflex testing, to see what the variant is.

[VIDEO OF RHONDA RANDALL SPEAKING ALONGSIDE SLIDE 7]

So most people who go in to get a COVID test, you're just finding out you're either positive or

negative. A certain amount of those samples are sent to reference laboratories to find out what

the circulating prevalent strains are in the communities, and then there's just an assumption

that when somebody gets tested, that they are likely to have the common strains that are

circulating in those communities. So here you see the ten regions where the CDC monitors those

labs. The strains that you see circulating now, BA.5, that's the original Omicron. And these

others, BQ.1 and BQ.1.1, those are other Omicron strains. So, the overwhelming majority of

what on this list is some Omicron variant. And we know that Coronaviruses all of them, not just

COVID-19, the ones that cause the common cold as well, they're slow mutators so we can

expect this phenomenon of variants slowly changing over time to continue. And then let's go to

the next slide.

[VIDEO OF RHONDA RANDALL SPEAKING ALONGSIDE SLIDE 8]

[Text On Screen – Testing, vaccine & treatment updates]

So, just a couple comments here. So, I did mention where we are with vaccine in the United

States. We continue to have two that are fully approved by the FDA, the Pfizer Comirnaty is

approved for 16 and up. Moderna at full FDA approval for 18 and up. But then in addition to

that, there is significant EUA, or Emergency Use Authorizations, that includes Johnson and

Johnson's vaccine. That includes the Novavax vaccine. That includes the bivalent boosters, which

have most recently received their emergency use authorization down to the age of six months.

So a broader swath of the population now meets the criteria to be eligible for the bivalent

boosters. Bivalent meaning it contains protection against both the original strain and Omicron.

Other things that I wanted to give an update here, there's been, I'm not going to go into it in

great detail, but just so you know, the FDA has done a lot of recent approvals on testing

different methods of testing such as saliva tests, tests that combine both flu and COVID at the

same time. Excuse me, I have a little touch of laryngitis today. And then in the treatment

update, I wanted to share with you that we're seeing low use of the outpatient antiviral

Paxlovid. So that's something that now pharmacists are also able to prescribe, in addition to

traditional prescribers like physicians and nurse practitioners. Pardon me.

[FULL SCREEN OF SLIDE 8]

So, if somebody has symptoms consistent with COVID, it's important to get that test early,

generally within the first 24 to 48 hours, and get access to that prescription for the over-thecounter,

excuse me, for the outpatient antiviral. Let's go to the next slide.

[Text On Screen – Nearly 1/3 of Americans who reported having COVID-19 also report symptoms

consistent with long COVID]

Alright, I'm going to share this information and then I'm going to ask my friend Craig to help me

out here while I get my voice back.

CRAIG KURTZWEIL: I got you.

RHONDA RANDALL: So this comes from America's Health Rankings, and this comes from survey

data that the U.S. Census Bureau does. And it asked people who had been diagnosed with

COVID if they had symptoms of long COVID. And what you'll see here is as many as a third of the

population that ever was diagnosed with COVID, is self-reporting, excuse me, self-reporting that

they had symptoms consistent with long COVID. But I want to pass this along to Craig to share

with you what we're seeing in our own claims data.

CRAIG KURTZWEIL: I’ll give you a chance to get a drink, Dr. Randall. So as Dr. Randall just

mentioned, there are some pretty big numbers when you look at the number

[Text On Screen – Long COVID-19]

of people that identify as having longer term issues associated with COVID. But when we look

into the claims data, so this is again, our book of business data within UnitedHealthcare, we are

tracking people that are actually going to the doctor and being coded or having claims

associated with long COVID. And then that you can see the numbers here, they ramped up as

long COVID became a much more popular item. And the Omicron wave was going through in

January, early of ’22, we saw higher rates, that number has consistently come down. But what I

would just gaze your eyes towards is the left-hand side, the scale. We're seeing very few

claimants. So at the peak we were seeing two per thousand in our book of business. We're now

on average seeing about one per thousand. So even though we know a wide swath of the

population has had COVID, very, very few individuals, even though they might be feeling

symptoms and issues associated with it, as far as people going in to see their doctor and being

treated, it is a significantly rare event at this point, one in a thousand or so. And then, then

when you look at the costs associated with long COVID, the treatment of those claims that are

coming in is under a thousand dollars. So very rare, not as expensive as I think most people were

anticipating. But there is a disconnect between how people feel versus what we're seeing as far

as claims coming through the system.

