COVID-19 FAQs to help you answer client questions

Good afternoon, everyone.  Thank you so much for joining us this afternoon.  We’re super happy to have you here with us.  Some of you it’s hard to believe it’s been three months since our last call.  Things continue to transpire really quickly, so whether you’re joining us for the first time or you’ve been joining us for the last several years, we know it’s an important hour out of your day, and we hugely appreciate you spending it with us.  We do our best to be able to cover the topics and information that we think is relevant for you, but I do want to point out that we pay really close attention to the Q&A, so, as you enter and question throughout the course of the call, we do our best to answer the common themes at the end.  We take it all back, we look at it, and we try to make sure that United Healthcare, UMR, [INDISCERNIBLE 00:00:41] representative have the answers to those questions for you.  As usual, we’ve got a great line up for you today.  We’ve got Craig Kurtzweil, the Head of our Advanced Analytics Center, who’s going to talk to you not just throughout the course of the pandemic, but I think importantly today you’ll see the shift from Craig and ourselves of what should you expect next and what’s the next stage of this and what are some of the after effects.  Dr. Rhonda Randall will be here.  She’ll talk about the different updates around vaccines and treatments.  She’ll also come back later onto the call, and she’ll talk about long Covid which I think is a—now that we’ve got a little more time under our belts, we understand the data a little bit better and will be able to give you some insights on that today.  And then we’ve also got Samantha Baker, who’s going to be talking to you about digital enhancements, and obviously the digital being the most important front door in this modern ecosystem, and what we’re doing there in areas, for example, such as behavioral or getting people engaged and how we’re interacting on the digital front, so that’s the lineup that we’ve got for you today.  I will close it off with the always riveting topics of the consolidated appropriations acts and transparencies, so I know everyone’s just waiting with baited breath for that one, but we’ll just cover that quickly and lightly at the end.  Before we get started, just a couple housekeeping items.  The call’s being recorded.  We do our best to try to talk to generalities across United Healthcare, but there are different parts of our business, depending on which part you’re with, and so we just want to encourage you to please make sure that you’re talking with your United Healthcare rep for details or nuances that may impact the part of the business that you’re with.  And then finally I’m not going to read through our full legal disclaimer here on the next slide, but just needless to know, it’s the call’s intent to provide general information and does not constitute formal advice.  So finally before I hand it over to Craig, just want to say again, we’re deeply grateful for your business.  We’re deeply grateful for the trust that you place in United Healthcare, and I just want to emphasize, we’re really working hard day in and day out to make sure that we protect your interests as the broker and employer, but also we’re really working hard on behalf of the consumers, right?  We really know that they’re always under pressure within between price and delivery and what they expect, and we’re really working hard to meet those expectations.

PHIL KAUFMAN:  All right, Craig, I’m going to turn it back over to you.

CRAIG KURTZWEIL:  Thanks, Phil.  Craig Kurtzweil, I lead our Center for Advanced Analytics.  I’m happy to be back to talking with you all. I will cover a bit different sort of view of Covid, so we’ll talk a little bit about where we are today, but focus more of our time and attention on kind of where do we go from here as we look at the ripple effects that Covid is going to have, and so our first slide in the next view looks at kind of where we are today.  As we look across the country, you can see that we’ve shifted from just looking at cases, bringing in hospitalization data into our views.  You can see the bars are looking at the cases.  The orange line is looking at the hospitalization rates, and the black line is looking at the mortality, and so, at the end of the day, we are seeing that levels across all three of those data points are at some very low points.  This week, just to give you some perspective, we are going to start to see that cases are again dropping down, even though in some pockets of the country, we are seeing some increases.  Nationally cases are coming down, mortality continues to come down, and importantly hospitalization is basically flat this week, and is at its lowest level at any point during the pandemic, so there are some pockets of the country increasing, decreasing.  We’re going to start to see that as the numbers get low, but these metrics on hospitalization and mortality continued to be at near record lows during the pandemic.  As we move into the next slide, we start to think about why do we start to see those cases drop off.  In our case, it’s something we really should be tracking, because we know that they rely incredibly on testing, which is why we’re now relying more and more on mortality and hospitalization, because the part you see here is the matter of book and business and looking at the number of non-over the counter tops that are coming to the system.  And you can see as we start to jump into 2022 where Omicron was still real and still coming through the system at high rates, we started to see it, especially in February, a dramatic reduction in people getting [INDISCERNIBLE 00:01:55], and I think it’s not just a United Healthcare view across the system.  Many, many less people are getting tested, at least through the medical system and more using some of those over the counter tests to see if they have Covid or not, so testing data’s becoming a little bit less reliable, which is why, again, we’re shifting into the hospitalization data, but those over the counter tests have really opened up some opportunities for our consumers, and now they start to understand and recognize that doing some testing at home is something that provides some real convenience and value.  And in the next view, we definitely see that there are some opportunities to expand and go into some other directions.  On the next slide, we highlight some of those areas.  We think there is opportunities to continue to expand into diabetic care, heart health, and even looking to see if we can get in cancer screenings and making sure that—but where there’s options for at home testing and make sure that’s available, because, again, due to Covid and some of the at home testing expansion there, there’s much more of an appetite within the consumer base to take advantage to some of these convenient testing options, because in one of the important pieces with especially getting some of the colorectal cancer screenings back in the hands of members, so they can do that in a convenient way, on the next slide, we know that during the pandemic there has been abatement of wellness care.  And so we thought it would be a good time, given we have three years of data here, you’ve seen me talk about this if you’ve joined these calls in the past, looking at what happened in 2020, what happened in 2021, and now we have a complete picture, so the gray line is our wellness data from 2019, a pre-Covid look.  The light blue is what we’ve seen in 2021, so the most recent 12 months, and on that dark blue is the heart of Covid, so in 2020 where we saw shutdowns of the system, and you can see a very similar pattern.  In April and May of 2020, you saw a significant reduction to people getting cancer screenings, wellness visits, outpatient [INDISCERNIBLE 00:03:50] and so on, but also a very common theme.  Since that time, you can see that basically we’ve gotten back to 2019 levels, so we haven’t gone back to make up enough for the big dip we saw in those first couple months, but it was really a quick return to health across the United States.  So you can start to see, as we start to think about what’s going forward, there’s going to be pressures on the system, right?  There’s going to be this abatement of care and folks coming back to the system to receive care to get those surgeries done and to get those screenings done.  But, on the next slide, we also know that there’s other pressures on the system.  We’ve seen a tremendous shift in inflation, so this is a view of both healthcare inflation you can see in the blue line, and in the orange line, looking at general U.S. inflation rates, consumer price inflation, and so you can see throughout history, through this couple decade look here, typically the healthcare inflation rate outpaces the CPI by a couple points, 1, 1 ½ points higher than normal CPI, but that’s changing.  In March of 2022, we saw over an 8% CPI increase, which we haven’t seen in a decade.  And so that is obviously due to a lot of the constraints that are on the system, supply issues, as well as some of the workforce issues, and obviously that’s also going to have an impact in what happens within the healthcare system, especially, again, during the pandemic, there’s a lot of pressure on the hospital systems.  They’re dealing with staffing issues, they’re dealing with supply issues.  And that pressure is going to be felt across the system.  It’s going to take some time, right?  Healthcare doesn’t change on a dime, like the price of corn and things like that, like commodities, but over time, especially as some of these contracts come to you, there’s going to be some [INDISCERNIBLE 00:05:33] and inflation hitting healthcare as well.  It’s a top priority for us, it’s a continued focus.  We’re on this, we’re reviewing it, and we’re making sure that we’re doing our due diligence to making sure we’re staying on top of them and making sure that we can make sure that the healthcare system is as sustainable as possible.  So just know that’s a focus for us, but it’s definitely, as we start to look forward, we think about abatement of care, we think about the shift into over the counter testing, and we think about what is this inflation impact going to really have?  What impact is it going to have on the healthcare system?

CRAIG:  So with that, I’ll pause and hand the ball over to my good friend, Dr. Rhonda Randall to walk through some of our clinical insights.