RHONDA RANDALL: Yeah, it was such a significant disconnect that Craig and I wanted to share

that information with you today.

CRAIG KURTZWEIL: And Brandon, with that, I'll kick it over to you. You're on mute, Brandon.

BRANDON CUEVAS: I apologize. Didn't realize they put me on mute. Well, hopefully Dr. Randall,

you get a drink of water. I have never wanted a drink of water more in my whole life

[Text On Screen – Preparing for the end of the public health emergency]

than listening to you talk. I was feeling for you. Well, let's get into the next section. We're going

to talk a little about the public health emergency end. Up on the screen, you'll see some key

topics that we're going to be talking with you about

[VIDEO OF BRANDON CUEVAS SPEAKING ALONGSIDE SLIDE 11]

coming up in January. There's some additional information that we're gathering. As you know

today, the public health emergency, we've been actively planning for the end and it looks as it

will be ending in early 2023, as of now. That's obviously subject to extension, but for now we are

still planning as if it will be early 2023. And we'll be getting back together with you in January to

talk through each of these areas on the screen. Some will be impacted in bigger ways than

others. And we've been talking with you a little bit about that and what will be changing, things

that change on the way in, things that'll be changing on the way out. We'll be gathering the

information. We’re bringing that to you here very shortly. But just be assured that as we move

across into the expiration, we'll be communicating with you, with your teams, with our teams,

making sure that you are fully prepared. And so these are some of the key topics. But one area

that I wanted to double click into today is a little bit, is on this term redeterminations. It's

something that I don't believe we spent a lot of time talking about, and today I want to unpack

that a little bit just so you can know what to expect as we're beginning to move. And it's one

thing that will be changing on the other side of the expiration of the PHE. So as you know, just

want to give you some, let me start with some background on Medicaid redeterminations. It's

called Medicaid renewal, or re-certification is another name for it. And basically, what it is, is

that every state in Medicaid has income and asset or resource limits that you have to have to be

qualified for Medicaid. During the PHE, the states stopped doing what's called redeterminations,

where they would go in on an ongoing basis and at regular intervals and validate that people are

still eligible to stay on the Medicaid program. Well, that was paused during the PHE. And so

basically, what will end up happening is once the PHE ends, Medicaid redeterminations, the

evaluation of income and assets and resources, will come back in. And then as that starts and

the states begin to redetermine members, that will actually begin effectively on the first day of

the month after the PHE ends. And states are going to have 14 months to redetermine all of

their Medicaid beneficiaries. So not every state will start right away. Some states will start

sooner than others. It'll be different and will obviously, you know, each state will be a little bit

different in its timeline. But once the PHE ends, the redetermination process has to resume and

it will specifically start right after the PHE, the first day of the month, and that'll continue as

states redetermine over a 14 month period. So, just as some context, is the number of people

that you could presume are impacted by that redeterminations. About 18 million members, or

excuse me, 18 million people went into the Medicaid program. The program grew by that much,

according to CMS data, over the course of the public health emergency. And industry experts

believe that at the end of the PHE, about 40% will remain eligible for Medicaid, so they'll be

redetermined and they'll be redetermined that they are able to stay for coverage on Medicaid.

We believe another 40% approximately, in the industry, that will be coming and be eligible for

employer coverage. Now, these would be people that became eligible for Medicaid during the

PHE, potentially got coverage or were eligible for employer coverage, but are still on Medicaid.