RHONDA RANDALL:  Thank you, Craig.  It’s good to be with you all again.  I’m going to just dive right in and talk about what’s top of mind and what you need to know in the current data, and then I’ll be back with you in a little while to spend a little bit more time on something that we’ve gotten a lot of feedback that you’re interested in getting more information on long Covid, so let’s start with a little bit of what we’re seeing with current variants.  It is rapidly evolving, so I want to give you a view here just to orient you to what you’re looking at, so on the left side of your screen, this comes from something called Now Cast, looking at the different variants that are in the United States.  This is on the CDC’s website if you’re ever interested in following along with this, but what you’re seeing in those different color bars there is weeks in time, and then, on the right, I’ll orient you to the map in a moment.  What we’re looking at right now is three to four different Omicron variants in the same graph, and you’re seeing there from several weeks ago until the most recent bar is this week, and what variants are predominant.  This is a United States overall national view on your left, and then, if you look at the pie charts on the right, that’s looking at CMS’s regions and where those different strains are, so all of these colors, the pinks and the purples and whatever that orange-ish color is, those are all Omicron variants.  But they’re different strains and sub-strains of the Omicron variant, so the deep purple there is BA.1, right?  That was the original Omicron that we started seeing at the end of last year that was responsible for all of those infections and hospitalizations in January, for example, and then the one that is really more than three quarters of the cases now, BA.2, also an Omicron variant, but what’s notable about this one is it has some significant mutations over the Omicron wave that just happened a few months ago, about eight mutations in this one.  So that’s one of the reasons why we’re watching it.  We also know that it is more transmissible than the original Omicron, and then right behind it in that orange-ish color starting to see it creep up rather quickly and start to be a significant factor in some areas, you know, particularly there in the northeastern United States, where that strain is making up about half of the strains that are tested, and this one is even more transmissible than the one before it.  Now, the good news is so far neither of those BA.2 or BA.2.1 2.1, neither of those strains appear, at least initially, to be more lethal than the Omicron 1, so we’ll be watching that very carefully, but it is one of the reasons that we’re seeing some of that outbreak happen in some of those areas, and we’re going to be tracking very closely around case increases and hospitalizations.  I want to just kind of give you a sense of how this is tracked and what it means.  The labs do surveillance, so they randomly take some samples of the PCR tests that were sent into the lab, so the swabs that were sent to the lab and test them for what type of variant.  Not every single test gets this.  It’s random sample with surveillance to look at what strains are circulating, where this is also done around the rest of the world, and you can see that some of these strains are responsible for some of the significant outbreaks and hospitalizations that we’re seeing in other points of the globe.  So let’s go to the next slide, and I want to connect these two for you.  So I want to introduce a concept to you called hybrid immunity.  If you haven’t heard it before, hybrid immunity is a combination of getting immunity from having been vaccinated as well as having been infected with the same virus, and I certainly wouldn’t want to be irresponsible and recommend that anyone go get an infection that is not a safe way.  It’s still the best way to protect yourself is to get vaccinated.  But because so many of us, if we hadn’t already been exposed, did have an infection with the Omicron variant, whether we were tested or not.  It’s one of the reasons that we see back in Craig’s data that we dropped off so much, it’s because right now we have good hybrid immunity in the nation, so we have a lot of individuals who’ve been vaccinated.  We also have a lot of individuals who have been infected.  And most importantly, many individuals who have both been vaccinated and infected and have hybrid immunity.  So the good news is it looks like that combination of having the vaccine plus having had a recent infection has good protection with it, so it is likely the cause of why we’re not seeing too bad of an outbreak with the BA 2 versions of the Omicron.  Now, recently just within the last few weeks, because we were starting to see this outbreak that it’s more transmissible, particularly in individuals over the age of 50, those who live in nursing homes, people who were immunocompromised down to the ages which the vaccines are approved, there is a recommendation to get a second booster, regardless of whether your primary series was the J&J vaccine, Pfizer, or Moderna, so for those individuals who are older and for those individuals who are immunocompromised, the current recommendation is that it’s prudent to get a second booster.  So your primary series, and after the first booster, if it’s been at least four months to go ahead now and get that second booster, so that is authorized through an emergency use authorization from the FDA.  It’s available to those special populations now.  And, you know, it’s just with your self-attestation that you qualify for the second booster if you want to get it.  So hopefully that concept of hybrid immunity is—I thought this little visual, this comes from science.  It was really helpful to show the two together really make a significant difference in the outcomes that we’re seeing here, and then the last thing that I wanted to cover with you is just a little bit of an update on treatments, so we know that the oral antivirals that can be prescribed on an outpatient basis, during the first Omicron wave, they were just really ramping up production of the Molnupiravir and Floxavid, so Merck and Pfizer’s oral antiviral drugs.  Those drugs are now in good supply, but what’s interesting is not as much demand is there.  So even though we are seeing these outbreaks, we’re not seeing as many prescriptions.  I can tell you looking at United Healthcare’s data, the Pfizer drug is the more popular prescription of the two, but the Merck drug has recently had some additional studies produced, and it may be even more effective than we initially thought.  And then the other thing, just to mention in treatment, with each of these strains, whether it’s one of the subvariants of Omicron or another strain, we’re seeing differences in the effectiveness of the monoclonal antibodies, and there are several that are out there that were—had emergency use authorization from the FDA, and you will continue to see over time the effectiveness of those individual monoclonal antibodies on each of these strains, so I just want to say I expect that we will continue to see some of these monoclonal antibodies work better for some strains than others, and we’re all going to need to be prepared for that and flexible, and we’re still seeing great results from the IV antiviral Remdesivir that’s used in both in patient and outpatient treatment settings, so the antivirals are really right now the mainstay of treatment, as we see changes in the monoclonal antibodies that are and are not effective, and I would expect to see that continue.  So just a couple notes there on treatment.  We do not yet have any of the medications that have been in front of the FDA.  They haven’t been reviewed yet for pre or post exposure prophylaxis, so you might be used to seeing that for influenza, for example, Tamiflu, somebody in your house gets it, you can start taking that medication to prevent getting it yourself or if you do get it to end up with a milder case.  Those drugs have not been reviewed at this point for per or post exposure prophylaxis for Covid-19, but I do expect that to be the next chapter in how those medications are utilized.  So those do not have authorization for that indication at this point.

LAUREN:  So that’s just some of the exciting work that we’re focused on in digital, and now I’m going to hand it back to Dr. Rhonda Randall.

RHONDA RANDALL:  Very good.  Thank you, Lauren.  So the last thing that I wanted to spend a little bit of time with you all on is something that often is referred to as long haulers. In the late term, sometimes we refer to it as long Covid.  The medical diagnosis for it is post-acute sequelae of Covid.  Sometimes you see it abbreviated as PASC, and so I wanted you to know what that is.  In case you see it, there actually is now coding for it.  But we’ve recently got some new data, and there’s some work that United Healthcare has been doing for quite some time in this area that I wanted to bring to your attention, so let’s go to the next slide.  So we certainly know that long Covid can affect a lot of people and that it has a lot of different symptoms, so we batch all of these into a single diagnosis, but it is by no means a single condition.  For some individuals who are hospitalized with other respiratory illnesses, we see things like de-conditioning.  We see prolonged inflammation of the lungs that requires sometimes to be on steroids for usually just a period of time.  It can develop into chronic lung diseases and other things that are common with pneumonia, sometimes influenza, things that require hospitalization, but with Covid, we also saw some other symptoms that were new and just recognizing here when I say it has many faces, that it can affect a lot of different populations, but the constellation of symptoms is wide, and it is varied.  And the expertise on treating this is really very much emerging in our nation.  So there was a study I’m going to share with you next that was reported in nature just this year, and we’ll go to the next slide.  And if you’re interested in reading more on this, I think I have the citation in here for you.  And maybe it’s my slide after this.  And just kind of looking at even people who had milder cases of Covid developing some of the pesky or long Covid.  Now, what you’re looking here at in your slide is on the left, the conditions and symptom categories.  And you see the one that’s on the bottom, other is the largest one, right, more than 80% of people who have this saying that they have something else that’s not on this list.  That just really goes to show you that other one you get down to the individual conditions underneath that, there’s no one thing that really spikes out a lot.  So these symptoms can be quite varied, but then the other bucket that really pops out here are the cardiovascular conditions mainly vascular in nature, so we know of things like Covid toes and so forth, and then the neurological conditions, also really seems to be related to some of the inflammation, like the loss of smell that can be prolonged afterwards.  Now the good news is that for most people, the development of post-acute sequelae of Covid is related to the severity of the illness, so somebody who was more severely ill who was hospitalized, more likely to develop post-sequelae of Covid than somebody who had a milder case and was able to recover easily at home.  And the other thing is that for individuals who develop this, most of them will have milder symptoms that can be treated by a local primary care physician or a local specialist, so that’s the good news.  But some individuals have prolonged or very significant symptoms related to past C or long Covid, and the spend for these individuals can be significantly higher.  So I’ve included some of that information here for you on the right, and we have been really working on understanding and identifying and picking up in the data and the claims that we get, the lab information, the prescription drug information, and the diagnostic codes that we received from physicians, who is likely to have post-acute sequelae of Covid, because we’re looking for those sicker individuals, those ones that seem to have more rare conditions, so that we can connect them with the emerging expertise in the healthcare system.  Let’s move to the next slide.  So this is what I was referring to earlier.  This was surprising.  You might have heard people use the term Covid brain after they’ve recovered, and maybe it’s you or someone you know or someone you work with, that they had a mild case of Covid, they stayed at home, they recovered there, they didn’t get hospitalized, but they have a little bit of brain fog that lasts for a few days, maybe a few weeks, hopefully not longer than that. Well, this was published in Nature just earlier this year in demonstrating that that brain fog associated with post-acute sequelae of Covid may not be proportionately related to how severe their illness is, so that we see those brain changes, and it was demonstrated on brain scans, in individuals who had mild cases, as well as individuals who had more serious cases requiring hospitalization.  So it’s not all in your head, it’s actually in your head.  Let’s go to the next slide.  And then I wanted to share with you some of the work.  We’ve been doing this for quite some time to collaborate with external advisory council members at some of our nation’s leading institutions who are doing deep studies on understanding more of this, and we want to make sure that it is informing the work that United Healthcare is doing and also helping us inform the research and the science and get those individuals who have that more severe post-acute sequelae of Covid, get them identified and get them connected with these centers of excellence, if you will.  That’s not an official term but a term I’m using here, because there is really a limited number of academic institutions in the United States who understand and can go deep in this area, and we want to make sure that our patients get the care that they need through consultation or direct care from those institutions.  So happy to share more about this with you through your account executives, if you’re interested in getting more information or if you have an employee who you’re concerned about.