And about 20% of these individuals after redetermination will be eligible for the individual

exchange. They'll have a different level of eligibility, won’t be Medicaid eligible, but will be

eligible for coverage potentially under the individual exchange, in individual and family plans

offered in the exchange marketplaces. So the PHE ends. These members are going to be

notified. Some will see the notification, some will, there will be a lot of attempts and efforts to

make sure that members or that individuals are notified of their eligibility expiration, and that

they've been redetermined out. But then they will, obviously, have some decisions to make

around their coverage. So, I want to give an example of a scenario that could happen. So, you

can imagine a scenario where you have an individual that qualified for Medicaid at some point

during the pandemic. The PHE allowed them to stay covered for a period of time beyond the

typical eligibility redetermination timeframe. And when the PHE ends, that individual will no

longer be eligible, based upon changes in their household income. In fact, they might even now

be employed and have access to employer coverage. So they lose their Medicaid coverage and

perhaps they don't see the notifications, they're not aware. Sometimes that population may

not, you know, be as easy to engage. And so if they don't see the notification and they don't

actively pursue coverage with their employer or in another area, they will go uncovered. And

this is someone who may not know all of their coverage options. They may not know what

serves as a qualifying event, or how to even get onto employer coverage, or buy a plan through

the exchange, and may be confused about the process. Well we don't want those individuals to

find themselves in an emergency room with a medical emergency and end up without coverage.

And this is where we all have a role to play. Empowering members to take action, providing

information they need to get the proper coverage is going to be important. For Q1 distribution,

we're going to be developing member resources that can be leveraged by our brokers and our

employers for outreach, so that they can notify their employees that they may be eligible for

coverage. We want to make sure that you're prepared to actively distribute the information

about coverage options to members who may not have coverage today, and could be losing

Medicaid coverage and as a result of the PHE, could end up uncovered. So, our goal is to make

sure that you have all of the resources that you would need to make sure that your members

are aware of their coverage options and that your employees are – or that your employees,

excuse me, are aware of their coverage options. Again, we expect this to be an early 2023 end

date. As we continue to stage forward, we'll keep this in front of you. But the key is that there's

going to be a major coverage change impact to 18 million Americans approximately, and there's

going to be a lot of change in the market. We want to make sure that our clients and our brokers

are aware, that they have the information they need, and then we can help you navigate

through that time. We feel like we're in a great spot to help. We have a lot of great coverage

options available for folks, no matter what their situation is. But we also want to make sure that

we're good partners with you, and help you kind of navigate through that, and you have the

resources to help your employees navigate through it. So with that, I'll turn it back to Craig to go

over some information that we're seeing on flu.

[Text On Screen – Preparing for the end of the public health emergency]

[Text On Screen – UHC Commercial flu and COVID-19 admissions/1,000]

CRAIG KURTZWEIL: We have a few different data points on flu. First, I thought it would be good

to start with the combination, right. So, we spent a lot of time talking about COVID over the past

few months, few years at this point. And as we talked about during those discussions, flu kind of

disappeared. And I think this chart, it was interesting to me at least, to kind of see that dynamic

starting to occur. So in the dotted lines, you can see the shift of the flu season during this time

of year, so the fall/winter months. You can see the, when you look at the green dashed line,

that's the first wave. That's the first fall that we had with COVID in 2020. The dotted blue is what

we experienced last year in 2021. And the dotted red is what we're experiencing right now. So

clearly, a very different season when it comes to people being admitted for COVID than what we

saw in the prior two years. But the views on flu are just as interesting. So you can see the 2020

versus 2021 versus 2022 lines associated with the flu with the green being lowest, flu went

away. In 2021, flu was back a little bit, but not nearly to what it used to be historically. But now

it is back. The red solid line shows that flu is now much more prevalent when it comes to

admissions at this point than what we see across COVID at this point. So, we thought it'd be

good to spend a little bit more time diving into flu and what we're seeing across that population.

Next slide.

RHONDA RANDALL: This is a good time too, Craig, to remind everyone that there actually is a

fairly good match between the flu shot and the circulating strain that's out there today. And

even when it's not a perfect match, those who get flu vaccines have a much milder case and a

shorter course of illness and are less likely to be hospitalized. So it's not too late to remind your

employees to get their flu shot, that it can still be given, even with these circulating strains that

we see now. And you also may be hearing in your community's news from hospitals of, hey,

we're full. Between COVID and the flu and RSV, we are busting at the seams. And what you see

here in the commercial data is although our flu emissions are up slightly, most of what you're

hearing is in a Medicare population. And Craig will show you a little bit here with regard to RSV

in the pediatric population.