RHONDA RANDALL:  So with that I’m going to close here and turn back over to my colleague, Phil Kaufman.

PHIL KAUFMAN:  Great, thank you so much, Dr. Randall.  Super appreciate your expertise.  I never fail to learn something every time you’re talking about this really complex issue, and just want to emphasize again for all of you listening.  What we’re really trying to do is to try to take all of this insight and think about how can we better support those members we serve and what insights d we have here and how can we kind of help them get through this to the extent that they’re struggling with these really difficult issues.  I’m going to pivot and talk a little bit about the Consolidated Care Act and transparency, and I’m just going to spend a few minutes here, and then we’ll jump into Q&A, and the first thing, if you go to the next slide, I’ll start with this.  What’s happened already?  And the big thing that happened January 1st of that year was what I’ll call the no surprises element, and there isn’t a lot of content here on this.  Just bear with me, which is January 1st of this year, really what happened is he said, hey, if a member goes, has an emergency, and for whatever reason they end up in an out of network facility, that facility is—their cost share is not supposed to be more than what they would have paid at the in network facility, and frankly the insurance company and the provider, hey, you’re just supposed to figure it out.  Don’t put the member in the middle.  And then that’s for emergency services, and then there’s this kind of subheading which is like, hey, you know what, if it’s a nonemergency service, but I went to an in network facility, and, for example, I had an out of network radiologist or anesthesiologist who was practicing in that facility, that would be subject to the same rules.  The member’s not supposed to be caught in between.  And then the third part was air ambulance.  So there’s those three components there, and really that’s the no surprises part, so that went in effect January 1st, and I would tell you so far, so good from what we’re been hearing on the member feedback side.  I think there’s still work to do to educate members that if they see one of these bills or either of these come to them, hey, you know what, you shouldn’t be paying that, we’re working hard on that, I know the providers are too, so there’s still a member education element, but I would say from an implementation standpoint, so far, so good.  Now, these are enormously complex pieces of legislation, both the CAA and the transparency, the role on transparency, so I’m not going to go into an extensive amount of detail.  I just want to keep it simple and say, okay, look, these are the three big dates that you’re going to see, and these are going to be the impacts coming forward here.  The first is barring any delays, July 1st of this year, United Healthcare, along with all other insurance companies are going to need to disclose their negotiated rates for every provider in a machine readable file, so that, when you think about transparency, which United Healthcare has always been a big believer in transparency, this is radical transparency, and once that transparency goes onto the market, we’re watching really closely how that evolves the market.  It could mean in the next year or two new products.  It could mean new configurations, and so that’s a very important dynamic in terms of, you know, will it make provider rates go up, go down, will it make the system more simple?  Will it make it more complex?  So we’re watching that really closely, and that’s really what I’ll call more system complexity that is becoming transparent. Two and three here is what I’ll call consumer transparency, and so January 1st of 2023, it will require for 500 of the most common services that a consumer will be able to say, hey, this is how much this costs in advance of me getting this service.  Now the good news is across most of our United Healthcare business today, you already have a significant amount of transparency.  We already have cost calculators.  You can do a lot of this.  It’s just the expectation that these tools are going to get much better, and they’re going to incorporate your own individual plan cost share into that calculation, so it’ll incorporate am I in the co-pay, am I in the deductible, how exactly that worked, so that’s pushing that just a little bit further from where it’s at today, but it just gives that broader sense of consumer transparency.  And then 1124 takes those 500 services to all items and services fully transparent to the consumer in some type of a searchable web format, so those are kind of the big three.  There’s lots of other stuff in here, which I’m not going to get to today.  But I just wanted to highlight that.  And I think the biggest message coming out of this is, hey, United Healthcare were on top of it, were of course keeping you compliant, but we’re thinking about how can we use these new rules and regulations to bring down the overall cost in the healthcare system both for you and for your members.  So we’re trying to do both of those things.