CRAIG KURTZWEIL: You're spot on, Dr. Randall. The next slide, I think, will show that. So we,

[Text On Screen – UHC flu admissions/1,000]

as we zoom into flu, in particular, I broke it apart between what we're seeing in the commercial

population versus what we see in the Medicare. It may look like on the left-hand side,

commercial is spiking. It's a much more vertical line when it comes to the rise of flu in the 2022

season. But just notice the scale. So, the rate of admissions for flu are ten times that in the

Medicare population than what we see in the commercial group. So both are rising, both

important, but by far the vast majority, ten to one, are cases that are coming in for the 65 plus

Medicare population. So similar to what we saw in COVID, much greater exposure and

prevalence of admissions for this disease when you're older, in the Medicare bucket. Next page.

So, let's take

[Text On Screen – US Total – UHC flu claimants/1,000]

another click into the flu data. So, this looks at not just the people that are being admitted, but

just the rapid spread of the flu. So these are just broad claimants, people that are going in to see

their doctor for treatment and testing positive for the flu. And again, a few different years on

here. Again, COVID disappeared during COVID. But as we ramp out of COVID, we can start to see

that that purple line, the 2022 line, as we saw in the admission data, is starting to spike. It's

spiking. It's coming up sooner and coming up faster than what we saw in 2021, 2020, and even

in a pre-COVID world, in 2019. Next slide.

[Text On Screen – US Total – UHC flu claimants/1,000]

If we look at where it is escalating, so this is the last week, so looking at the last two weeks to

see where are we seeing trends and drivers. So the bars are the last two weeks, with the red bar

being the most recent week. And then the green line behind there is the trend. So first of all, on

the far left, you can see that the states that are seeing the highest prevalence of flu, in claims

data at least. Louisiana, Nevada, Texas, Mississippi. So at this point, really focused on the South

and West is where we're seeing the big drivers. But we are starting to see trend and swirl as you

go up into the Northeast and in the Central, starting to move in that direction. But right now, a

predominant focus in that South and West states at this point. Next page.

[Text On Screen – UHC respiratory syncytial virus (RSV) admissions/1,000]

And we have a broad topic around respiratory illness because it is not just COVID, it's not just

flu, but obviously, RSV is in the headlines these days. So, we thought it'd be good to just give you

some line of sight into what are we seeing around RSV at this point. This is focused on

admissions data in our commercial block of business. And again, the red line is the one to focus

in, that's what we're seeing in the current season. Obviously, a spike. But you can start to see,

it's a little bit early, but in the last few weeks we have started to see that line start to come

down. It's potential that we're over that initial wave, or at least the first wave, but things are

looking better than they did a couple weeks ago. I would also note, again, look at the scale. The

admissions that we're seeing here in the commercial block are still lower than we're seeing

across flu, a bit higher than we see across COVID. But again, seeing a bit of good news as RSV is

starting to come down, and knock on wood, hopefully that continues.

RHONDA RANDALL: Yeah, and the pediatric population with this illness has a tendency to be the

most vulnerable and highest risk for hospitalization. So, most of what you're seeing here is

admissions to pediatric hospitals.

CRAIG KURTZWEIL: Right well, let's keep going. We have a section here on

[Text On Screen – Return to Health]

return to health. Throughout the pandemic, we've been giving you some views on abatements

and the impact that's going to make on the population. We thought it'd be good to give you

[Text On Screen – Wellness abatement]

a quick update on what we're seeing. So, this is now a four year view of utilization of preventive

care across our book of business. So, lots of data on here, but you can start to see if, for

example, you look at mammography is right in the middle. In the upper portion you can see

breast cancer screenings. Obvious huge dip during the heart of the pandemic when the health

system shut down, but a rapid return in May and June, back to getting mammographies at a

very similar rate to what we saw in 2019. And in general, that's the theme, whether you're

talking about wellness visits, mammographies, colonoscopies, outpatient surgeries, in general,

we are back to normal, so to speak, at least 2019 levels, as far as what we're seeing across the

book of business. The couple of areas where we're not are on the right-hand side. So, measles

vaccinations and chickenpox vaccinations remain consistent to what we're seeing during the

pandemic, but much lower than what we had seen in a pre-pandemic world. And that's pretty

consistent and we'll show what that looks like across the country as well. Let's go to the next