MALE:  Okay, I’m going to shift into Q&A.  We always get tons of questions, literally hundreds from all of you as we do these calls, and so I want to try to get to some of those themes.  Just as a reminder, we love your feedback on these, so you see www.menti.com and a code there, a QR code if you want to scan it and give us feedback, so, as we do Q&A, I would love to hear your feedback on this call.  Dr. Randall, going to start with you.  A lot of questions, and I’ve seen this in the news over the last couple of days over the Covid breathalyzer, as it’s being called.  Any commentary on what I’ll call efficacy of that, accuracy, you know, is it as good as an at home test, is it as good as a PCR test, where do you see it being used?  If you could comment on that, that would be great.

RHONDA RANDALL:  Yeah, so that is going to be used in a provider’s office, so that’s what the UA is for.  So you do need to go in to your physician.  We expect that it’s going to be equivalent to the kind of swab that a physician can test in the office.  The gold standard of the PCR test still remains the one that that would get sent off to the lab that has a tendency to be able to detect lower levels of virus earlier on and later in the course of the illness, so, when in doubt, that’s the one to get, but these are—the breathalyzer kind of falls in that same category as a rapid test, but instead of using a swab, you’re using your exhaling just like you would another breathalyzer that you may be familiar with.

MALE:  Awesome, thank you.  Craig, I’m going to go to you next, and it’s a question on the accuracy of the data that we have, and the question is really around how accurate or reliable do we think the different hospitalization data is, the different testing data?  Can you comment on that a little bit and kind of our relative confidence in the different sources that we have?

CRAIG:  Yeah, and it’s been a common theme throughout the pandemic, what data can you rely on, what can you connect, because sometimes it was hit or miss during some points in the pandemic, but I do have a lot of confidence in the data that we’re using.  And one reason for that is we do check that against the data that we have in house.  So, for example, looking at that hospitalization data, admission data, we also can look at that across our internal book of business, and that chart would look identical.  Right now across our book of business, we have the lowest number of people in a bed today with Covid, similar to what you saw on that chart, so there definitely is some skewed data when you look at the case rates right now, again, because there’s not as much capture of that data anymore, but the mortality and the hospitalization data is pretty reliable at this point.