slide and show that. I just thought this was interesting. So we have seen, obviously, big

reductions

[Text On Screen – MMR by state]

in people going in for, or children, going in for their measles vaccinations. So I was curious, is

there a pocket of the country where this was kind of highlighted or focused in. And so the bars

behind there are looking at what we're seeing in the most recent 12 months compared to what

we saw in a pre-pandemic 2019 world. And the orange line, which is where I would focus your

attention, is the change. So the change between today versus what we saw pre-pandemic. So on

the far right, are those states that saw the most significant decline in children being vaccinated

for measles. And it's not what I think you would expect if I were to take a poll on who you

expected, what states you expected to drop the most. It's states like Hawaii, California,

Washington, New York, where we saw the most significant reductions. Now, some of those

states were at a high level before and kind of dropped back to the norm but saw significant

drops. On the far left are a bunch of states that have had low levels, to be clear, so the numbers

get skewed a little bit, but Mississippi, Maine, Connecticut, some of the smaller states, where

we're seeing actually less of an impact with measles vaccinations dropping. So, I just thought it

was interesting. We've talked a little about it. Is this driven by some vaccine hesitancy and things

like that across society? It appears to be spread across America. This isn't focused on one pocket

of states at this point.

RHONDA RANDALL: The other thing that I see interesting here, Craig, is that it dropped in all 50

states.

CRAIG KURTZWEIL: Yes. All right, Dr. Randall, I'll hand it over to you.

RHONDA RANDALL: All right, thanks. I really don't have flu or the COVID.

[Text On Screen – America’s Health Rankings]

I really do just have laryngitis and it caught up with me, so thanks for – thanks for bearing with

me there. I want to share with you an important report that the United Health Foundation has

been publishing now for 33 years.

[Text On Screen – America’s Health Rankings® 2022 Annual Report]

This is the America's Health Rankings Annual Report. This is America's data. It's not

UnitedHealthcare data. And this particular report looks at 80 different measures of our health.

And the overall platform also contains reports on the health of women and children, the health

of seniors,

[VIDEO OF RHONDA RANDALL SPEAKING ALONGSIDE SLIDE 22]

the health of those who served in the U.S. military, and in total, those reports contain over 150

measures of our health. We look at things like the community and environment where someone

lives, both physical environment like housing, as well as the broader area where you live. We

look at the clinical care you receive when you go to the doctor or the hospital. We look at

people's behaviors. Are you smoking? Are you getting physical activity? And we look at

outcomes, things like mortality rates and chronic conditions. And you can get more information

on this and I'll share with you, so you don’t have to remember, at AmericasHealthRankings.org.

These are just some of the headlines. And I'm going to share with you national data, but really

the state level data and the subpopulation data within it is very important. So, if you are –

particularly have employees who live and work in a certain state, that's really where you'll see

the actionable data. What we saw in this year's report from a sobering perspective, is that we

had a 30% increase in drug deaths between the year 2019 and 2020. That's probably not a

surprise. You've all seen the headlines. Most of that, about 70% of it, is due to non-prescription

opioids. So you hear things like the fentanyl crisis. That's what we're seeing here. What this

means is about 91,000 people lost their lives in the year 2020 due to a drug overdose, generally

opioid.

[VIDEO OF RHONDA RANDALL SPEAKING ALONGSIDE SLIDE 23]

[Text On Screen – Premature death spiked amid the pandemic, widening racial and ethnic

disparities]

And then the other thing that I think is important here, is this affects all populations.

[VIDEO OF RHONDA RANDALL SPEAKING ALONGSIDE SLIDE 24]

[Text On Screen – Premature death spiked amid the pandemic, widening racial and ethnic

disparities]

We saw it rise among all races and ethnicities. And you'll see there on the graph on the right, the

difference between the population that has the lowest rate of drug death and the population

that has the highest rate. Right, let's go to the next slide.

[VIDEO OF RHONDA RANDALL SPEAKING ALONGSIDE SLIDE 25]

[Text On Screen – Rates of multiple chronic conditions and some components worsened since

2019]

Chronic conditions also worsened. I do think that this is a bit of return to care, where we're

seeing people who are getting back to the doctor and getting these conditions diagnosed. I don't

really think that they dropped off that much during the pandemic, but we are seeing an increase

in chronic conditions like cancers, depression, and arthritis. So that increased between the year

2020 and 2021. The other thing about this year's report is almost all of the measures contain

data that's coming from the years of active during the pandemic. Let's go to the next slide.

[VIDEO OF RHONDA RANDALL SPEAKING ALONGSIDE SLIDE 26]

[Text On Screen – Fourth-grade reading proficiency dropped amid pandemic while racial

disparity grew]

This is concerning and one I'm going to want to follow. Fourth grade reading proficiency

dropped among the pandemic and the racial disparity in that grew. One of the measures that we

also very much tie to health in this report, is the high school graduation rate. Those who've

graduated high school and have a high school diploma are much more likely to have better

health throughout the course of their life. So, as employers, for those of you that are really

engaged in ensuring your communities have high school graduation rates,

[Text On Screen – Fourth-grade reading proficiency dropped amid pandemic while racial

disparity grew]

bravo. That is something that is not yet reflective of the years of the pandemic that will come

out in next year's report. So these two things in concert, I'm paying very close attention to, that

fourth grade reading proficiency and then next year I'll be really looking at high school

graduation rate. Keep an eye on that. Go to the next slide.

[Text On Screen – Q&A and Poll; Scan code or visit www.menti.com; Enter code 6213 3377]

Couple other things before we close out for America's Health Rankings that I just wanted to

mention. Good news, we saw high speed internet access. So I just shared with you some

concerning news. High speed internet access increased. About 94% of U.S. households have

access to high speed internet and a connected device to use it on. We also saw an increase in

those who are choosing primary care and mental health as professions. So we know we still

need more primary care professionals and we know we still need more licensed mental health

professionals, but it has been increasing now. Both of those have been increasing for the last

several years, so that's very encouraging. And with that, I think I'm going to turn it back over to

Brandon to walk us through Q&A.

BRANDON CUEVAS: Perfect. Thanks, Dr. Randall. Thanks Craig. So, really quick, as we're queuing

up the questions, we want to hear from you. Again, we want to know whether these calls are

still a valuable use of your time. Obviously, going through the pandemic, there was a lot of

interest. We're migrating through. There's a lot of work still left to do to come to the end of the

PHE, as you can imagine, and there are other topics that we want to continue to bring to you as

we asked early in the call, to let us know what topics you want. But go ahead and click on the QR

code. Let us know your feedback. Again, if you want to visit via Menti, you can enter the code

that's on the screen, 6213 3377. So with that, we're going to start our Q&A session. It’s not too

late. Please get your questions in and we will try to go through them. And I'll ask that we get the

questions teed up, and then we can go from there.

FEMALE: Brandon, thank you. And we do have some questions coming in. Definitely, I know in

conversations I've had with folks, people are talking about the flu and all of those things. Dr.

Randall, the flu shot. If someone got caught having the flu already, is that something they still

can go get the flu shot for the season?

RHONDA RANDALL: You still can. If you formally tested positive for the flu, not just thought you

had it, but actually went and got a swab and tested positive, that's a conversation that you

certainly can have with your primary care physician. I think they're always the best one to ask.

You know, I did test positive. I think it would still be prudent to go get my shot. It is absolutely

safe to do so. You also, I can anticipate this other question is, can I get a flu shot and a COVID

shot on the same day? Yes, you can. So, you can go get either your original series or your

booster for COVID and you can get that vaccine the same day as your flu shot, excuse me.

FEMALE: Great. Some questions coming in. The data you covered, Craig, on COVID and the

deaths that were happening during COVID, is there delineation in that data? Whether their

death was caused by COVID or they happened to have a positive COVID test at the same time?

CRAIG KURTZWEIL: Yeah, what we're tracking in the data that I showed you and we actually do

some research on these cases, are the inpatient admissions where COVID is the reason for the

admission, not just an adjunct claim or diagnosis associated with it. So, they can get a little bit of

gray in that area, but we do our best to sift through that data and make sure we’re reporting on

those cases that COVID is the primary reason for the admission.