MALE:  Great, thank you, Craig.  And I’m just going to pivot this a little bit into something that—I’m going to pivot into two subtleties but important.  We had a question on, hey, has the public health emergency period been renewed and how long do you think that’s going to be renewed for.  So it was renewed for another 90 days. It’s difficult to predict how long that will extend.  However, we’re watching this really closely.  My personal prediction is it will be extended at least one more time.  But so you’ll probably see that extend into the fall, but we’re watching that really closely, because there’s a lot of things that ride side by side with that, and particularly for all of you out there, the two things that you need to be thinking about is once the PHE ends, then we have a decision to make on will cost share return for testing or not, number one.  Number two, how will we treat cost share for vaccine?  So those are two really big issues.  A third is really what’s happening right now is a lot of elective medical procedures within hospitals, they are testing for Covid just automatically, as they kind of come through, and so you’re picking up what I’ll call a lot of asymptomatic cases.  They’re showing up as a Covid case in the hospital, they really weren’t there because they had Covid, they were testing because of some other procedure, so there’s a lot that’s going to flow through post the PHE, and I don’t think  we’re ready to make any pronouncements today on what the right path is, but I just especially for all of you who are self-funded, even if you’re fully ensured and you think about the cost profile, some of the things we’re talking about, once that PHE ends, it means that a lot of the more traditional rules will come back and apply again, and we need to think about how to apply those different rules to both testing and to treatment.  Okay, the next question, Samantha Baker, I’m going to come your way.  And the question is around vaccine pass.  And can you talk about, hey, if someone’s—first of all, where are you getting the data from, number one, and, number two, if it’s not accurate, is there a way to kind of correct the record or fix it or how can they kind of get that data and information?

SAMANTHA BAKER:  Yes, so we are using data from a couple of different sources to populate the vaccine pass, so, first, we have our claim data, but then we’re also working with state registries, and, as you can imagine, each state has different rules around how we can access that data, and so we don’t have every registry, but we’re pulling in all the available data that we have, so I will say that there’s a little bit of a delay, so be patient if you’re not seeing things immediately, but definitely reach out and let us know if you’re seeing any discrepancies.  We do have a team that can kind of mine the data and make sure that we’re displaying it correctly.  The other thing I will say is that in the next month, we’ll be bringing some new functionality forward that will also make it even more user friendly, so, you know, obviously Dr. Randall talked about boosters, and so right now we only have that first booster being displayed, but we’re working on displaying functionality that will automatically pull your latest booster, as some of the population will continue to have the need for both boosters over time.  Another feature that will come in May is just making sure that that booster is being displayed both via the [INDISCERNIBLE 00:06:05] experience and the mobile app.  And then, finally, allowing subscribers to enable passes for their dependents, if that’s a need as well.  So we’re still investing in this tool and making sure that it’s as user friendly as possible.

MALE:  Great, thank you, Samantha.  A number of questions on the—great content today, but do you have materials for us as the employer to be able to communicate this to our employees?  And the answer to that is a simple yes.  And what I would encourage you to talk to your broker, talk to your consultant, talk to your United Healthcare rep.  They will help you to be able to get the content that supports you on anything that we’ve talked about today.  And, frankly, if we don’t have it and you feel like you have a need there, we need to hear that from you, and we will produce it.  We will get that to your hands.  So we are very attentive to that.  We think about that all the time.  I think there’s different situations, depending on which type of customer you are and in which market, so rather than just say globally go here, that would be really easy, but talk to your United Healthcare rep support, and they will get you what you need.  Dr. Randall, I’m going to come back to you, and let’s just talk about kind of at home test kits for a second.  And both I think accuracy as well as talk to us about expiration dates on those kits and what we’re hearing there.

RHONDA RANDALL:  Yeah, thanks for that question, so I think the FDA recently got questions on can you use these things after the expiration date, and they said no, so, if you have some supply at home, make sure that you’re keeping an eye on when they expire and not using them after that.  The rapid tests have their utility, and they have a shorter window in which they detect virus, so they’re looking for particles of the virus and generally done by an anterior nasal swab, usually the short swab, and you put that in a reagent and get your answer right in the comfort of your home.  That’s been really I think an important way for us to detect somebody who has a positive test and then what to do next, right, particularly to make sure that we’re quarantining appropriately, that we’re isolating those who are positive and for individuals who have a greater risk of severe illness or hospitalization that we’re using that positive test to get them to early treatment, those antivirals and monoclonal antibodies that are available, so it has a really important piece in detection.  But it doesn’t detect as early as the PCR, and the PCR can detect a little later, so, if somebody is symptomatic and they do that over the counter test and it’s negative and there’s concern, the best thing is to go get one of those PCR tests.  Most employers, schools, and so forth are accepting a presumed positive test.  It doesn’t need to be double checked, so, if you do an over the counter test and you test positive, you can often take a photo of that, submit it to school till you get a school excuse for a child, for example, and that will be accepted.  But to return, sometimes they’re requiring that that be a test that’s done in a physician’s office or proctored or a formal PCR test that’s read by a lab to say that it’s negative and you’re safe to return to certain settings.