FEMALE: Perfect. Thank you. And Dr. Randall, when you – we talk about long COVID, is there any

detail or anything coming out in the industry around associations with certain variants? Do we

know?

RHONDA RANDALL: So, you know long COVID, the definition is symptoms that are lasting two

months or more. And as we saw from the survey data, a high percentage of people are saying

they have some symptom. A lot of that is things like fatigue. And in the good news is in most

cases it's mild. But there has been some research to suggest that even people who have

asymptomatic COVID or very mild cases of COVID can still have long COVID, but there is a strong

correlation between severity of illness. So those who are hospitalized for COVID are more likely

to have the more significant symptoms of long COVID, where you're seeing that track in our

claims data, where they're actually seeing specialists, when they're sending us an ICD 10 code.

We don't have a particular study that suggests that one variant versus another was more likely

to cause long COVID but we did see higher rates of it during those more significant spikes that

Craig showed you in the data. Earlier this year and the year prior, when there was a much higher

rate of illness, we saw higher rates of long COVID at that time.

FEMALE: Gotcha. And if somebody feels like, you know, long COVID might be something they're

facing, is there a place you might recommend they start?

RHONDA RANDALL: Yeah, first of all, start with your primary care physician. In many cases, those

mild symptoms of long COVID can be documented and treated by your primary care doc. But for

those more complicated cases, this is actually something where UnitedHealthcare and

UnitedHealth Group has led the way. We put together a COVID, a long COVID advisory board.

We call it post-acute sequelae of COVID or PASC, bringing together experts from the best

centers around the United States who have done a lot of research into this. We also have

created an algorithm to hunt in our claims data for people who look like they have long COVID

because they are doctor shopping with different symptoms. And we're working to get them to

those centers, not formerly centers of excellence, but very similar to what we would consider a

center of excellence, to get their care. So, I'd say start with your primary care physicians. And for

our members, if you're needing support getting to a place because you have those more

significant symptoms, certainly call the number on the back of your card. Our advocates can

help get you to a nurse or another clinician who can get those referrals going.

FEMALE: Great detail there. Thank you for that. A lot of questions coming in specifically related

to coverage on particular plans. Because we have such a diverse group joining us here today, we

do highly recommend that you reach out to your broker and consultant or your account

management team here at UnitedHealthcare to find out details about what's covered on your

particular plan. And having said that, we will have a recording available at the same link that you

accessed today when you came to the call. And Brandon, I will turn it over to you to close us out

for the rest of the year.

BRANDON CUEVAS: Well, thanks. Like I said, it's been a busy year. It's been a great year, a lot of

great advances. Been really proud of the partnership that we've had with our employers, our

brokers. The feedback that we get from you is invaluable to us. You know, we talked a lot about

earlier in the year, behavioral health impacts and that advised the way that we are bringing

products to the marketplace. We have made significant strides in behavioral health navigation

for your employees and for our members and being able to get through our desktop application

to be able to go in and identify different types of care that we have, that was all born out of the

partnership and the feedback that we get from you, what matters to you, what we're seeing in

the data, and in our experience. And so that partnership of coming together and listening,

creating new solutions for your employees and for our members, is we think is one of the things

that, it’s what our employees like to get up and come to work for every day is the partnership

that we have with you. But we just want to say thank you for giving us your feedback. Thanks for

the time today. Our entire UnitedHealthcare team is available at your convenience to make sure

that we provide guidance in any way that you need. You heard earlier, if you have questions

about coverage, reach out to your teams, to our teams, and to your brokers, and we can make

sure that we get that support going. We know that your time is valuable this time of year, so

spending this time with us is critical. We will get back to any questions that came in that we

weren't able to answer. We will get the survey updates. But more than that, we're looking

forward to seeing you after the first. We hope you have a happy holiday. Please stay safe. You

know, we hope that you have plenty of time

[Text On Screen – Thank you for joining us today. We will start shortly.; In the meantime, please

share with us what topics you’d like to hear about in the future UHC Briefings; Scan code or visit

www.menti.com and use code 1332 8209; Today’s meeting is a video webcast. There is no dial-in

for this meeting.]

to recharge. But we'll look forward to getting back after these updates with you after the first of

the year. Happy holidays to you and your families. And we'll talk to you soon.

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