MALE:  Great, thank you, Dr. Randall.  Samantha, I’m going to come back to you, and you gave us a lot of really good information today on the digital assets and how we’re trying to engage consumers.  And this is a two part question.  The first is, just can you talk to us about like kind of what information you’re tracking, and I think that’s more of a privacy question, so I’ll tackle that, but then can you talk about all the different things we measure and monitor on the website and how we try to optimize about that?  So, on the first part, I just want to be clear that—because I think people rightly have a lot of sensitivity about their personal information, what are Google and Facebook and what are they collecting about me, and I just want to emphasize, if United Healthcare has data about you, number one, we never sell it.  We’re never marketing or selling that data to anybody else.  Number two, if we do use it, we’re always using it to close clinical gaps in care, so that is our singular or optimized consumer experience in some way, shape, or form, so that is our singular purpose, and we’re really cautious around protecting everyone’s data, so that’s a really important dynamic for us.  But, Samantha, can you talk about just kind of practically?  When you [INDISCERNIBLE 00:10:51] experience like all the different things that we monitor and measure and that we’re trying to optimize for day in and day out.

SAMANTHA BAKER:  Yes, absolutely.  So thanks for the question, Phil.  So first obviously we focus on stability, right, so is our site up and available and were members able to sign in and login and complete what they were looking to do?  So we have a ton of just performance metrics just basically making sure that we’re providing a stable environment for our members to engage in, and then I talked about it a little bit earlier, but we’re looking at registration, engagement, how often our members are engaging, and, when they do come, what parts of our digital ecosystem are they engaging in, whether it’s our RX experience or our claims, and within each of those experiences, we also want to make sure that members, like I said, can complete what they’re looking to do, so we’re looking at task completion.  And also NPS, right, so are our members satisfied?  And we look at not only just the kind of numerical rating of NPS, but when our members are giving us verbatim, we’re making sure that we’re mining that member feedback and looking for opportunities to improve that experience, and that often feeds kind of our pipeline of enhancement, so we are constantly monitoring where and how our members are using the site, but also making sure that we’re continuing to look for opportunities to enhance their experience.

MALE:  Great, thank you, Samantha.  Just one last question that I’ll take, and then I’ll close it out, which is do you have to provide the machine readable files to consumers directly?  And the answer to that, as far as I—everything that I’ve seen, no is the answer, and I can tell you, these files are going to be the furthest thing you can imagine from consumer friendly.  I mean, you’re talking they’re going to be massive.  Thousands and thousands and thousands of lines in there in terms of different fields and everything else like that, so they’re not really targeted at the consumer, so you as an employer don’t really have a responsibility around the—you have a responsibility for disclosing the machine readable file, and I don’t want to get into too many technicalities here, but in most cases United will do that on your behalf, but you don’t have a consumer responsibility in terms of notification.  There were a number of questions of saying, hey, will you have a separate webinar to talk about a lot of the intricacies, and, yes, if there’s demand, absolutely we will.  It’s probably a little bit different form from what we have here, because a lot of the intricacies will apply only to certain clients and not the broad base, but, if that’s a need, absolutely we will put something together.  So, as we close today, I just want to say again, we know your time’s valuable.  Every instance that we have of this, we work really hard to make sure that the content is timely and relevant on your behalf.  I just want to close again where we started, which is at United Healthcare we hugely appreciate the trust that you’ve put in us, whether you’re a broker or a client.  We work really hard to try to be able to satisfy all of your expectations, and, frankly, exceed them, and I think every day—I’ve been saying this a lot recently when I’ve been speaking in public forums, which is we don’t wake up every day being like, man, we’re the biggest and we’re the best and we’re winners.  I think we wake up every day being like, frankly, we’re behind.  And there’s a lot that our consumers are expecting of us that we’re not doing.  There’s a lot that you’re expecting of us, and the price is still rising at an unsustainable rate, versus the rest of the cost in your business, and so I want to emphasize to you that that’s our MO every single day, and we think about that, and we think about what more can we do to help bring those costs down, to help improve the member experience, and we’re far from declaring victory on this, so we’re working hard every day to make it better.  We appreciate your faith in us as we do that.  I hope you have a great day.  And thanks again.  A reminder, just talk to your United Healthcare rep if you need additional detail on anything we talked about today.  Have a great day, everyone.